Postpartum Emergencies Flashcards
1
Q
What are the leading direct causes of postpartum death?
A
- Thrombosis and thromboembolic disease (during and up to 6 weeks after the end of the pregnancy).
- Suicide
- 3rd largest cause during and up to 6 weeks after the end of pregnancy.
- Leading cause of direct deaths within a year after the end of the pregancy.
2
Q
What are the physiological changes in pregnancy and their implications for resuscitation?
A
3
Q
What are the causes of maternal collapse?
A
- Hypoxia
- PE
- Sepsis
- Hypothermia
- Hypovolaemia
- Haemorrhage
- Hypo / hyperkalaemia
- Sepsis
- Eclampsia / pre-eclampsia
- Thromboembolic
- VTE
- AFE
- Toxins
- Local anaesthetic
- MgSO4
- Tamponade
- Tension pneumothorax
4
Q
Describe primary and secondary PPHs.
A
- Primary
- Blood loss >500mL within 24 hours of delivery.
- Minor: 500-1000mL / no hypovolaemic shock.
- Major: >1000mL / hypovolaemic shock
- Secondary
- Significant vaginal bleed >24 hours and <12 weeks following delivery.
5
Q
What are the causes of PPH?
A
- Tone (~90%)
- Uterine 3rd stage contraction leads to compression in intramyometrial blood vessels and placental site.
- Tissue (retained)
- Retained placental tissue, inhibiting uterine contractility.
- Trauma
- Perineal tear, episiotomy, cervical tear.
- Uterine incision / extension, rupture.
- Thrombin (coagulopathy)
- DIC (sepsis / abruption / PPH / AFE / IUD)
6
Q
Describe the aproach to management of a PPH.
A
- Coordinated team approach
- Assess and resuscitate the mother
- Observations / EBL
- IV access
- Fluids
- Blood
- Identify and manage the cause
- Is placenta delivered / complete?
- Is the uterus contracted?
- Is there trauma?
- It may be multifactorial!
7
Q
Describe the management of atony.
A
- Mechanical compression:
- Bimanual compression
- Intrauterine balloon
- Brace sutures
- Pharmacological
- Syntocinon
- Ergometrine
- Carboprost
- (Misoprostol)
- Tranexamic acid
- Advanced procedures
- Embolisation
- Uterine artery ligation
- Hysterectomy
8
Q
Give definitions for these hypertensive diseases of pregnancy:
- Chronic hypertension
- Eclampsia
- HELLP syndrome
- Gestational hypertension
- Pre-eclampsia
- Severe pre-eclampsia
- Mild hypertension
- Moderate hypertension
- Severe hypertension
A
9
Q
What are the risk factors for pre-eclapmpsia / eclampsia?
A
- Hypertensive disease in previous pregnancy
- CKD
- Autoimmune disease (SLE / APS)
- DM (T1/T2)
- Chronic hypertension
- Primiigravida
- Age >40
- Pregnancy interval >10 years
- BMI >35
- FH or PET
- Twins
10
Q
What are the signs and symptoms of pre-eclapmsia / eclampsia?
A
- Headache
- Visual disturbance
- RUQ pain
- Oedema
- Vomiting
- Restlessness / agitation
- Papilloedema
- Hyperreflexia / clonus
- Biochemical / haematological
11
Q
Describe the management of pre-eclampsia / eclampsia.
A
- Delivery
- Blood pressure:
- Labetalol
- Nifedipine
- Methyldopa
- (ACE-I - postnatally)
- Eclampsia
- MgSO4
12
Q
What are the complications of pre-eclampsia / eclampsia?
A
- HELLP syndrome / DIC
- Hypertensive crises
- ‘Fluid’ crises
- Foetal compromise
13
Q
Describe the management of thromboembolism.
A
- LMWH
- Massive PE:
- Unfractioned heparin
- Thrombolysis
- Embolectomy
14
Q
What is an amniotic fluid embolism?
A
- Amniotic fluid enters maternal circulation.
- Rare complication
- 1-12 in 100,000
- Mortality ~20-40%
- Rare complication
- Presentation:
- Usually in labour or within 30 minutes of delivery.
- Sudden collapse
- Acute hypotension
- Respiratory distress
- Acute hypoxia
15
Q
How is amniotic fluid embolism diagnosed?
A
- Clinical
- Bronchial lavage
- Autopsy
