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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
Q

what management for eclampsia/ seizure in pregnancy

A 
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
Q

what treatment for anaphylaxis

A 
Remove allergen
High flow oxygen
IM adrenaline 500mcg every 5 mins and IV Crystalloid bolus
Chlorpheniramine 20mg IV
Hydrocortisone 200mg IV
Salbutamol neb
27
Q

what treatment for hypoglycaemia

A

Glucose, <3mmol/l- 50ml of 10% dextrose Ivor 1mg glucagon IM or glucogel (stop insulin!)

28
Q

what is the diagnostic criteria for DKA

A

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
Q

what is an amniotic fluid embolism

A

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
Q

what is the presentation of an amniotic fluid embolism

A

Acute presentation: profound fetal distress, sudden resp distress, seizure & DIC

31
Q

what is the treatment for an amniotic fluid embolism

A

support ITU

32
Q

when are women most at risk of a PE

A

postnatally

33
Q

what are the features of a massive PE

A

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
Q

what Ix for a PE

A

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
Q

treatment for a PE

A

Therapeutic Tx with heparin

Thrombolysis

36
Q

what CVAs can happen in pregnancy

A 
PET
Thrombosis/embolus
AFE
Haemorrhagic- AV malformation or aneurysm
Infarct- infection, cocaine, vasculitis
37
Q

how might a CVA present

A

headache, vomiting, hypertension, seizure, collapse

Can have focal signs, neck stiffness, papilloedema

38
Q

what Ix for a CVA

A

Head CT/MRI

Echo, coag, thrombophilia screen, carotid Doppler, lumbar puncture, cerebral angiography

39
Q

what is cord prolapse associated with

A

malpresentation, preterm labour, 2nd twin, artificial membrane rupture

40
Q

what is the risk of cord prolapse

A

Direct compression and cord spasm = decreased flow- hypoxia- death
is an emergency

41
Q

what is the management for cord prolapse

A

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
Q

what is shoulder dystocia

A

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
Q

what are the risk factors for shoulder dystocia

A

obesity, diabetes, macrosomia, prolonged 1st & 2nd stage, instrumental delivery

44
Q

what are the signs of shoulder dystocia

A

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
Q

what are the risks of shoulder dystocia

A

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
Q

what is the management of a shoulder dystocia

A 
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
Q

what is the role of the maneouvers used to treat a shoulder dystocia

A

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
Q

what should you assume a fitting pregnant women has

A

eclampsia

49
Q

when should you declare status epilepticus

A

after 5 mins

50
Q

what is disseminated intravascular coagulation

A

when blots clots form throughout the body, hyperactive clotting due to infection/ other disease

51
Q

what can cause a cord prolapse

A

rupturing membranes before babies head in engaged in pelvis

Reproduction (51 decks)

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