Resuscitation in pregnancy

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