Pregnancy Complications 18.05.2023 v2.pdf

Pregnancy Complications Pre-eclampsia Eclampsia Sepsis Session objective Understand the anatomy, physiology and assessment of the pregnant woman Understand the risk factors, signs and symptoms of common conditions caused by complications in pregnancy Be able to manage conditions ca...

Pregnancy Complications Pre-eclampsia Eclampsia Sepsis Session objective Understand the anatomy, physiology and assessment of the pregnant woman Understand the risk factors, signs and symptoms of common conditions caused by complications in pregnancy Be able to manage conditions cause by complications in pregnancy, in accordance with agreed ways of working Understand the management of common conditions caused by complications in childbirth London Ambulance Service NHS Trust 2 Pre-eclampsia London Ambulance Service NHS Trust 3 Pre-eclampsia What is it? - New hypertension (>140/90mmHg) with proteinuria after 20 weeks gestation What does proteinuria indicate? - ORGAN DYSFUNCTION London Ambulance Service NHS Trust 4  Symptoms of Pre-eclampsia? London Ambulance Service NHS Trust 5 London Ambulance Service NHS Trust 6 Risk factors for Pre-eclampsia First pregnancy Age 40 years or older Pregnancy interval of more than 10 years Body mass index of 35 or more Family history of pre-eclampsia or pre-eclampsia in previous pregnancy Multiple pregnancy Medical co-morbidities (hypertension, renal or cardiac disease, diabetes) London Ambulance Service NHS Trust 7 Management of pre-eclampsia ABCDE assessment – report findings Are there any time critical features/red flags? If YES, pre-alert to nearest obstetric unit If NO, continue with thorough assessment During conveyance: Right of left lateral positioning Continuous BP measurements London Ambulance Service NHS Trust 9  Important: Pre-eclampsia can be life- threatening even in the absence of seizure activity. The organ dysfunction associated with severe pre-eclampsia can cause sub- arachnoid haemorrhage and stroke. Between 2017-2019, more women died of pre-eclampsia than of eclampsia in the UK. London Ambulance Service NHS Trust 10 Eclampsia London Ambulance Service NHS Trust 11 Eclampsia What is it? - New onset of convulsions during pregnancy or post-partum, generally in a woman with pre-eclampsia - Presents as a tonic/clonic convulsion. Eclamptic seizures are short-lasting (20 weeks or recently post-partum, treat as Eclampsia IV access and drugs if paramedic on scene London Ambulance Service NHS Trust 13 Maternal Sepsis London Ambulance Service NHS Trust 14 Maternal Sepsis Ante-partum and Post-partum sepsis are one of the leading causes of maternal mortality in the UK Can be: - Direct cause- i.e. pregnancy or genital tract related - Indirect cause e.g. influenza, COVID-19, Group A and B Strep Reduced immunity in pregnancy means that maternity patients are more susceptible to infection Can have rapid onset London Ambulance Service NHS Trust 15 Management of suspected sepsis NEWS2 is not validated for use in pregnancy to due maternal physiology Always use the Maternity Assessment Card to identify red flags Pre-alert to nearest obstetric unit- antibiotics need to be administered in hospital within an hour of sepsis onset London Ambulance Service NHS Trust 16  1 red flag or 2 amber flags = TIME Where to go: Convey to maternity (obstetric CRITICAL unit): If 20 or more weeks Go to the nearest hospital with gestation AND woman stable obstetrics on site Convey to ED with obstetrics Early blue call pre alert via PD09 on site: If less than 20 weeks gestation OR woman unstable (for example, ongoing life DO NOT CALL A MIDWIFE threatening haemorrhage, recent seizure, reduced GCS) London Ambulance Service NHS Trust Summary Suspected pre-eclampsia requires close and continuous assessment up to point of handover at hospital. Use the maternal assessment card on JRCALC+ to guide assessment and management of pregnancy complications Call for additional resources early but do not delay on scene Do not call a midwife in the presence of red flags- this will delay care (unless the patient declines to be transferred) Datix all cases of pregnancy complications London Ambulance Service NHS Trust 18