Why pregnant patients die.docx

Defining Mortality Maternal death Maternal death is death of a patient while pregnant or less than 42 days of termination of pregnancy Late Maternal Death is defined as maternal death occurring between 42 days and 1 year from the pregnancy. Maternal morbidity ratio is defined as the maternal deaths...

Defining Mortality Maternal death Maternal death is death of a patient while pregnant or less than 42 days of termination of pregnancy Late Maternal Death is defined as maternal death occurring between 42 days and 1 year from the pregnancy. Maternal morbidity ratio is defined as the maternal deaths per 100,000 live births. Canada is doing worse with maternal morbidity ratio. A lot of mothers are dying. Direct maternal death is caused by obstetrical complications Indirect Maternal Death Pre-existing disease or diseases developing during pregnancy not caused by the pregnancy Examples of causes of indirect maternal death listed below: Cardiac disease, Neurologic disease (epilepsy) Mental Health Violence/Intimate partner violence Substance use is a growing cause Postpartum hemorrhage is defined as greater than 500ml of blood loss after vaginal birth and greater than 1000ml after caesarean birth. With pregnancy estimation of blood loss is difficult. In pregnancy trauma, heart rate is more sensitive and occurs first and blood pressure occurs 2nd. Blood pressure will only fall after losing around 2 liters of blood The 4 most common causes of postpartum hemorrhage are listed below: Tone caused by atonic uterus (incidence: 70%) Trauma caused by lacerations or uterine rupture/inversion (incidence 19%) Tissue caused by retained placenta or accumulated clot (incidence 10%) Thrombin caused by coagulopathies or DIC (incidence 1%) 4 signs of placental separation include: gush of blood umbilical cord lengthening, uterus rising uterus becomes globular. Active management of 3rd stage of pregnancy is very important, and management includes 2 steps; giving uterotonics and controlled chord traction. Uterotonics aid with uterine contraction/tone and speeds up separation of placenta. Examples of uterotonics include oxytocin and carbetocin. Controlled cord traction can speed up separation of placenta but there is a risk of uterine inversion and cord avulsion. This is still unclear how much benefit so use controlled cord traction with caution. When someone is going through post-partum hemorrhage here are the management steps below: Evaluate vital signs every 5 minutes. Remember hypotension is a late sign. Give 2 large bore IVs Give crystalloid, colloid and blood products. Make sure to crossmatch. To manage post-partum hemorrhage caused by tone you should do 5 things listed below: Bimanual massage Uterotonics (these drugs include oxytocin, carboprost, ergonovine, misoprostol) Rule out other causes of PPH Stabilization Debrief To manage refractory atony in post-partum hemorrhage, consider the 4 steps below: Balloon tamponade Uterine compression sutures Radiologic uterine artery embolization Hysterectomy For stabilization do these 3 things below: Foley catheter as it monitors for adequate resuscitation Warm patient Establish surveillance of patient: does the patient need to go to the ICU, repeat labwork, vital sign frequency.