Maternal Collapse Flashcards

1
Q

what groups of women are most at risk of maternal death

A

black women
asian women
older women
women from deprived areas

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2
Q

what is the leading cause of death up to six weeks after pregnancy

A

thromboembolism and cardiac disease

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3
Q

what is the leading cause of maternal death from six week to a year after pregnancy

A

cancer and suicide

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4
Q

whos life comes first- the mothers or the babies

A

mum

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5
Q

define maternal collapse

A

respiratory or cardiac distress that may lead to cardiac arrest (range of causes from syncope to cardiac arrest)

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6
Q

what are the 6 H’s for causes of maternal collapse

A

Head- eclampsia, epilespy, cerebrovascular accident, vasovagal response
Heart- MI, arrythmias, peripartum cardiomyopathy
Hypoxia- asthma, PE, pulmonary oedema, ananphylaxis
Haemorrage- abruption, atony, trauma, uterine rupture, uterine invesion, ruptured aneurysm
wHole body and Hazards- hypoglycaemia, amniotic fluid embolism, septicaemia, trauma, anaesthetic complications, drug overdose

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7
Q

why shouldnt pregnant women lie of their backs

A

causes vasovagal- pressure on aorta, Aortocaval compression

if they collapse roll them on their side

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8
Q

should you be cautious given pregnant women oxygen

A

wont do any harm giving 15 L

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9
Q

what should you consider before giving a rapid fluid bolus

A

other co morbidities e.g. PET

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10
Q

what position should unconscious pregnant women be in

A

left lateral position

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11
Q

at what blood glucose level should you give glucose

A

<4

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12
Q

why are pregnant women harder to resuscitate

A

Gravid uterus
-Aortocaval compression
-Ventilation difficult – pressure on diaphragm
Fetus/placenta
-‘Steals’ oxygen and circulation from mother
-20% decrease in pulmonary functional residual capacity and a 20%
increase in oxygen consumption – more risk of hypoxia
More likely to aspirate (hormonal relaxation of the oesophageal sphincter and delayed gastric emptying)
More difficult to intubate (oedema and the larger tongue and breasts of pregnancy)

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13
Q

what is aortocaval compression

A

From 20 weeks gestation, in the supine position the gravid uterus can compress IVC and aorta reducing venous return
Decreasing cardiac output by up to 40%, causing supine hypotension
As soon as infant is delivered vena cava returns to normal and cardiac output is restored

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14
Q

what is MUD

A

manual uterine displacement

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15
Q

how is aortocaval compression prevented

A

Displace uterus to relieve pressure on aorta and vena cava and improve venous return to the heart:
Keep mother supine and apply left manual uterine displacement or 30-degree tilt if on theatre table

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16
Q

when should a perimortem C section be done

A

do at 5 minutes, prepare at 4

If there is no response to correctly performed CPR within 4 minutes of maternal collapse delivery should be undertaken to assist maternal resuscitation (aortocaval compression reduces CO from chest compressions from 30% to 10%)

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17
Q

what is needed for a perimortem C section

A

A limited amount of equipment is required
Sterile preparation and drapes are unlikely to improve survival
Moving to an operating theatre is not necessary
CPR should continue throughout
Diathermy will not be needed as there is little blood loss if there is no cardiac output
If the mother is successfully resuscitated she can be moved to theatre to complete the operation

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18
Q

when should adrenaline and amiodarone be given in resus

A

given after the third shock and then every other cycle (i.e. every 4 minutes)
Amiodarone 300 mg should be given after the third shock.

