Causes of maternal collapse

 

List:

·         Obstetric (5)

·         Anaesthesia (3)

·         4H and 4T

 

Obstetric:

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.Sepsis

·      i.e. chorioamnionitis

·      Hx: constitutional symptoms

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

·      Ix: ↑WCC, ↑CRP

3.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

·       

4.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

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

 

Anaesthesia:

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)

 

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