PAR3031 - Week 11 - Trauma, Cardiac Arrest and other medical conditions of pregnancy

What was the maternal mortality ratio (MMR) in Australia in 2023?

8.2 deaths per 100,000 women giving birth.

What percentage of maternal deaths in Australia were directly related to pregnancy in 2023?

52%.

What percentage of maternal deaths in Australia were indirectly related to pregnancy in 2023?

48%.

How does Australia's maternal mortality ratio compare to that of the United Kingdom?

Australia: 6.8 per 100,000; UK: 9 per 100,000.

What is the maternal mortality ratio in the USA?

14 per 100,000 women giving birth.

What is the maternal mortality ratio in Papua New Guinea?

215 per 100,000 women giving birth.

What mnemonic can be used to remember the possible causes of maternal cardiac arrest?

BEAUCHOPS.

What does the 'B' in the BEAUCHOPS mnemonic stand for?

Bleeding/DIC.

What does the 'E' in the BEAUCHOPS mnemonic refer to?

Embolism (cardiac/pulmonary/amniotic fluid).

What does the 'A' in the BEAUCHOPS mnemonic represent?

Anaesthetic complications.

What does the 'U' in the BEAUCHOPS mnemonic stand for?

Uterine atony.

What does the 'C' in the BEAUCHOPS mnemonic indicate?

Cardiac disease (MI/ischemia/aortic dissection/cardiomyopathy).

What does the 'H' in the BEAUCHOPS mnemonic refer to?

Hypertension/preeclampsia/eclampsia.

What does the 'O' in the BEAUCHOPS mnemonic mean?

Other - Review standard ACLS guidelines (Hs and Ts).

What does the 'P' in the BEAUCHOPS mnemonic stand for?

Placental abruption, placenta previa.

What does the 'S' in the BEAUCHOPS mnemonic represent?

Sepsis.

What are the 4 H's associated with maternal cardiac arrest causes?

Hypoxia, Hypovolemia, Hyperkalemia, Hypothermia.

What are the 4 T's associated with maternal cardiac arrest causes?

Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary).

What is Hyperemesis Gravidarum?

Severe vomiting in pregnancy, often linked to elevated β HCG levels and multiple births.

What are common symptoms of Hyperemesis Gravidarum?

Severe vomiting, potential hypovolaemia, and electrolyte imbalances.

What is the management for Hyperemesis Gravidarum?

History taking, examination of vital signs, and possible transport to obstetric services.

What is an incompetent cervix?

Painless dilatation of the cervix leading to the expulsion of the fetus, typically in the second trimester.

What is the management for an incompetent cervix?

Placement of a cervical stitch if there is a known risk of pre-term labor.

When do fetal movements typically start?

Fetal movements start between 16-24 weeks of gestation.

What should a woman do if she notices decreased fetal movements?

She should be assessed within 2 hours of noticing the decrease.

What is Venous Thromboembolism (VTE)?

A condition where a thrombus in the venous system becomes detached and lodges elsewhere.

What are the two types of VTE?

Deep Vein Thrombosis (DVT) and Pulmonary Embolus (PE).

What are some risk factors for VTE in pregnancy?

Age >35, obesity, parity >4, history of thromboembolism, and prolonged travel.

What is Amniotic Fluid Embolism?

A rare and unpredictable condition where amniotic fluid enters maternal circulation, leading to severe complications.

What are common signs of Amniotic Fluid Embolism?

Acute respiratory distress, breathlessness, chest pain, and collapse during labor.

What is the management for Amniotic Fluid Embolism?

Oxygen therapy, IV fluids, and transport with pre-alert.

What is the mortality rate associated with severe sepsis in pregnancy?

20-40% mortality rate.

What are common causes of sepsis in pregnancy?

Genital tract infections, retained products, and postoperative infections.

What are signs and symptoms of sepsis in pregnancy?

Similar to non-pregnant patients, plus vaginal discharge, abdominal pain, and D&V.

What is the management for severe sepsis in pregnancy?

Delivery of the fetus and management as per non-pregnant patients.

What causes fainting during pregnancy?

Vasodilatation, poor venous return, and supine hypotension.

What is the management for fainting in pregnancy?

Avoid long periods of standing and lying on the back later in pregnancy.

What are common symptoms of anemia in pregnancy?

Fatigue, weakness, shortness of breath, palpitations, and dizziness.

What is the management for anemia during pregnancy?

