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3a > WH: Complications in Pregnancy > Flashcards

WH: Complications in Pregnancy Flashcards

1
Q

Why do pregnant women have a greater UTI risk?

A
  • Urine has more sugar, protein and hromones
  • Uterus presses on bladder so more difficult to fully empty
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2
Q

Which UTIs are pregnant women at greater risk of?

A

upper and lower
(cystitis and pyelonephritis)

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3
Q

what does UTI in pregnancy increase the risk of?

A

increase risk of preterm delivery
- and low birth weight + preeclampsia

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4
Q

what is asymptomatic bacteriruea ?

A

bacteria presen in urine without symptoms of infection

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5
Q

what does asymptomatic bacteriuear increase the risk of?

A

increased risk of upper + lower UTI => increase risk of preterm labour

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6
Q

when do pregnant women get their urine tested antenatally ?

A

at booking clinic and throughout pregnancy (MSU)

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7
Q

LUTI presentation ?

A
  • Dysuria (pain, stinging, burning)
  • suprapubic pain
  • increased frequency of urination
  • urgency
  • incontinence
  • Haematuria
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8
Q

Pyelonephtirits presentation?

A
  • Fever
  • Loin/suprapubic/back pain
  • General malaise
  • Vomiting
  • Loss of appetitie
  • Haematuria
  • Renal angle tenderness
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9
Q

What is most common UTI causative organism ?

A

E.coli

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10
Q

what type of bacteria is e.coli? gram staining? shape? often found where?

A

gram -ve, anaerobic, ro-shaped bacteria found in faeces

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11
Q

what does e.coli produce in urine ? from what?

A

gram -ve bacteria (e.coli) break down nitrates (normal waste product in urine) to nitrites => nitrite presence suggest bacterial infection

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12
Q

Apart form nitrites, what could indicate infection in the urine?

A

leukocytes

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13
Q

UTI in pregnancy management ?

A
  • 7 days Abx (nitrofurantoin, amoxicillin)
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14
Q

what antibiotic should be avoided in the 3rd trimester?

A

nitrofurantoin

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15
Q

What is anaemia

A

low concentration of haemoglobin as result of underlying disease

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16
Q

when are pregnant women screening for anaemia?

A
  • booking clinic (may also then get screened for thallasaemia and sickle cell disease)
  • 28 weeks gestation
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17
Q

why pregnant women more prone to be anaemic?

A

during pregnancy, plasma vol increases => decreased haemoglobin conc

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18
Q

anaemia presentation (5)

A
  • asymptomattic
  • sob
  • fatigue
  • dizziness
  • pallor
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19
Q

what could cause low MCV anaemia?

A

iron deficiency (+TAILS)

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20
Q

what could cause normal MCV anaemia?

A

pregnancy (physiological response)

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21
Q

what could cause raised MCV anaemia ?

A

b12 or folate deficiencya

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22
Q

anaemia management in pregnancy?

A
  • Iron supplements (ferrous sulphate)
  • Folate (should already be taking)
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23
Q

When and what is the does of folate in pregnancy?

A

400 micrograms before and during pregnancy (usualy first 1 weeks but if at risk of anaemia => whole prengnacy (maybe))

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24
Q

why is there increased VTE risk in pregnancy?

A

due to hyper coagulable stat => blood clot more likely

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25
Q

when is risk of DVT/PE greatest during pregnancy ?

A

highest during post partum period

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26
Q

DVT RF?

A
  • Smoking
  • age > 35
  • BMI > 30
    reduced mobility
  • multiple pregnancy
  • pre-eclampsia
  • thrombophilia
  • IVF pregnancy
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27
Q

when start DVT prophylaxis during pregnancy ?

A

if 3 RF, start at 28 weeks
if 4 RF, start immediately

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28
Q

What is used for DVT prophylaxis in pregnancy ?

A

LMWH
(daltparin, tinzeparin, enoxaparin)

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29
Q

how long is the DVT prophylaxis taken for?

A

continued throughout pregnancy until 6 weeks post fatally
(stopped during labour)

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30
Q

what is offered if LMWH is contraindicated for DVT prophylaxis ?

A

mechanical prophylaxis
- Intermiiten pneumatic ompression
- Antiembolic comp stockings

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31
Q

DVT presentaiton

A

unilateral: calf of leg swelling, dilated superficial veins, tenderness to calf, oedema, colour changes to legs
- more than 3cm difference between calves (10cm below tibial tuberosity)

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32
Q

what is used to diagnose DVT during pregnancy?

