An Urgent Call to the Labour Ward
Highlights
- Maternal collapse is the generic term that may be used to describe the endpoint of a variety of clinical problems. It is defined as ‘an acute event involving the cardiorespiratory systems and/or brain resulting in a reduced or absent conscious level (and potentially death), at any stage in pregnancy and up to 6 weeks post-delivery (View Highlight)
- The patient should be resuscitated with a left lateral tilt of at least 15° (but <30°) to minimize aorto-caval compression, which reduces the efficacy of chest compressions during resuscitation (View Highlight)
- Perimortem Caesarean section should begin within 4 min of arrest and be accomplished by 5 min. The primary reason for perimortem Caesarean is to maximize the chance of maternal survival by relieving aorto-caval compression, improving venous return, and promoting transfusion of blood from the placental bed (View Highlight)
- once arrest occurs, fetal survival is also optimized by rapid delivery; the best chance of survival for fetuses occurs when delivery occurs within 5 min of maternal arrest (View Highlight)
- Pre-eclampsia is defined as new hypertension [diastolic arterial pressure (DAP) ≥90 mm Hg or systolic arterial pressure (SAP) ≥140 mm Hg] presenting after 20 weeks of pregnancy with significant proteinuria (View Highlight)
- The majority of deaths in women with severe pre-eclampsia/eclampsia are secondary to intracranial haemorrhage and eclampsia. (View Highlight)
- In patients with severe hypertension, arterial pressure should be controlled to SAP of <150 mm Hg and DAP between 80 and 100 mm Hg, using one of the following agents:
labetalol (i.v. or orally),
hydralazine (i.v.),
nifedipine (orally). (View Highlight)
- All patients who suffer eclamptic seizures should be treated with magnesium sulphate. A loading dose of 4 g should be administered i.v. over 5 min. This should be followed by an infusion of 1 g h−1, which should be continued for 24 h. Recurrent seizures should be treated with a further bolus dose of 2–4 g over 5 min (View Highlight)
- diazepam, phenytoin, and other anticonvulsants, should not be used in eclampsia (View Highlight)
- At high plasma levels (5–6.5 mmol litre−1), magnesium can result in paralysis of respiratory muscles and respiratory arrest. Should this occur, the airway should be maintained, and 10 ml of 10% calcium chloride should be given i.v (View Highlight)
- The term ‘high spinal’ is used to describe a subarachnoid block that has extended above the higher thoracic dermatomes. However, inadvertently high block can also arise as a complication of epidural analgesia/anaesthesia (View Highlight)
- there have been no reported deaths secondary to high spinal in the last 20 yr. Delayed maternal resuscitation has, however, resulted in hypoxic–ischaemic encephalopathy of the baby. (View Highlight)
- Time to onset of a high spinal is variable, and the spectrum of clinical manifestations is wide (Table 1). They can include:
Hypotension and bradycardia secondary to sympathetic block of vasoconstriction and cardiac accelerator fibres. This can be compounded by aorto-caval compression.
Respiratory arrest after loss of motor supply to the intercostal muscles and the diaphragm.
Loss of consciousness secondary to lack of blood flow and block of the reticular activating system. (View Highlight)
- Major obstetric haemorrhage (MOH) has an incidence of ∼3.7/1000 maternities (View Highlight)
- Uterine atony is a common cause of post-partum haemorrhage. It can be treated pharmacologically or surgically. Pharmacological management includes administration of oxytocin, ergometrine, carboprost, or misoprostol (View Highlight)
- The classification of the urgency of Caesarean section, recognized by both the Royal College of Anaesthetists and Royal College of Obstetricians and Gynaecologists, is based upon the presence or absence of maternal or fetal compromise (View Highlight)
- Category 1 Caesarean section (the most urgent category) is defined as immediate threat to life of either the woman or the fetus (View Highlight)
- General anaesthesia is considered to be faster than regional anaesthesia, but is associated with increased maternal morbidity and mortality (View Highlight)