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Questions and Answers
What is crucial for the survival of the mother and fetus in cases of cardiac arrest?
What is crucial for the survival of the mother and fetus in cases of cardiac arrest?
Management in the first critical minutes.
What should all obstetricians be able to diagnose regarding cardiac events?
What should all obstetricians be able to diagnose regarding cardiac events?
Cardiac arrest.
What does the ABC of resuscitation stand for?
What does the ABC of resuscitation stand for?
Emergency caesarean section should be done immediately in all cases of cardiac arrest in pregnancy.
Emergency caesarean section should be done immediately in all cases of cardiac arrest in pregnancy.
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What percentage increase in maternal oxygen demand occurs in the latter half of pregnancy compared to the non-pregnant state?
What percentage increase in maternal oxygen demand occurs in the latter half of pregnancy compared to the non-pregnant state?
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What should be done if a patient is not breathing during resuscitation?
What should be done if a patient is not breathing during resuscitation?
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To improve resuscitation, the gravid uterus should be displaced to decrease the effect of aortocaval compression during ______.
To improve resuscitation, the gravid uterus should be displaced to decrease the effect of aortocaval compression during ______.
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List one physiological and one pathological abdominal pain cause in pregnancy.
List one physiological and one pathological abdominal pain cause in pregnancy.
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Which of the following is NOT a potential cause of abdominal pain unrelated to pregnancy?
Which of the following is NOT a potential cause of abdominal pain unrelated to pregnancy?
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What should be the position of a pregnant woman during transport after trauma?
What should be the position of a pregnant woman during transport after trauma?
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Up to 30% of blood volume may be lost before changes in pulse and blood pressure are observed.
Up to 30% of blood volume may be lost before changes in pulse and blood pressure are observed.
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Study Notes
Resuscitation in Pregnancy
- Survival of mother and fetus in cardiac arrest depends on initial minutes of management
- Obstetricians must know how to diagnose cardiac arrest and start CPR
- Obstetricians should be able to recognize impending cardiorespiratory arrest and take measures to prevent its deterioration
ABC of Resuscitation
- Airway: is it clear?
- Breathing: is the chest moving or is there air movement at the lips?
- Circulation: can you feel a carotid or femoral pulse?
- Displacement: of the gravid uterus to decrease aortocaval compression on Venus return
- Emergency Cesarean: within 5-10 minutes if initial resuscitation is unsuccessful
Changes in Maternal Physiology
- Maternal oxygen demands in the latter half of pregnancy are 20% higher than in the non-pregnant state
- Cardiac output is 40% higher than non-pregnant
- The gravid uterus makes ventilation more difficult
- 10% of maternal cardiac output goes to the uterus and fetus
- Ineffective resuscitation may result in a hypoxic fetus
Airway Management
- Clear the airway of debris, dentures, or vomit
- Tilt the head back and thrust the lower jaw forward, moving the base of the tongue from the posterior pharyngeal wall to create a clear passage
Breathing Management
- If the patient is breathing, place her in the coma position
- If the patient is not breathing:
- Ventilation should be at a rate of 2 breaths to 30 chest compressions
Circulation Management
- Effective cardiac massage requires a firm surface (the floor can be used)
- Cardiac massage is more difficult in pregnant patients due to displacement of the diaphragm and rib cage by the gravid uterus
- Compressions should be carried out mid-sternum to avoid possible liver damage
- Compression should be carried out at a rate of 100 per minute
Displacement of the Gravid Uterus
- With the patient lying on her back, aortocaval compression by the gravid uterus decreases venous return, making effective resuscitation difficult
- To decrease aortocaval compression without compromising effective cardiac massage, apply one of the following methods:
- Place a wedge under the right hip
- Use a rolled-up blanket or pillow under the right hip
Emergency Cesarean Section
- If resuscitation hasn’t produced a spontaneous cardiac output within 5 minutes, perform an emergency Cesarean section in situ
- Continue full resuscitation during the Cesarean section
- This has the advantages of:
- Relieving aortocaval compression
- Allowing for direct fetal resuscitation
Abdominal Pain in Pregnancy
Pregnancy-Related Causes
-
Physiological:
- Labor: accompanied by cervical effacement or dilatation and descent of the presenting part
- Musculoskeletal pain: due to ligament stretching
- Constipation: common
-
Pathological:
- Ectopic pregnancy: implanted outside the uterus
- Miscarriage: pregnancy loss before 20 weeks
- Placental abruption: placenta separates from the uterine wall before delivery
- Polyhydramnios: excess amniotic fluid
- Chorioamnionitis: infection of the amniotic sac
- Symphysis pubis dysfunction (SPD): pain in the pelvic joint
- Pre-eclampsia: high blood pressure and protein in urine during pregnancy
- Acute fatty liver of pregnancy (AFLP): rare but serious liver condition
- Complications of uterine fibroids: benign growths in the uterus
- Uterine rupture or scar dehiscence: tear in the uterine wall
- Uterine torsion: uterus twists on its axis
Causes unrelated to pregnancy
-
Ovarian cyst: fluid-filled sac in an ovary
-
Gastrointestinal tract:
- Appendicitis: inflammation of the appendix
- Acute cholecystitis: inflammation of the gallbladder
- Gastroenteritis: inflammation of the stomach and intestines
- Intestinal obstruction: blockage in the intestines
- Acute pancreatitis: inflammation of the pancreas
- Peptic ulcer disease: sores in the stomach or duodenum
- Inflammatory bowel disease (ulcerative colitis and Crohn’s disease): inflammation of the digestive tract
- Diverticulitis: inflammation of pouches in the colon
-
Urinary tract:
- Cystitis: inflammation of the bladder
- Acute pyelonephritis: kidney infection
- Urolithiasis: kidney stones
-
Other causes:
- Sickle cell crises
- Pleurisy
- Splenic infarction
- Malaria
- Acute intermittent porphyria
- Vascular complications
Trauma in Pregnancy
-
Causes:
- Road traffic accidents (RTAs)
- Falls
- Domestic accidental and non-accidental injury
- Assault
- Penetrating trauma
Anatomical and Physiological Effects of Pregnancy
- Up to 30% of blood volume may be lost before pulse and blood pressure change
- Uterine perfusion may be compromised while maternal pulse and blood pressure are still maintained
- Reduced venous return in the supine position due to inferior vena cava (IVC) compression by the enlarged uterus
- Blood loss into the uterus or abdomen may be concealed
- Uterine size and position in late pregnancy render it more prone to trauma
- The fetus may be more immediately affected than the mother
- Delayed gastric emptying increases the risk of vomiting and aspiration
Approach to Management
- Nurse and transport the pregnant woman with a 15-30° left tilt using a wedge or rolled-up clothing or in the left lateral position
- For major trauma, start immediate resuscitation
- Transfer the woman to...
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Description
Test your knowledge on the crucial strategies for resuscitating pregnant women in cardiac arrest. This quiz covers essential topics including the ABCs of resuscitation, physiological changes during pregnancy, and emergency interventions. Understanding these principles is vital for obstetricians to ensure the survival of both mother and fetus.