A

Doppler US
(not D-dimer!)

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33
Q

why can d-dimer not be used in pregnancy?

A

pregnancy is a cause of raised d-dimer

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34
Q

what risk score is used for DVT? is this used in pregnancy?

A

wells score
- NOT used in pregnancy

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35
Q

DVT management ?

A

same as prophylaxis but higher dose
- LMWH (enoxa/tinza/dalteparin)

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36
Q

what is used to diagnosis PE in pregnancy?

A
  • CTPA or VQ scan
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37
Q

What is pre-ecclampsia a disease of?

A

placental disease

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38
Q

what is pre-eclampsia ? when?

A

Hypertension in pregnancy with en organ failure (most often proteinuria) after 20 weeks gestation

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39
Q

describe how BP changes in normal pregnancy? describe physiology

A

normal pregnancy state: vasodilation (by NO + progesterone) => decrease peripheral resistance => decrease BP improved placental perfusion
(starts risking again from 28 weeks)

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40
Q

what causes pre-eclampsia ? pathophysiology (long answer)

A

caused by high vascular resistance in the spiral arteries + poor perfusion of placenta
- spiral arteries form abnormally => high vascular resistance in serial arteries => poor perfusion of the placenta => (fetal growth restriction) + oxidative stress => inflam chemical release into systemic circulation => systemic inflam + impaired endothelial function (in maternal blood vessels)

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41
Q

What is the pre-ecclampsia triad?

A
  • Hypertension
  • Proteinurea
  • Oedema
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42
Q

What is chronic hypertension (related to pregnancy)

A

High BP that exists before 20 weeks gestation + is long standing

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43
Q

what is gestational hypertension?

A

hypertension occurring after 20 weeks gestation without proteinuria

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44
Q

what is eclampsia ?

A

it is when seizures occur as a result of pre-eclampsia

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45
Q

Pre eclampsia RF ?

A
  • Pre-existing hypertension
  • preve hypertension in pregnancy
  • diabetes
  • CKD
  • maternal age >40
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46
Q

pre-eclampsia symptoms ?

A

present as complications
- Headache (most common)
- Visual disturbance
- N&V, epigastric pain
- Oedema
- Low urine output

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47
Q

what is required for pre-eclampsia diagnosis ?

A

BP >140/90mmHg
PLUS any of:
- proteinurea
- End organ damage
- placental dysfunction
(in pregnancy women after 20 weeks)

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48
Q

how many weeks gestation does patient need to be for it to be pre-eclampsia ?

A

after 20 weeks gestation

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49
Q

what are the aims of pre-eclampsia management ?

A
  • Prevent development to acclampsia
  • Minimise complication risk
    therefore regular BP monitoring is important
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50
Q

When should you treat patients prophylactically for pre-eclampsia ?

A

single high risk factor of 2 moderate RF

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51
Q

what is pre-eclampsia prophylaxis ? when started? how long?

A

aspirin from 12 weeks gestation until birth

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52
Q

what is first line managmetn for pre-eclampsia ?

A

(pre-ecclmapsia can only be cured by delivering the baby)
first line anti-hypertensive: labetolol
(then nifedipine)

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53
Q

why might IV Mg Sulphate be given during labour to women with pre-eclampsia ?

A

given during labour + next 24 hrs to prevent seizures

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54
Q

eclampsia management ? (5)

A

medical emergency
1) Resuscitation (ABCDE)
2) cessation of seizures (magnesium sulphate)
3) Blood pressure control (labetalol)
4) prompt delivery of baby + placenta (usually CS) (only definitive treatment)
5) Monitoring (+ assess for complications: HELLP syndrome, DIC)

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55
Q

What is HELLP syndrome?

A

complications associated with eclampsia + pre-eclampsia

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56
Q

what does HELLP syndrome stand for?

A

subtype of sever pre-eclampsia characterised by:
- Haemolysis
- Elevated Liver enzsymes
-Low Platelets

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57
Q

complication of pre ecclmpasia ?

A
  • Ecclampsia
  • HELLP syndrome
  • DIC
  • Fetal distress
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58
Q

What is congenital rubella syndrome ? caused by what ? what GA ?

A

caused by maternal infection with rubella virus during first 20 weeks of pregnancy

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59
Q

another name for rubella ?

