Pregnancy Complications Flashcards
What are causes of maternal collapse?
Massive haemorrhage
Cardiac problems
Pulmonary and amniotic fluid embolism
Drug reaction
Trauma
What is maternal collapse?
An acute event involving cardiorespiratory systems and/or brain resulting in reduced or absent conscious level at any stage in pregnancy and up to 6 weeks after delivery
What is the most common cause of maternal collapse?
Massive haemorrhage
What is an amniotic fluid embolism?
Amniotic fluid, fetal cells, hair, or other debris enters into the maternal pulmonary circulation, causing cardiovascular collapse
What is the prognosis of amniotic fluid embolism?
Dangerous - often fatal
What is the presentation amniotic fluid embolism?
Acute hypotension
Respiratory distress
Acute hypoxia
Seizure
Cardiac arrest
When can amniotic fluid embolism present?
During labour, delivery, or within 30 mins of delivery
What is the pathophysiology of amniotic fluid embolism?
Amniotic fluid enters maternal circulation
This triggers a syndrome similar to that seen in anaphylaxis and septic shock
Pulmonary distress develops due to vascular occlusion - by debris or vasoconstriction
This can resolve, LV dysfunction or failure results
After the initial event, disseminated intravascular coagulation develops, resulting in massive postpartum haemorrhage
What is the management of amniotic fluid embolism?
Immediate specialist assistance
Supportive in ITU
What are cardiac causes of maternal collapse?
MI
Aortic root dissection
Cardiomyopathy
What is the presentation of aortic root dissection
Central chest or inter scapular pain
Wide pulse pressure
What is the cause of aortic root dissection in pregnancy?
Mainly secondary to systolic hypertension
How concerning are new cardiac murmurs in pregnancy?
Physiological systolic murmurs are common in pregnancy
But any new cardiac murmur needs referral to cardiologist with imaging
Most often these are ejection systolic murmurs caused by increased blood flow, tend to be grade 1 or 2 and don’t radiate
What are the most common causative organs of sepsis in pregnancy?
Group A, B, D streptococcus
Pneumococcus
E coli
Should you be concerned about sepsis in the absence of pyrexia and raised WCC?
Yes - bacteraemia can still be present and can progress rapidly to septic shock and collapse - high index of suspicion
What are the most common causes of drug toxicity causing collapse in obstetrics?
Magnesium sulphate (in the presence of renal impairment)
Local anaesthetic agents injected IV by accident
What is the presentation of drug toxicity causing collapse in pregnancy?
Drowsiness, light-headedness
Sedation
Circumoral paraesthesia (around the mouth)
Twitching and convulsion
What is the pathophysiology of anaphylaxis causing collapse in pregnancy?
Significant intravascular volume redistribution leads to decreased cardiac output
Acute ventricular failure and myocardial ischaemia
Upper airway occlusion secondary to angio-oedema, bronchospasm and mucous plugging of smaller airways contribute to hypoxia and ventilation difficulties
What its the positional management of maternal collapse, and why is it done?
Left tilt, or manual displacement of the uterus
To avoid aortocaval compression
Iff the uterus compresses the IVC the volume of blood returning to the heart will be lower as will cardiac output - CPR will be less effective
What is the protocol for maternal collapse if cardiac output is not restored after 3 mins of CPR in a women who is still pregnant?
The foetus should be delivered by C-section - will improve the effectiveness of maternal resuscitation efforts and may save the baby
What is the definition of gestational hypertension
Systolic BP >140mmHg or diastolic >90mmHg
Increase above booking readings of >30mmHg systolic, or >15mmHg diastolic
No proteinuria or oedema
What is pre-eclampsia?
Pregnancy induced hypertension + proteinuria
Seen after 20 weeks gestation
What does ore-eclampsia increase the risk of?
Fetal prematurity and intrauterine growth retardation
Eclampsia
Haemorrhage due to placental abruption
Cardiac failure
Stroke
VTE
DIC, HELLP
Pulmonary oedema
Multi-organ failure
What are risks factors for pre-eclampsia?
Hypertensive disorder in prev pregnancy, chronic hypertension
CKD
Autoimmune disease
T1 or T2 diabetes
Multiple pregnancy
Age 40+
Pregnancy interval of 10 years +
BMI 35+ at first visit
Family history of pre-eclampsia
