Resuscitation in pregnancy
From IDWiki
Differential Diagnosis
- Amniotic fluid embolus
- 1-10 in 100,000 deliveries
- Risk factors: age, eclampsia, C/s, instrumental delivery, induction, placenta previa or abryptio, grand multipatiry
- Causes respiratory failure, cardiogenic shock, and DIC
- Diagnosis of exclusion
- Management is supportive
- Hypermagnesemia
- Causes long PR
- Stop magnesium, consider fluids +/- loop diuretic, calcium gluconate, dialysis
- High spinal anaesthesia
- Causes hypotension without compensatory tachycardia
- Causes dyspnea, respiratory depression, diaphragmatic paralysis (warning sign is shoulder weakness), aspiration
- Stop epidural, reverse Trendelenberg, supportive care
- LAST (another anaesthesia problem)
- Stop epidural infusion
- Benzos for seizure
- Lipi emulsion (20%) 1.5mL/kg IV over 1 minute then 0.25mL/kg/min
- Can titrate up, repeat boluses
- Continue for 10 minutes after stability
- Prepare for ECMO or bypass if no response
- Cardiac arrest
Epidemiology
- 1 in 16,000 pregnancies
Management
- Call OB and Peds immediately
- Emergent delivery for women in cardiac arrest in the second half of pregnancy
- IV access above the diaphragm
- Left lateral displacement of uterus (push or pull it towards the left)
- 100% oxygen
- Assess and treat hypotension
- Consider it as a difficult airway