A

German measles

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60
Q

what is rubella (pathogen) ? describe

A

single strand RNA virus

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61
Q

how is rubella transmitted ?

A

highly contagious by airborne droplets

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62
Q

Should pregnancy women have MMR vaccine? why?

A

pregnant women should not receive MMR vaccine (as it is live vaccine)
- women planning to get pregnant should have had MMR vaccine

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63
Q

Maternal features of rubella infection ?

A
  • Often asymptomattic
  • Malaise
  • Headache
  • Coryza
  • Fine macula papular rash
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64
Q

Fetal affects of maternal rubella infections ? presentation of this ?

A

congenital rubella syndrome
- congenital deafness, congenital cataracts, congenital heart defects, LD
- Triad: deafness, blindness, CHD

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65
Q

what CHD are associated with rubella ? (2)

A
  • PDA
  • pulmonary stenosis
66
Q

How is rubella transmitted to fetus ? when is risk greatest?

A

risk of vertical transmission is great the earlier on in the pregnancy

67
Q

explain the IgM and IgG responses to rubella infection/meaning of them

A
  • IgM (present in acute infection)
  • IgG (present following infection/vaccination)
68
Q

rubella management in pregnancy ?

A

no treatment
- symptomatic

69
Q

What pathogen causes chicken pox ?

A

varicella zoster virus (VZV)

70
Q

what causes shingles

A

a result viral reactivation (VSV)

71
Q

What can maternal chicken pox infection cause ?

A
  • more severe maternal infection
  • fetal varicellar syndrome
  • Severe neonatal varicella infection
72
Q

what effects can maternal chicken pox cause for the mother? (3)

A
  • varicella pneumonitis
  • hepatitis
  • encephalitis
73
Q

what investigation would you do for maternal chicken pox infection ? describe

A

testing immunity: +ve for VZV IgG indicates immunity

74
Q

when would you treat maternal chicken pox infection ?

A
  • no prev infection
  • no vaccine
  • IgG -ve
75
Q

how would you manage a pregnant woman with no chicken pox immunity ?

A

IV varicella immunoglobulins (prophylaxis)

76
Q

how would you manage a symptomatic pregnant woman with chicken pox ?

A

aciclover (>20 weeks)

77
Q

fetal complications of maternal chicken pox infection ?

A

congenital varicella syndrome

78
Q

features of congenital varicella syndrome ?

A
  • FGR
  • Microcephaly
  • Hydrocephalus
  • Congenital cataracts
79
Q

What is gestational diabetes mellitus (GDM) ?

A

diabetes triggered by pregnancy
- resolves after birth

80
Q

what causes GDM ?

A

caused by reduced insulin sensitivity during pregnancy
(progressive insulin resistance)

81
Q

GDM RF ? (5)

A
  • Prev GDM
  • Prev macrosomic baby
  • BMI >30
  • diabetes FHx
  • PCOS
82
Q

what is used to screen for GDM ? who is offered this ?

A

Oral glucose tolerance test (OGTT)
- those with RF
- or features of GDM

83
Q

What are some features of those with GDM ? mother ? baby ?

A
  • Polyuria, polydipsia, fatigue
  • Large for date, polyhydramnios
84
Q

When is OGTT done ?

A

at 24 - 28 weeks
(plus 13 - 14 if prev GDM)

85
Q

what are the abnormal fasting and 2 hr results for the OGTT

A

5678
- fasting >5.6 mmol/L
- 2 hr > 7.8 mmol/L

86
Q

GDM management ?

A
  • Education (dietary, regular exercise)
  • US to monitor fetal growth
  • Medical: metformin (first line), then PLUS insulin
87
Q

what does metformin do ?

A

acts on liver to lower glucose production

88
Q

Management of pregnant patients with pre-existing diabetes ?

A
  • Should take 5mg folic acid instead of 400micrograms
  • Metformin + insulin (other diabetic meds should be stopped)
  • retinopathy screening
89
Q

When retinopathy screen in pregnancy ? why important ?

A

offered to diabetic mothers as pregnancy increases risk of diabetic retinopathy
- shortly after booking + 28 weeks gestation

90
Q

when plan delivery for diabetic mother

A

37 to 38+6 weeks gestation

91
Q

Post-natal care for women with GDM? pre-existing diabetes ? When check HbA1c?