Increase dietary iron intake and consider iron supplements.

What is morning sickness?

Nausea and vomiting that usually occurs in the first trimester.

What are management strategies for morning sickness?

Smaller, more frequent meals, ginger, dry biscuits, and prescription medications.

What causes reflux during pregnancy?

Progesterone relaxing the gastric sphincter and increased pressure from the growing fetus.

What causes constipation during pregnancy?

Progesterone relaxing the bowel and displacement by the growing uterus.

What causes increased frequency of urination during pregnancy?

The bladder competes for space with the growing uterus and fetal head.

What is the management for back pain in pregnancy?

Reassurance, education on posture, pelvic floor strengthening, and physiotherapy if severe.

What are the common causes of cardiac arrest in pregnancy?

Cardiac disease, pulmonary thrombo-embolism, haemorrhage, sepsis, hypertensive disorders, poisoning, self-harm, amniotic fluid embolism.

What is aortocaval compression?

A condition where the uterus compresses the inferior vena cava, affecting blood flow and circulation.

What is the recommended position to alleviate aortocaval compression during resuscitation?

Left lateral tilt with manual displacement of the uterus.

What is the optimal angle of left lateral tilt during resuscitation?

Between 15 and 30 degrees.

What is the first step to take when managing cardiac arrest in pregnancy?

Summon help immediately, including an obstetrician and neonatologist.

What should be prepared if initial resuscitation efforts fail?

Emergency Caesarean section.

What is the significance of effective maternal resuscitation?

It optimizes fetal outcomes.

What is the golden rule for achieving return of spontaneous circulation (ROSC) in pregnancy cardiac arrest?

The window to achieve ROSC is less than 4 minutes.

What should be done if a woman arrests in a pre-hospital environment?

LOAD AND GO while performing CPR en-route.

What airway management technique is preferred in pregnant patients due to the risk of aspiration?

Endotracheal intubation (ETT) is preferred over Laryngeal Mask Airway (LMA).

Why is advanced airway management crucial in pregnant patients during cardiac arrest?

Due to the increased risk of regurgitation and aspiration.

What physiological changes affect ventilation in pregnant patients?

Decreased functional residual capacity and functional residual volume.

What should be considered when performing CPR on a pregnant patient?

CPR should be performed higher than usual due to diaphragm elevation and abdominal contents.

What is the role of manual displacement of the uterus during resuscitation?

To remove caval compression and improve circulation.

What is the main concern regarding the unborn child during maternal cardiac arrest?

The viability of the unborn child during resuscitation efforts.

What is the primary focus of ANZCOR recommendations for cardiac arrest in pregnancy?

To apply all principles of basic and advanced life support while considering additional factors specific to pregnancy.

What is the recommended action if the patient is more than 20 weeks pregnant during CPR?

Manual displacement of the uterus is normally required.

What percentage of pregnancies in Australia are complicated by trauma?

~5%

What are the most common causes of trauma in pregnant women?

Domestic violence, motor vehicle accidents, and falls.

What is the significance of tachycardia in a maternity patient?

It is a critical indicator of an unwell patient and suggests hypovolaemia until proven otherwise.

What can be the first sign of hypovolaemia in a pregnant trauma patient?

Foetal distress.

What is the risk of foetal loss from minor trauma incidents?

1-3% of minor trauma incidents may result in loss of the fetus.

What are some pregnancy-specific complications to consider in trauma?

Placental abruption, cardiorespiratory arrest, preterm labour, uterine rupture, and haemorrhage.

What is the importance of activating retrieval systems early in trauma cases?

To ensure timely transportation to facilities with adequate trauma and obstetric care.

What is the recommended action if a pregnant patient does not meet time-critical criteria but has sustained trauma?

Transport to a hospital with both obstetric and trauma capabilities.

What is the risk of blood loss in pregnant trauma patients?

They may experience blood loss of 30% to 50% without showing symptoms.

What are the potential outcomes of minor traumatic injuries during pregnancy?

60% to 70% of foetal losses after trauma are a result of minor injuries.

What should be done if a pregnant trauma patient is on their left side?

Pull the uterus towards you.

What should be done if a pregnant trauma patient is on their right side?

Push the uterus away.

What is a key consideration for fluid replacement in pregnant trauma patients?

They require early and vigorous fluid replacement.

What is the role of the midwife or PIPER in trauma management?

Early consultation for advice on managing the trauma case.