Podcast
Questions and Answers
What is the recommended response for a woman experiencing eclamptic seizures?
What is the recommended response for a woman experiencing eclamptic seizures?
- Transport to the nearest pharmacy
- Monitor for an hour and call a midwife
- Administer IV access and drugs if paramedic is on scene (correct)
- Wait for further instructions from the mother
Maternal sepsis can only be caused by direct pregnancy-related issues.
Maternal sepsis can only be caused by direct pregnancy-related issues.
False (B)
What does NEWS2 stand for in the context of managing suspected sepsis?
What does NEWS2 stand for in the context of managing suspected sepsis?
National Early Warning Score 2
A pre-alert should be made to the nearest _________ unit when suspected sepsis is identified.
A pre-alert should be made to the nearest _________ unit when suspected sepsis is identified.
What constitutes a critical condition requiring immediate attention?
What constitutes a critical condition requiring immediate attention?
Match the following causes of maternal sepsis with their description:
Match the following causes of maternal sepsis with their description:
When should antibiotics be administered to a patient with suspected sepsis?
When should antibiotics be administered to a patient with suspected sepsis?
It is important to call a midwife in the presence of red flags to ensure proper care.
It is important to call a midwife in the presence of red flags to ensure proper care.
What defines pre-eclampsia?
What defines pre-eclampsia?
Eclampsia is defined as having new onset convulsions during pregnancy without a history of pre-eclampsia.
Eclampsia is defined as having new onset convulsions during pregnancy without a history of pre-eclampsia.
What does the presence of proteinuria indicate in a pregnant woman?
What does the presence of proteinuria indicate in a pregnant woman?
Individuals with a body mass index of ______ or more are at higher risk for pre-eclampsia.
Individuals with a body mass index of ______ or more are at higher risk for pre-eclampsia.
Match the pregnancy complications with their definitions.
Match the pregnancy complications with their definitions.
Which of the following is NOT a risk factor for pre-eclampsia?
Which of the following is NOT a risk factor for pre-eclampsia?
It is safe to ignore signs of severe pre-eclampsia until the patient has a seizure.
It is safe to ignore signs of severe pre-eclampsia until the patient has a seizure.
What position should a patient with pre-eclampsia be in during conveyance?
What position should a patient with pre-eclampsia be in during conveyance?
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Study Notes
Pre-eclampsia
- Defined as new hypertension (blood pressure >140/90 mmHg) with proteinuria occurring after 20 weeks of gestation.
- Proteinuria indicates organ dysfunction, signalling potential complications.
- Risk factors include:
- First pregnancy
- Age 40 or older
- More than 10 years between pregnancies
- Body mass index (BMI) of 35 or more
- Family history of pre-eclampsia or occurrence in prior pregnancies
- Multiple pregnancies
- Existing medical conditions (hypertension, renal or cardiac disease, diabetes).
- Management requires thorough assessment using the ABCDE approach, with a focus on identifying time-critical features.
- Continuous monitoring of blood pressure and left or right lateral positioning are essential during transport.
- Severe pre-eclampsia poses life-threatening risks such as stroke and sub-arachnoid hemorrhage.
Eclampsia
- Characterized by new-onset convulsions during pregnancy or postpartum, typically in women with pre-eclampsia.
- Convulsions present as tonic/clonic seizures and are usually short-lived.
- Treatment includes ensuring intravenous access and administering appropriate medications if paramedics are present during seizures.
Maternal Sepsis
- Ante-partum and post-partum sepsis is a leading cause of maternal mortality in the UK.
- Can arise directly from pregnancy-related issues or indirectly due to conditions like influenza, COVID-19, or streptococcal infections.
- Pregnant women experience reduced immunity, increasing susceptibility to infections, and can present with rapid-onset sepsis.
Management of Suspected Sepsis
- NEWS2 (National Early Warning Score) is not validated for pregnant patients; use the Maternity Assessment Card to identify critical red flags.
- Immediate pre-alert to the nearest obstetric unit is crucial, and antibiotics should be administered within one hour of sepsis onset.
- One red flag or two amber flags indicate urgent action:
- If 20 weeks or more gestation and stable, convey to maternity unit.
- If less than 20 weeks gestation or unstable, convey to Emergency Department with obstetric support.
- Avoid calling a midwife in the presence of red flags to prevent delays in care.
Summary
- Close monitoring and continuous assessment are vital for suspected pre-eclampsia until handover at the hospital.
- Utilize the maternal assessment card for guiding assessments in pregnancy complications.
- Request additional resources promptly but avoid scene delays.
- Document all cases of pregnancy complications in Datix for record-keeping and accountability.
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