A
  • GDM improves immediately after birth (so can stop meds)
  • Pre-existing: lower their insulin + be aware of hypos (as insulin sensitivity increases)
  • Check HbAlc 13 weeks later
92
Q

What does obesity during pregnancy increase the risk of ? mum + baby ?

A
  • Pre-eclampsia
  • Gestational hypertension
  • Blood clotting problems GDM
  • CS birth

baby: Macrosomia, LGA, Congenital heart defects

93
Q

What is breech presentation ? occurs how often ?

A

breech is when presenting part of fetus is legs/bottom
- occurs in <5% by 37 weeks

94
Q

what are the 4 types of breech presentation ? describe each one

A
  • Complete breech: hips + knees fully flexed (cannonball)
  • Incomplete breech: on leg flexed at hip + extend at knees
  • Extended breech: both legs flexed at hip, extended knee
  • Footling: one foot presenting though cervix with leg extended
95
Q

when would you start active management of a breech presentation ? how many week s?

A

from 37 weeks onwards
(36 weeks in nulliparous women)
(they often turn spontaneously so no intervention required)

96
Q

what does managmetn of breech presentation involve ?

A

from 37 weeks: ECV (external cephalic version)

97
Q

What is ECV ? when done ? how successful ?

A

> 37 weeks
- technique to tun baby form breech to cephalic using pressure on abdo (50% successful)
- women given tocolysis to relax uterus before procedure (reduce contractility of myometrium => easier for baby to turn)

98
Q

if ECV unsuccessful, what breech management ?

A
  • vaginal birth (but risk of fetal birth asphyxia/trauma)
  • elective CS (better for baby)
99
Q

What is antepartum haemorrhage ?

A

genital trac bleeding from 24 + 0 weeks gestation

100
Q

most important causes of APH (3) ?
plus other causes ?

A
  • Placenta praevia
  • Placental abruption
  • Vasa praevia

other: cervical polyps, cervical ectropion, vaginal abrasions, vaginitis

101
Q

What is placenta praevia ?

A

It is where the placenta lies in lower segment of uterus (lower than the rpesenign part of the fetus) => complete or partial covering of internal os

102
Q

if placenta does not cover internal os, what is this ?

A

low lying placenta

103
Q

What does placenta pravia increase the risk of ? (7) important complication ?

A
  • Haemorrhage (before, during or after delivery)
  • emergency CS, emergency hysterectomy, maternal anaemia, low birth weight, stillbirth
104
Q

Placenta praevia RF ?

A
  • Prev CS (uterine scarring)
  • Prev placental praecia
  • Increasing maternal age
  • Maternal smoking
  • Structural abnormalities (fibroids)
105
Q

placenta praevia presentation ? (3)often found when

A
  • osten asymptomattic
  • Painless vaginal bleeding (at around 36 weeks)
  • Light contractions

often found on 20 week anomy scan to assess placental position

106
Q

What may be found in clinical examination of placenta praevia ? (4)

A
  • Non-tender uterus
  • Painless vaginal bleeding
  • Low lying placenta on 20-week scan
  • Lie or présentation may be abnormal
107
Q

What investigations would you do for placenta praevia ?

A
  • USS (abdo or TVUS)
108
Q

placenta praevia management ? When scans ?

A
  • Repeat transvaginal USS at 32 + 36 weeks
  • Corticosteroids: between 34 and 35+6 weeks (in case of preterm labour)
  • Planned C-section delivery (at 36-37 weeks to avoid spontaneous labour + bleeding, vaginal birth no possible as placenta blocks way out for fetus)
109
Q

What is management for low lying placenta ?

A

similar to placenta praevia
- consider CS
(check this one)

110
Q

What is placental abruption ?

A

complete or partial detachment of the placenta from the uterine wall during pregnancy

111
Q

what are the 2 types of placental abruption. describe them ?

A
  • revealed abruption: when blood escapes through vagina
  • Concealed abruption: bleeding occurs behind the placenta or cervical os remains closed => no vaginal bleeding
112
Q

placental abruption RF ?

A
  • Maternal ae >35
  • multiparity
  • pre-eclampsia/hypertension
  • prev abruptions
  • trauma (consider domestic violence !)
113
Q

Placental abruption presentation ? (3)

A

abdo pain + painful vaginal bleeding !
- sudden onset severe abdo pain (continuous, not related to contractions)
- vaginal bleeding
- Shock (hypotension + tachycardia, due to blood loss)

114
Q

placental abruption investigations ? diagnosis ?

