Causes of maternal collapse

 

List:

·        Obstetric (5)

·        Anaesthesia (3)

·        4H and 4T

 

Obstetric causes:

1.Haemorrhage

·     Hx:

o    Risk factors for each of TTTT

o    Pre-syncope, dyspnoea

·     Ex:

o    General: pale, cold, slow cap refill, drowsy vs agitated

o    Vital signs: ↑HR, ↑RR, ↓BP, ↓PP

o    O&G: tract trauma, abdo distension, boggy uterus

·     Ix: ↓Hb, ↓pH, ↑lactate

2.Pre-eclampsia

Eclampsia:

·     Hx: altered conscious state

·     Ex: ↑BP, ↑HR, seizure activity, hyperreflexia, clonus

·     Ix: ↑creat, ↓plt, ±↑LFT, ±∆coags

Stroke:

·     Hx: headache, vomiting

·     Ex: ↑BP, pupil signs, abnormal neuro, signs of ↑ICP

·     Ix: extravasation of contrast on CT brain

PRES:

·     Hx: headache, altered conscious state, visual impairment

·     Ex: ↑BP, ±abnormal neuro

·      

3.Thromboembolism

VTE:

·     Risk factors: e.g. FVL

·     Hx: chest pain, dyspnoea, dizziness

·     Ex: ↑HR, ↑RR, ↓BP, ↓SpO2

·     Ix: dilated RV

AFE:

·     Hx: chest pain, dyspnoea, dizziness

·     Ex: ↑HR, ↑RR, ↓BP, ↓SpO2, cyanosis, petechiae, bleeding

·     Ix: dilated RV, ↓plt, coagulopathy

4.Sepsis

·     i.e. chorioamnionitis

·     Hx: constitutional symptoms

·     Ex: ↑temp, ↑HR, ↑RR, ↓BP, altered conscious state if severe

·     Ix: ↑WCC, ↑CRP

5.Cardiac

Differentials:

·     Arrhythmia

·     AMI

·     Peripartum cardiomyopathy

·     Aortic dissection

·     Decompensation of existing condition

Presentation:

·     Hx: chest pain, dyspnoea

·     Ex:

o    General: ↑WOB, distressed

o    Vital signs: ↑HR, ↑RR, ↓BP, ↓SpO2

o    Basal crackles

·     Ix: poor systolic function on TTE

 

Anaesthetic causes:

1.Total spinal

·     i.e. total spinal -> unconsciousness, CVS collapse

·     Hx: no pain

·     Ex: ↓HR, ↓BP, ±eyes open

2.LAST

·     i.e. excessive epidural local anaesthetic -> neurotoxicity

·     Hx: tinnitus, paraesthesia

·     Ex: seizure, coma, ↑↓HR, ↑↓BP, arrest

·     Ix: ECG pulled apart, ventricular tachyarrhythmia

3.Drug

·     Hypnotic

·     Opioid

·     Muscle relaxant

 

4Hs and 4Ts:

H

·     Hypovolaemia

·     Hypoxia

·     Hypothermia

·     Hypo/hyper electrolytes

T

·     Thrombus (AMI, PE)

·     Toxin (see anaesthetic)

·     Tamponade (e.g. with aortic dissection)

·     Tension pneumothorax (e.g. IPPV)

 

Maternal resuscitation:

A

·     Airway manoeuvres

B

·     100% O2

·     Bag-mask ventilation

C

·     Left lateral

·     Fluid

·     Vasopressor

 

Intra-uterine resuscitation:

Interventions

·     Left lateral

·     Fluid

·     Vasopressor

·     Tocolysis

Monitoring

·     Frequent obs

·     Continuous CTG

·     Foetal scalp lactate

 

 

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