Maternal Collapse Flashcards
Why should you make sure that no heavily pregnant mother is lying on her back?
- compresses vena cava
- reduces cardiac output
=> can fail to perfuse baby
What is the leading cause of maternal death up to 6 weeks following delivery? Is this a direct or indirect cause?
- Cardiac disease
- indirect
What are the principles of care in maternal collapse?
- Two lives are at stake BUT mum comes first
- 2222 Ask for Maternity Emergency and Arrest Team
- Use NEWS/MEWS chart to identify mother getting sicker
What are the potential causes of maternal collapse?
Head - eclampsia, epilepsy Heart - MI, arrhythmia Hypoxia - asthma, PE, pulmonary oedema Haemorrhage - abruption, atony, uterine trauma wHole body and Hazards
How should a maternal collapse be managed?
A -
B - non-breather mask (15L) (wont harm pregnant women)
C - venous access, emergency bloods (FBC,U/E, XMatch, Lactate, Cultures, ABG), fluids (beware PET)
D - GLUCOSE, AVPU, left lateral tilt
E - Top->toe examination - check for bleeding, infection, check FOETUS
Why may resuscitation be difficult in a pregnant woman?
- ventilation difficult due to pressure on diaphragm
- foetus steals oxygen => demand = higher
- progesterone relaxes all ligaments/sphincters => heartburn => aspiration
- more difficult to intubate
Without obstructing the vena cava, how do we allow mothers to lie flat in order to perform CPR?
Manual uterine displacement (held to the LHS by one team member - if enough people present)
If not enough people present, put object under right hip to indirectly move uterus off vena cava
After what duration of CPR should the baby be delivered if the mother has collapsed?
4 minutes
for health of mother and baby
There is usually a lot of blood loss associated with peri-mortem c-section. TRUE/FALSE?
FALSE
- very little blood loss due to poor circulation
What are the 4Hs and 4Ts (and ONE other cause) which are thought to cause arrest?
Hs Hypoxia Hypovolaemia Hypo/hyper - metabolic Hypothermia
Ts Thrombosis Tamponade Toxins Tension Pneumothorax
+pre-eclampsia
Eclampsia seziures usually last for how long?
2 minutes
An eclampsia seizure lasting >5minutes is considered to be what?
Status epilepticus
What are the principles of management if a mother has a seizure due to eclampsia?
- Make patient safe (i.e. move equipment, put cots up on side of bed)
- Note time/length of seizure
- Give O2
- venous access
- left lateral position once seizure has terminated
How should pregnant mothers in anaphylaxis be managed?
- remove allergen
- high flow O2
- adrenaline
- don’t try and lie patient flat when they are breathless, let them stent their own airway (e,g, holding table etc)
What treatment other than adrenaline can be used if a mother is in anaphylaxis?
- Chlorphenamine IV
- Hydrocortisone IV