A
  • CTG abnormalities (fetal distress)
  • clinical Dx based on presentation)
  • US to exclude placenta praevia
115
Q

what might be seen on examination of placental abruption ?

A

woody abdomen (constituted contracted)

116
Q

Placental abruption management ? depends on what ? what other things given alongside ?

A

obs emergency (clinical diagnosis based on presentation)
- US to exclude placenta praevia
- depends on fetus alive/dead/distress (dead=> induce vaginal delivery)
- fetus alive but distressed => immediate CS
- Fetus alive no distress, wait until 36 weeks => IOL + vaginal delivery
- Antenatal steroids (as preterm)
- Anti-D prophylaxis

117
Q

What is vasa praevia ? what sctructure involved ? pathophys

A

The fetal vessels are exposed (outiside normal protection of umbilical cord) and pass over the internal cervical os => exposed vessels prone to bleeding => fetal blood loss => fetal death

118
Q

what is another name for the fetal membranes ?

A

chorioamniotic membranes

119
Q

what are the vessels found in the umbilical cord ?

A

two umbilical arteries + one umbilical vein

120
Q

vasa praevia RF ? (3)

A
  • Low lying placenta/placenta praevia
  • IVF pregnancy
  • Multiple pregnancy
121
Q

Vasa praevia presentation ? typical triad ? when else might it present ?

A

rupture of umbilical cord vessels => rapid deterioration in fetal condition)
- vaginal bleeding
- ROM
- fetal compromise

  • incidentally on US
  • Antepartum haemorrhage
122
Q

management of vasa praevia ? depends on what ?

A

depends if spotted antenatally
- Asymtpomattic: corticosteroids (from 32 weeks) + elective CS at 34-36 weeks (early del => reduce comp risks)
- Antepartum haemorrhage: emergency CS

123
Q

Px presents with antepartum haemorrhage plus abdo pain. what most likely ?

A

placental abruption
(placenta praevia and vasa pravia dont present with pain as often)

124
Q

Px presents with antepartum haemorrhage plus a tender uterus

A

placental abruption

125
Q

Px presents with antepartum haemorrhage plus abnormal lie

A

placenta praviea
(presentation/lie usually normal in placental abruption and vasa praevia)

126
Q

Px presents with antepartum haemorrhage. describe the fetal HR changes associated with the 3 main types of antepartum haemorrhage ?

A
  • Placenta praevia: normal fetal heart
  • Placental abruption: absent/distressed fetal heart
  • Vasa praevia: fetal bradycardia
127
Q

What is placenta accreta ? causes what ?

A

It is when the placenta iplacnts deeper, through + past the endo metric (to Myometrium/perimetrium) => difficult to separate the placenta after delivery => PPH

128
Q

where should the placenta usually attach ?

A

usually placenta attaches to endometrium => can easily detach in 3rd stage of labour

129
Q

RF for placenta accreta ? (4)

A
  • can implant into defect (prev Endo curettage (miscarriage, TOP), prev CS)
  • prev placenta accreta
  • placenta praevia
  • increasing age
130
Q

describe the spectrum of placenta accreta ? what does it depend on ? what 3 types are there ?

A

spectrum depending on how deep
- Superficial placenta accreta
- placenta increta
- placenta percreta

131
Q

what is superficial placental accreta ?

A

placental accretion that implants in surface of myometrium

132
Q

what is polenta increta ?

A

placental accreta where placenta attaches deeply into myometrium

133
Q

what is placenta percreta ?

A

placental accreta where placenta implants past Myometrium + permetrium (may be reaching other organs (bladder))

134
Q

placenta accreta presentation ?

A

typically no symptoms during preg
- incidentally of US
- diagnosed at birth (with PPH)

135
Q

placenta accreta management ?

A
  • if diagnosed antenatally: antenatal steroids, planned CS (35-36 weeks)
  • plus: hysterectomy, uterus perverse surgery, expectant (risky)
136
Q

What is still birth ?

A

birth of a dead fetus (after 24 weeks gestation) as a result of intrauterine fetal death

137
Q

causes of sitllbirth ? (7)

A
  • unexplained (50%)
  • pre-ecclampsia
  • placental abruption
  • Vasa praevia
  • Cord prolapse
  • obstetric cholestais
  • DM
138
Q

what key 3 symptoms should pregnant women immediately report ?

