Maternal Collapse

Question 1

Why should you make sure that no heavily pregnant mother is lying on her back?

Answer 1

• compresses vena cava
• reduces cardiac output
  => can fail to perfuse baby

Question 2

What is the leading cause of maternal death up to 6 weeks following delivery? Is this a direct or indirect cause?

Answer 2

• Cardiac disease

- indirect

Question 3

What are the principles of care in maternal collapse?

Answer 3

• 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

Question 4

What are the potential causes of maternal collapse?

Answer 4

Head - eclampsia, epilepsy
Heart - MI, arrhythmia
Hypoxia - asthma, PE, pulmonary oedema
Haemorrhage - abruption, atony, uterine trauma
wHole body and Hazards

Question 5

How should a maternal collapse be managed?

Answer 5

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

Question 6

Why may resuscitation be difficult in a pregnant woman?

Answer 6

• ventilation difficult due to pressure on diaphragm
• foetus steals oxygen => demand = higher
• progesterone relaxes all ligaments/sphincters => heartburn => aspiration
• more difficult to intubate

Question 7

Without obstructing the vena cava, how do we allow mothers to lie flat in order to perform CPR?

Answer 7

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

Question 8

After what duration of CPR should the baby be delivered if the mother has collapsed?

Answer 8

4 minutes

for health of mother and baby

Question 9

There is usually a lot of blood loss associated with peri-mortem c-section. TRUE/FALSE?

Answer 9

FALSE

- very little blood loss due to poor circulation

Question 10

What are the 4Hs and 4Ts (and ONE other cause) which are thought to cause arrest?

Answer 10

Hs
Hypoxia
Hypovolaemia
Hypo/hyper - metabolic
Hypothermia

Ts
Thrombosis
Tamponade
Toxins
Tension Pneumothorax

+pre-eclampsia

Question 11

Eclampsia seziures usually last for how long?

Answer 11

2 minutes

Question 12

An eclampsia seizure lasting >5minutes is considered to be what?

Answer 12

Status epilepticus

Question 13

What are the principles of management if a mother has a seizure due to eclampsia?

Answer 13

• 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

Question 14

How should pregnant mothers in anaphylaxis be managed?

Answer 14

• 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)

Question 15

What treatment other than adrenaline can be used if a mother is in anaphylaxis?

Answer 15

• Chlorphenamine IV

- Hydrocortisone IV

Question 16

If Glucose is found to be under 4 in a mother who has collapsed, what treatment can be given?

Answer 16

IM glucagon

Glucogel

Question 17

How would you identify if a collapsed mother was in DKA?

Answer 17

Ketonuria

High Blood Glucose

Question 18

Amniotic fluid embolism is not preventable. TRUE/FALSE?

Answer 18

TRUE

- 30% mortality

Question 19

What symptoms are experienced by the patient in an amniotic fluid embolism?

Answer 19

• features of disseminated intravascular coagulation (excessive bleeding from different parts of body, blood clots, easy bruising etc)
• foetal and maternal respiratory depression

Question 20

How is a diagnosis of amniotic fluid embolism usually confirmed and where do most mother receive treatment?

Answer 20

Diagnosis = foetal squames present in maternal circulation

Tx = ITU

Question 21

Should you thrombolyse a collapsed mother who has suffered a massive PE?

Answer 21

Yes

- even though there is an increased risk to the foetus, the mothers health comes first

Question 22

What is cord prolapse?

Answer 22

Cord dangles outwith womans body or within vagina often due to malpresentation of baby

• may be seen outwith body OR felt on vaginal examination
• may cause foetal distress
• obstetric emergency

Question 23

What is meant by a category 1 delivery?

Answer 23

FASTEST method of delivery possible

• C-section if woman is not in labour
• forceps delivery if she is already in labour

Question 24

How is shoulder dystocia during labour managed?

Answer 24

• Woman brings knees to chest
• One person applies traction to baby’s head
• Other person applies suprapubic pressure with fist