Obstetric Emergency and Management

Question 1

What are the Most common direct causes of Maternal death during pregnancy?

Answer 1

• Thrombosis and Thromboembolism (leading cause).
• Sepsis.

Question 2

What are the most common causes of Maternal Death post pregnancy?

Answer 2

Cardiac disease leading cause (up to 6 wks).

Suicide (2nd most common up to 6 wks) + (most common 6 wks - 1 year)

Question 3

Why is a Left uterine displacement done during CPR in Pregnant women?

Answer 3

To reduce compression of IVC and Aorta thus improving venous return to the heart during CPR.

Question 4

What is Maternal Collapse?

Answer 4

Respiratory or Cardiac distress that may lead to cardiac arrest.
There is a wide Range of causes.

Question 5

What are the “Head” causes of Maternal Collapse?

Answer 5

Eclampsia
Epilepsy
Stroke / CVA
Vasovagal Response

Question 6

What are the “Heart” causes of Maternal Collapse?

Answer 6

MI
Arrythmias
Peripartum Cardiomyopathy (a type of dilated cardiomyopathy typically presenting between the last month of pregnancy and 6 months postpartum)

Question 7

What are the “Hypoxia” causes of Maternal Collapse?

Answer 7

Asthma, PE, Pulmonary Oedema, Anaphylaxis.

Question 8

What are the “Haemorrhage” causes of Maternal Collapse?

Answer 8

Abruption, Trauma, Uterine Rupture, Uterine Invasion, Ruptured Aneurysm.

Question 9

What are the “wHole body and Hazards” causing Maternal Collapse?

Answer 9

Hypoglycaemia, amniotic fluid embolism, septicaemia, trauma, anaesthetic complications, drug overdose.

Question 10

What are the Reversible causes of Cardiac arrest? (4 H’s + 4 T’s + 2 C’s)

Answer 10

• Hypoxia.
• Hypovolaemia (blood or sepsis).
• Hypo/Hyper metabolic.
• Hypothermia.
• Thrombo-Embolism (DVT, PE, Cerebral VT)
• Tamponade
• Toxins (opiates, Magnesium, Insulin, Local Anaesthetic)
• Tension Pneum.

And in Pregnancy - Two C’s
- Eclampsia.
- Intracerebral Bleed.

Question 11

When to do a Perimortem C-section?

Answer 11

If there is no response to correctly performed CPR after 4 mins of collapse.
Delivery should be done to assist maternal resuscitation.

Question 12

What are the shockable types of Cardiac Arrest?

Answer 12

VF or Pulseless VT.

Question 13

When is Adrenaline given in ALS CPR?

Answer 13

Shockable: Adrenaline 1mg given after 3rd shock and then every other cycle (every 4 mins)

Non-Shockable: Adrenaline every 3-5 mins.

Question 14

When is Amiodarone given in ALS CPR?

Answer 14

Amiodarone 300mg given after 3rd shock.

Question 15

What can be Given in Magnesium toxicity?

Answer 15

1g Calcium Gluconate.

Question 16

What can be given in Local Anaesthetic Toxicity?

Answer 16

1.5ml 20% Intralipid.

Question 17

What is given in Opiate Overdose?

Answer 17

Naloxone 0.4-0.8mg.

Question 18

What is the Emergency management of Eclampsia?

Answer 18

• High Flow O2.
• Don’t restrain Px during a fit (note length and time of seizure).
• Get IV Access.
• Move Px to left lateral and Open airway.
• Monitor Baby (only deliver when Mum Stabilised)

Question 19

What is the Emergency Management of Anaphylaxis?

Answer 19

• Remove Allergen.
• High Flow O2.
• IM Adrenaline 500mcg every 5 mins and IV Crystalloid Bolus.
• Chlorpheniramine 20mg IV.
• Hydrocortisone 200mg IV.
• Salbutamol Neb.