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ALS > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

What is a maternal cardiac arrest?

A

A cardiac arrest that occurs at any stage in pregnancy and up to 6 weeks after delivery

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2
Q

What are the maternal deaths most commonly associated with

A
  • cardiac disease (congenital and acquired)
  • pulmonary embolism
  • epilepsy and stroke
  • sepsis
  • mental health conditions
  • bleeding
  • malignancy
  • hypertensive disorders of pregnancy
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3
Q

What are many cardiovascular problems associated with pregnancy caused by?

A

Compression of the IVC and the aorta by a gravid uterus

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4
Q

What should be done if a left lie is not possible?

A

Manually displace the uterus to the left

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5
Q

Who should be called in a maternal cardiac arrest?

A
  • obstetrician
  • neonatologist
  • anaesthetist
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6
Q

After what gestation can the uterus press down and impede venous return?

A

20 weeks

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7
Q

Where should IO/IV access be obtained in a maternal arrest?

A

Above the diaphragm

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8
Q

What degree of tilt is required?

A

15-30 degrees

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9
Q

What is there an increased risk of in maternal arrest?

A

Pulmonary aspiration of gastric contents

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10
Q

What are the specific causes of cardiac arrest/collapse in pregnancy?

A
  • Haemorrhage
  • drugs
  • CV disease
  • pre-eclampsia/eclampsia
  • amniotic fluid embolism
  • pulmonary embolism
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11
Q

What can be the causes of haemorrhage specific to pregnancy?

A
  • ectopic
  • placental abruption
  • placenta praevia
  • abnormal placentation (increta/percreta)
  • uterine rupture
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12
Q

What should be considered in haemorrhage

A
  • 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
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13
Q

Which drugs can cause overdose in pregnancy?

A
  • magnesium sulfate
  • analgesia
  • anaesthesia
  • local anaesthetic
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14
Q

What is given for magnesium overdose?

A

calcium

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15
Q

What are the most common causes of death from acquired cardiac diseases

A

MI and aneurysm or dissection of the aorta or its branches, an peripartum cardiomyopathy

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16
Q

What is the reperfusion strategy of choice in STEMI in pregnant patients

A

PPCI

17
Q

What is eclampsia?

A

Development of convulsions and/or unexplained coma during pregnancy or post-partu, in patients with signs and symptoms of preeclampsia

18
Q

what might prevent eclampsia developing in labour

A

magnesium sulfate

19
Q

When does amniotic fluid embolus usually present?

A

Around the time of delivery

20
Q

What are the signs of amniotic fluid embolus?

A
  • sudden cardiovascular collapse
  • breathlessness
  • cyanosis
  • arrhythmias
  • hypotension and haemorrhage
  • DIC
21
Q

What are the warning signs of amniotic fluid embolus?

A
  • chest pain
  • breathlesness
  • feeling cold
  • light-headedness
  • panic
  • pins and needles in fingers
  • N&V
22
Q

What are the risk factors for amniotic fluid embolus?

A
  • older maternal age
  • multiple pregnancy
  • placenta praevia and IOL
  • instrumental vaginal and caesarean delivery
23
Q

When should fibrinolysis be considered in PE

A

when diagnosis is suspected and maternal cardiac output cannot be restored

24
Q

Why is peri-mortem caesarean beneficial?

A

It may improve the chances of resuscitation of both the mother and the fetus

25
Q

When is the best survival rate for infants over 24-25 weeks gestation in maternal cardiac arrest?

A

When caesarean takes place within 5 minutes of the mothers arrest

26
Q

When should peri-mortem caesarean happen immediately?

A

When there is obvious fatal injury to the mother

27
Q

At what gestation does fetal viability currently begin at

A

24 weeks

ALS (24 decks)

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