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19
Q

what are the 4H’s and 4T’s of reversible causes of cardiac arrest

A

Hypoxia
Hypovolaemia
Hypo/hyper metabolic
Hypothermia

Thrombosis
Tamponade
Toxins
Tension pneumothorax

Pre eclampsia

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20
Q

what drug for cardiac arrest

A

1 mg adrenaline (epinephrine) every 2minutes

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21
Q

what drug for VF/VT

A

300 mg amiodarone

22
Q

what drug for opiate overdose

A

0.4–0.8 mg naloxone

23
Q

what drug for magnesium toxicity

A

1 g calcium gluconate

24
Q

what drug for local anaesthetic toxicity

A

1.5 ml 20% Intralipid

25
what management for eclampsia/ seizure in pregnancy
``` cCall for help Make patient safe Note time and length of seizure Give high flow oxygen Don’t restrain patient during fit Get iv access Move patient into left lateral and open airway Monitor baby ```
26
what treatment for anaphylaxis
``` Remove allergen High flow oxygen IM adrenaline 500mcg every 5 mins and IV Crystalloid bolus Chlorpheniramine 20mg IV Hydrocortisone 200mg IV Salbutamol neb ```
27
what treatment for hypoglycaemia
Glucose, <3mmol/l- 50ml of 10% dextrose Ivor 1mg glucagon IM or glucogel (stop insulin!)
28
what is the diagnostic criteria for DKA
ketonaemia 3 mmol /l and over or significant ketonuria blood glucose over 11 mmol /l or known diabetes mellitus venous bicarbonate (HCO3 ) below 15 mmol /l or venous pH less than 7.3
29
what is an amniotic fluid embolism
Amniotic fluid enters maternal circulation- collapse+/- arrest Rare 1/8000 Mortality 30% Not predictable or preventable, usually in labour Diagnosis can be confirmed on post-mortem by squames on right sided circulation
30
what is the presentation of an amniotic fluid embolism
Acute presentation: profound fetal distress, sudden resp distress, seizure & DIC
31
what is the treatment for an amniotic fluid embolism
support ITU
32
when are women most at risk of a PE
postnatally
33
what are the features of a massive PE
Cyanosis, shock, collapse (tachy, dyspnoea, pain, apprehension, cough, haemoptysis, temp>37) JVP raised, enlarged liver, parasternal heave, fixed splitting of 2nd heart sound 15% have a DVT evident ECG tachy and right sided strain
34
what Ix for a PE
ECG tachy and right sided strain, rarely S1Q3T3 CXR to exclude pneumothorax and pneumonia, may see pleural effusion, raised hemidiaphragm and wedge collapse ABG- may show hypoxia and a normal or low CO2 Echo- rule out dissection and tamponade Consider pulmonary angiography Consider CTPA
35
treatment for a PE
Therapeutic Tx with heparin | Thrombolysis
36
what CVAs can happen in pregnancy
``` PET Thrombosis/embolus AFE Haemorrhagic- AV malformation or aneurysm Infarct- infection, cocaine, vasculitis ```
37
how might a CVA present
headache, vomiting, hypertension, seizure, collapse | Can have focal signs, neck stiffness, papilloedema
38
what Ix for a CVA
Head CT/MRI | Echo, coag, thrombophilia screen, carotid Doppler, lumbar puncture, cerebral angiography
39
what is cord prolapse associated with
malpresentation, preterm labour, 2nd twin, artificial membrane rupture
40
what is the risk of cord prolapse
Direct compression and cord spasm = decreased flow- hypoxia- death is an emergency
41
what is the management for cord prolapse
Scan for fetal cardiac activity Immediate delivery – Cat 1 (CS or forceps) Tocolytic and maternal positions to relieve pressure (cont ve/ knee- chest position)
42
what is shoulder dystocia
is any cephalic delivery where manoeuvres other than gentle traction are required to deliver the baby after the head has delivered =bony impaction of fetal anterior shoulder on the maternal symphysis
43
what are the risk factors for shoulder dystocia
obesity, diabetes, macrosomia, prolonged 1st & 2nd stage, instrumental delivery
44
what are the signs of shoulder dystocia
slow delivery of the head, face and chin, 'turtling' of head against perineum, lack of restitution 'head bobbing' – this is when the head consistently retracts back between contractions during the active second stage 'turtle-sign' – the delivered head becomes tightly pulled back against the perineum and there is difficulty delivering the chin
45
what are the risks of shoulder dystocia
stillbirth, Hypoxic brain injury, brachial plexus injury, fractures, PPH, 3rd & 4th degree distress Hypoxic ischaemic damage risk is low if delivery is achieved within 5 minutes from the time of delivery of the head.
46
what is the management of a shoulder dystocia
``` HELPER (call for) Help Evaluate for episiotomy Legs (McRoberts' manoeuvre) Pressure (suprapubic) Enter (rotational manoeuvre) Remove the posterior arm Roll the patient onto her hands and knees ```
47
what is the role of the maneouvers used to treat a shoulder dystocia
Increase the functional size of the bony pelvis Narrow the bisacromial diameter of the fetus Change the position of the bisacromial diameter within the bony pelvis
48
what should you assume a fitting pregnant women has
eclampsia
49
when should you declare status epilepticus
after 5 mins
50
what is disseminated intravascular coagulation
when blots clots form throughout the body, hyperactive clotting due to infection/ other disease
51
what can cause a cord prolapse
rupturing membranes before babies head in engaged in pelvis