Maternal mortality and medical problems during pregnancy Flashcards
(7 cards)
Describe the major medical diseases contributing to maternal mortality
Direct (amniotic fluid embolism, hypertensive disorders, thrombosis, obstetric haemorrhage) vs Indirect (psych, cardiac)
- pregnancy only conditions: hypertensive disorders of pregnancy (preeclampsia/eclampsia), gestational diabetes, amniotic fluid embolus
- conditions exaccerbated by pregnancy (heart disease, pulmonary hypertension, renal failure are particulararly dangerous)
- puerpural sepsis
- post partum haemorrhage
- diabetes, epilepsy, thrombosis
Describe the physiological changes associated with normal pregnancy
- increase in cardiac out put, decrease in total peripheral resistance
- increase in blood volume. But relative/dilutional anaemia
- procoaguable state in third trimester (increase in clotting factors)
- weight gain
- laxity of joints eg pelvis
Understand how pregnancy impacts on women with pre-existing medical disease
-increased stress on system/pushed to limits of functional reserve
Understand the approach to prepregnancy counseling for a woman with cardiac disease
-
Understand the approach to management of women with a past history of, or current, thromboembolism
-aspirin
Explain the principles of diagnostic imaging as applied to the pregnant mother
-where possible do imaging prior to becoming pregnant
-
Explain the principles of how to perform effective resuscitation in a pregnant woman.
- tilt to left to avoid compression of vena cava by gravid uterus/reduction in venous return/cardiac output
- care with regurgitation/aspiration. Reduced lower oesophageal sphincter tone and increased intraabdominal pressure. Low threshold to entubate if needs GA
- priority is always mother
- account for increased blood volume/increased volume of distribution with resuscitation fluids and drugs (will leave vascular compartment more)
