Maternal Mortality and Medical Disorders in Pregnancy Flashcards
What are direct maternal deaths?
Deaths resulting from obstetric complications of the pregnant state (i.e. amniotic fluid embolism, PE / VTE)
What are indirect maternal deaths?
Pre existing disease or disease that developed during pregnancy that was aggravated by the physiological effects of pregnancy (e.g. cardiac conditions, psych)
What are the resuscitation considerations in pregnancy relating to physiological adaptations of pregnancy?
- CV: L tilt to reduce aortocaval compression
- HAEM: Inc blood vol therefore inc vol of dist for resus drugs
- GIT/RESP: Inc risk aspiration (early endotracheal tubing)
- RESP: Dec FRC and inc BMR so rapid development of hypoxia
What is important to remember regarding commonly used classes of resus drugs and pregnancy?
Alpha adrenergic agents and alpha and beta agonists may reduce uteroplacental perfusion
Protocol in event of arrest?
- Defib (safe for foetus)
- Decision for peri-mortem CS at 4’; delivery by 5’
Why is CS during arrest beneficial for mother?
- decrease aortocaval compression and improve venous return / CO
- restore 25-50% blood volume in uterine AV shunt
- chest compressions more effective
- FRC increases improving oxygenation
What CV conditions are particularly affected by the increased CO of pregnancy?
- LV dysfunction (IHD, severe valvular disease, permpartum cardiomyopathy)
- Fixed output disease (AS, MS)
- Aneurysm formation (DTA, SAH)
What CV conditions are particularly affected by the increased HR of pregnancy?
Mitral stenosis: dependent on adequate diastolic filling time
Which patients have the greatest risk of thromboembolic disease?
Patients with pre existing cardiac disease
What are the CV conditions of particular challenge during labour?
Rapid volume changes during labour. Poorly tolerated if:
-LV dysfunction
-CO dependent on good preload (i.e. pul HTN)
-CO is fixed:
>sudden increase leads to APO (MS)
>sudden decrease leads to reduced coronary perfusion (AS)
Which conditions are particularly affected by a rapid increase in pre load post delivery?
Tolerated poorly by
- fixed output lesions
- poor LV function
- pulmonary HTN
What are the worst cardiac lesions to have when pregnant?
1) Pul HTN
2) Cyanotic heart disease
3) NYHA III - IV
4) Severe AS / MS
5) severe AR
Pre pregnancy counselling for individiuals with cardiac lesions?
1) Determine lesion and status. Echo, ECG and cardio referral.
2) Assess status (NYHA)
3) Advise on prognosis
4) Consider if risk to offspring
5) Consider anti coag issues
6) Discuss SBE prophylaxis
7) mx of arrhythmia / failure
Mx cardiac conditions in labour?
- Vaginal better
- least uterine work better
- Monitoring
- ABx for SBE proph
- Syntocinon for S3
Ensure haemodynamic stability:
- L lateral, semi Fowlers
- avoid pushing
- watch funds
- slow onset epidural
- minimise blood loss
Post natal mx mother with CV condition?
- Maintain area high dependency (for APO)
- Slow oxytocin infusion to prevent PPH
- Early ambulation
- Contraception
