surgery and trauma cases
- Appendectomy, cholecystectomy, Bartholins’s cysts
- Motor vehicle accidents, DV and other trauma
basic and advanced life support
left lateral position
use a wedge to avoid vena caval compression and improve cardiac output and venous return. Ensure the direction of compressions remains perpendicular when a tilt is used
basic and advanced life support oxygen
due to increased risk if hypoxia during pregnancy high flow oxygen (100%) is required whenever ventilation is assisted
basic and advanced life support stablising airway
take care as the risk of aspiration during resus is more likely due to increased gastric emptying/decreased motility and relaxation of the cardiac sphincter
basic and advanced life support drugs
consider increased drug dosages during resus if the standard dosages do not have desired effects due to the increased maternal fluid volume
basic and advanced life support blood volume
restore circulating blood volume, blood products, these may improve oxygen delivery to vital organs
basic and advanced life support surgery
if >20 weeks gestation and resus is not successful within 5 mins a perimortem caesarean section is advocated to assist with resus of the mother
top causes of maternal death
- Complications of pre-existing CV disease
- Sepsis
- Non-obstetric haemorrhage (brain, ruptured aneurysm)
- Thromboembolism
- Obstetric haemorrhage
- Amniotic fluid embolism
preventing maternal mortality
- If a midwife is unhappy with a medical opinion then they should consult a more senior doctor and seek support
- Poor communication
- Inadequate documentation
- Failure to perform observations
- Failure to act when a woman reported feeling unwell
- Failure to visit or revisit during the postnatal period
red flags (signs and symptoms) BP
- Systolic over 160
- Systolic under 90
- Diastolic over 80
red flags (signs and symptoms) sepsis
- Sore throat
- Pyrexia >38 degrees
- Sustained tachycardia >100bpm
- Breathlessness (rr >20)
- Abdominal or chest pain
- Diarrhoea and/or vomiting
- Reduced or absent fetal movements
- Reduced or absent fetal heart
- SROM or vaginal discharge
- Uterine or renal angle pain and tenderness
- Generally unwell, unduly anxious or panicking
red flags (signs and symptoms) breathlessness
- Sudden onset
- Associated with chest pain
- Orthopnoea (severe difficulty in breathing)
- Paroxysmal nocturnal dyspnoea
red flags (signs and symptoms) headache
- Sudden onset
- Neck stiffness
- Abnormal signs on neurological exam
red flags (signs and symptoms) mental health
- Ideas of suicide
- Marked change from normal functioning
- Mental health deterioration
- Persistent symptoms in late pregnancy or 6 weeks pp
- Panic attacks , obsessive thoughts
- Morbid fears
- Profound low mood or ideas
- Personal or family history of serious affective disorder
referrals
- Explain importance
- Check that the woman has been seen
- Remember referral is not treatment
FGM
- Traditional practice that occurs in more than 40 countries
- 130-140 million women and girls who have undergone some form of FGM
classifications type 1
Excision of the prepuce, with or without excision of part or the entire clitoris
classifications type 2
Excision of the clitoris with partial to total excision of the labia minora
classifications type 3
Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening
classifications type 4
Unclassified includes pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterisation by burning of the clitoris and surrounding tissue; scraping of the tissue surrounding the vagina
Clitoridectomy
excision of the clitoris
de-infibulation
surgical procedure to open up the closed vagina of type 3
excision
removal of the clitoral hood, with or without removal of part or all of the clitoris
FGM
comprises all procedures involving partial or total removal of the external genitalia or other injury to the female genital organs for non-medical reasons
