Pregnancy Flashcards
What is a maternal cardiac arrest?
A cardiac arrest that occurs at any stage in pregnancy and up to 6 weeks after delivery
What are the maternal deaths most commonly associated with
- cardiac disease (congenital and acquired)
- pulmonary embolism
- epilepsy and stroke
- sepsis
- mental health conditions
- bleeding
- malignancy
- hypertensive disorders of pregnancy
What are many cardiovascular problems associated with pregnancy caused by?
Compression of the IVC and the aorta by a gravid uterus
What should be done if a left lie is not possible?
Manually displace the uterus to the left
Who should be called in a maternal cardiac arrest?
- obstetrician
- neonatologist
- anaesthetist
After what gestation can the uterus press down and impede venous return?
20 weeks
Where should IO/IV access be obtained in a maternal arrest?
Above the diaphragm
What degree of tilt is required?
15-30 degrees
What is there an increased risk of in maternal arrest?
Pulmonary aspiration of gastric contents
What are the specific causes of cardiac arrest/collapse in pregnancy?
- Haemorrhage
- drugs
- CV disease
- pre-eclampsia/eclampsia
- amniotic fluid embolism
- pulmonary embolism
What can be the causes of haemorrhage specific to pregnancy?
- ectopic
- placental abruption
- placenta praevia
- abnormal placentation (increta/percreta)
- uterine rupture
What should be considered in haemorrhage
- fluid resus, rapid transfusion system and cell salvage
- TXA and correction of coagulopathy
- oxytocin, ergometrine, prostaglandins and uterine massage for uterine atony
- uterine compression sutures, uterine packs and intrauterine balloon devices
- interventional radiology
- surgical control- aortic crossclamping/compression and hysterectomy. placenta percreta may require extensive intra-pelvic surgery
Which drugs can cause overdose in pregnancy?
- magnesium sulfate
- analgesia
- anaesthesia
- local anaesthetic
What is given for magnesium overdose?
calcium
What are the most common causes of death from acquired cardiac diseases
MI and aneurysm or dissection of the aorta or its branches, an peripartum cardiomyopathy
What is the reperfusion strategy of choice in STEMI in pregnant patients
PPCI
What is eclampsia?
Development of convulsions and/or unexplained coma during pregnancy or post-partu, in patients with signs and symptoms of preeclampsia
what might prevent eclampsia developing in labour
magnesium sulfate
When does amniotic fluid embolus usually present?
Around the time of delivery
What are the signs of amniotic fluid embolus?
- sudden cardiovascular collapse
- breathlessness
- cyanosis
- arrhythmias
- hypotension and haemorrhage
- DIC
What are the warning signs of amniotic fluid embolus?
- chest pain
- breathlesness
- feeling cold
- light-headedness
- panic
- pins and needles in fingers
- N&V
What are the risk factors for amniotic fluid embolus?
- older maternal age
- multiple pregnancy
- placenta praevia and IOL
- instrumental vaginal and caesarean delivery
When should fibrinolysis be considered in PE
when diagnosis is suspected and maternal cardiac output cannot be restored
Why is peri-mortem caesarean beneficial?
It may improve the chances of resuscitation of both the mother and the fetus
When is the best survival rate for infants over 24-25 weeks gestation in maternal cardiac arrest?
When caesarean takes place within 5 minutes of the mothers arrest
When should peri-mortem caesarean happen immediately?
When there is obvious fatal injury to the mother
At what gestation does fetal viability currently begin at
24 weeks