A
  • Reduced fetal movements
  • Abdo pain
  • Vaginal bleeding
139
Q

still birth Management and diagnosis ? name the drugs
- plus what drug for after birth ?

A
  • US (diagnose IUFD)
  • anti-D prophylaxis (for rhesus -ve women)
  • Vaginal birth (first line): IOL of expectant: mifepristone, misoprostol
  • Dpamine agonist (caberogline): to suppress lactation after birth
140
Q

What is obstetric cholestatis ? aka ? characterised by ?

A

intrahepatic cholestatis of pregnancy
- characterised by reduced outflow of bile acids from the liver

141
Q

what is an important complication of obstetric cholestasis ?

A

increase risk of stillbirth

142
Q

obstetric cholestasis RF ? related to which hormones ? when develop ?

A

developed after 28 weeks
- due to high oestrogen and progesterone levles
- RF: genetic component, south asian ethnicity

143
Q

obstetric cholestasis pathophysiology ? plus normal physiology

A

bile acids made in liver form cholesterol breakdown => hepatic ducts => bile duct => intestines
- obstruction to outflow => build up of bile acids in blood => pruritus

144
Q

obstetric cholestasis Px ? what state of pregnancy ?

A

later in preg (often 3rd trimester): itching (main sx, palms + soles of feet)
- fatue, dark urin, pale greasy stools, jaundice

145
Q

causes of pruritus ? (4)

A
  • gall stones
  • acute fatty liver
  • autoimmune hepatitis
  • viral hepatitis (B,C)
146
Q

obstetric cholestasis Ix ?

A

LFT, bile acids

147
Q

which liver enzyme usually rises during pregnancy ?

A

normal for ALP-regnancy to rise in pregnancy (placenta produces ALP)

148
Q

obstetric cholestasis Mx ? (2)

A

ursodeoxycholic acid
- for the itching sx: emollients, antihistamines (help with sleeping)

149
Q

What is acute fatty liver of pregnancy ?

A

rare condition in 3rd trimester of pregnancy: rapid accumulation of fat within hepatocytes => acute hepatitis (inflam) => liver failure + mortality

150
Q

acute fatty liver of pregnancy pathophys ?

A

fetal genetic condition (LCHAD deficiency) that impairs fatty acid metabolism => impaired placental processing of fatty acids

151
Q

acute fatty liver of pregnancy px ?

A

vague Sx associated with hepatitis: malaise, fatigue, N&V, jaundice, abdo pain, anorexia, ascites

152
Q

acute fatty liver of pregnancy Ix ?

A
  • LFT (raised ALT + AST), raised bilirubin, raised WCC, low platelets
153
Q

pregnancy women presents with raised liver enzymes and low platelets. consider what ?

A

HELLP syndrome

(but keep in mind acute fatty liver of pregnancy)

154
Q

acute fatty liver of pregnancy mx ?

A

obs emergency
- prompt admission + delivery of baby

155
Q

What is polymorphic eruption of pregnancy ? aka ? affects when in pregnancy ?

A

pruritic + urticarial papules + plaques of pregnancy
- itchy rash that starts in 3rd trimester (improves toward end of pregnancy + postpartum)

156
Q

polymorphic eruption of pregnancy Mx ?

A
  • topical emollients
  • topical steroids
  • oral antihistamines
  • oral steroids (if severe)
157
Q

causes of cardiac arrest (in adults) (8) ?

A

4Ts, 4Hs
- Thrombosis (PE, MI), tension pneumonthorax, toxins, tamponade
- Hypoxia, hypovolaemia, hypothermia, hyperkalaemia/hypoglycaemia

158
Q

main causes of cardiac arrest in pregnancy ? (3)

A
  • obstetric haemorrhage
  • PE
  • Sepsis
159
Q

causes of massive obstetric haemorrhage ? (5)

A
  • ectopic preg
  • placental abruption
  • placenta praevia
  • placenta accreta
  • uterine rupture
160
Q

why don’t lie on your back when pregnant ? which position is best ?

A

uterus compresses IVC (+aorta) => reduce venous return => reduce CO => hypotension => loss of CO + cardiac arrest
- place women in left lateral position (reduce aortocaval compression)

161
Q

cardiac arrest during pregnancy Mx ?

A

emergency CS after >4mins of CPR (improve survival of mother)

3a (43 decks)

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