Sudden Maternal Collapse Flashcards
What are the potential causes for sudden maternal collapse?
Massive obstetric haemorrhage
Severe pre-eclmapsia with inter cranial bleed
Eclampsia
Amniotic fluid embolism
PE
Uterine Rupture
Uterine inversion causing neurogenic shock
Other causes for collapse:
- Infection
- MI
- causes of shock etc
How should you manage sudden maternal collapse?
ABCDE
+ Treat cause
Define massive obstetric haemorrhage?
Blood loss greater than 1500ml
What are the antenatal causes of massive obstetric haemorrhage? (5)
Antepartum:
- Placental abruption
- Retained products
- Placenta praevia
- Severe chorioamnionitis
- Severe pre-eclampsia
What are the intrapartum causes of massive obstetric haemorrhage? (5)
Intrapartum placental abruption Uterine rupture Amniotic fluid embolism Adherent placenta (placenta accreta/percreta) Loss from Caesarean section
What are the postpartum causes of massive obstetric haemorrhage?
haemorrhage greater than 1000ml
4 T’s
Tone: uterine atony (most common 90%)
Trauma: lacerations of the uterus, cervix, or vagina.
Tissue: retained placenta or clots.
Thrombin: pre-existing or acquired coagulopathy.
How do you manage a PPH (post partum haemorrhage) caused by uterine atony?
ABCDE
Replace blood loss with O negative until matched blood is available.
Medical:
- Bimanual uterine contraction
- Empty bladder
- Oxytocin injection
- Ergometrine 500 micrograms
- Oxytocin infusion
- Carboprost (prostoglandin) 250micrograms upto 8 doses
(misoprostol can be given as an alternative)
Surgical:
Uterine aa ligation
OR
Emergency hysterectomy
DIC can be a complication of massive obstetric haemorrhage how can it be managed?
Fresh frozen plasma 1U should be given with each unit of blood given.
Cryoprecipitate. (contains more fibrinogen but lacks antithrombin III which is often required)
What is amniotic fluid embolism and what is its significance?
It is where amniotic fluid enters the maternal circulation causing anaphylaxis, DIC, dyspnoea and hypotension.
It is rare but carries a high maternal mortality and severe neurological morbidity in those that survive.
How does amniotic fluid embolism present?
Hypoxia and respiratory distress.
Hypotension.
DIC (doesn’t usually present with this but occurs in all cases usually within 4 hours)
How is amniotic fluid embolism managed?
Resuscitation and transfer to ICU will need ianotropes/vasopressors.
If mother has not delivered: deliver baby by CS to facilitate resuscitation of mother.
What is uterine inversion?
It is a rare complication in pregnancy in which the placenta does not detach from the uterus.
This causes the uterus to invert during the third stage of pregnancy.
What are the signs and symptoms of uterine inversion?
Haemorrhage Severe lower abdominal pain Shock out of proportion to blood loss (neurogenic) Uterus not palpable abdominally Mass in vagina
How do you manage uterine inversion?
ABC Johnson manoeuvre (push uterus back up)
What is uterine rupture and what complications does it cause?
It is rupture of the uterus and it can occur de novo or from a previous c-section.
Massive internal haemorrhage from the rupture site and fetal hypoxia.
