Maternal Collapse and Emergencies Flashcards
(45 cards)
What are the most common causes of maternal death <6 weeks postpartum?
Thromboembolic disease
Cardiac disease
What are the most common causes of maternal death >6 weeks postpartum?
Cancer
Suicide
Name the five H’s - causes of maternal collapse
Head - eclampsia, CVA Heart Hypoxia Haemorrhage wHole body
What are the 4H’s and 4T’s of cardiac arrest?
Hypoxia
Hypovolaemia
Hypo/hypermetabolic
Hypothermia
Thrombo-embolism
Toxins
Tamponade
Tension pneumothorax
What are the additional two C’s of cardiac arrest in pregnancy?
Eclampsia
Intracerebral bleed
What makes resuscitation in a pregnant woman more difficult?
Gravid Uterus
Describe what is meant by the term gravid uterus
From 20 weeks in the supine position the uterus can compress the venous return to the heart and put pressure on the diaphragm making compressions and ventilation more difficult
How is supine hypotension reversed?
Turn the woman to the left lateral position
Why do pregnant women have an increased risk of aspiration?
Progesterone relaxes ligaments/muscles including the oesophageal sphincter causing delayed gastric emptying and intubation difficulties
Breast tissue and oedema also make it harder
If a pregnant woman collapses what must someone do?
Manual Uterine Displacement
What should be done if there is no response to CPR within 4 minutes?
Perimortem C-section
Describe a perimortem C-section
Little blood loss due to no cardiac output
CPR continues throughout and if successful mother is moved to theatre to complete operation
What drug treatment can be given after shocks?
Amiodarone - after 3rd shock
Adrenaline - after 3rd shock and every other cycle
What drug treatment can be given in non-shockable rhythm?
Adrenaline every 3-5 minutes
What drug can treat opiate overdose?
Naloxone
How is magnesium toxicity treated?
Calcium glutonate
How is anaesthetic toxicity treated?
Intralipid
Describe the treatment of Anaphylactic shock in pregnant women
High flow oxygen IM adrenaline and crystalloid IV bolus Chlorpheniramine Hydrocortisone Salbutamol
What are the three criteria for diagnosis of DKA?
- ketonaemia
- blood glucose
- venous bicarbonate <15 or pH <7.3
If a woman is hypoglycaemic what should be done?
50ml 10% dextrose IV
1mg glucagon IM or glycogen
Stop insulin
How is DKA treated?
Fluid replacement
Insulin therapy
ABG
Monitor baby
What is the percentage mortality in amniotic fluid embolism?
30%
Describe amniotic fluid embolism
Amniotic fluid enters maternal circulation usually in labour causing collapse and arrest
How does amniotic fluid embolism present?
Profound fetal distress, sudden respiratory distress, seizure, DIC
