MATERNAL RESUSCITATION

GOALS…

1. To understand issues related to maternal collapse

2. To learn how to do proper resuscitation

3. To achieve competence on those skills

INTRODUCTION Cardiac arrest is fortunately a rare event in

pregnancy.

The most common direct cause of maternal death was thromboembolism, which results in cardiac arrest.

A fast & effective resuscitation will determine the outcome of both mother and fetus

INTRODUCTION CAUSES OF COLLAPSE

THROMBOEMBOLISMAMNIOTIC FLUID EMBOLISMANAPHYLAXIS SHOCKHYPOVOLEMIC SHOCKHEART FAILURE

NCORT

National Committee for Resuscitation Training Created by Ministry Of Health Malaysia in 2006

Created the Guidelines on Resuscitation Training on MOH Hospitals and Health Care Facilities 2011

Based on ILCOR 2010 Suited for local cultural, economic, system differences in

practice and resources, and for ease of training

HIGHLIGHTS

CHALLENGES

Difficult intubation in pregnant woman

Increased risk of aspiration

Diaphragmatic splinting in pregnant woman make the ventilation difficult

Protect self from danger including:1. Wearing PPE; mask apron, and

gloves2. Avoiding spills of body fluid, sharps

and electrical wires at bedside3. Determining unstable beds and

trolleys Protect patient from danger

Bring to safe environment for resuscitation

DANGER

RESPONSE AROUSE PATIENT – “HELLO HOW ARE

YOU” IF NO RESPONSE, CALL FOR HELP Assessment of conscious level

A- Alert V – Respond to voice P – Respond to pain U – Unresponsive

Can also use Glasgow Coma Scale

AIRWAY

OPEN AIRWAY HEAD TILT, CHIN LIFT OR JAW THRUST SECURE AIRWAY BY USING ORAL-PHARYNGEAL

AIRWAY OR LARYNGEAL MASK AIRWAY

BREATHING Assessment of breathing Look for evidence of abnormal breathing or gasping Not more than 10 seconds Not for giving rescue breaths Not for LOOK, LISTEN and FEEL LOOK at chest, neck and face Absence of breathing or presence of abnormal = cardiac

arrest

IF BREATHING…

IF BREATHING BUT UNCONCIOUS, TURN TO LEFT LATERAL AND GIVE OXYGEN

REGULARLY CHECK BP, PR, FHR

ASSESS AND TREAT CAUSE OF COLLAPSE

RECOVERY POSITION

Recovery position is applied when victims resume normal breathing but remain unresponsive

Recovery position True lateral position Head in dependent

position Position is stable Position is safe and

comfortable to patient

SALSO 2015

IF NOT BREATHING…..

Start chest compression in the absence of normal breathing

CIRCULATION

High Quality chest compression Location:

Lower half of sternum No longer using inter nipple line landmark Heel of hand at center of chest with other hand on top

Keep arms straight and depress sternum, 4-5cm Rate:

At least 100 compression per minute Change the person of delivering compression to avoid getting tired

SALSO 2014

In supine position while CPR is being carried out, an assistance displaces the uterus to the left side.

Tilt patient to the left with wedge pillow

SALSO 2015

• Perform 15-30 degree left lateral tilt

• Aim: to relieve aorto-caval compression

• Aorto-caval compression reduces the efficacy of chest compression during resuscitation

• Cardiac output improves 30-40%

COMBINE RESCUE BREATHING WITH A RATIO OF 30 COMPRESSIONS to 2 BREATHS

CONTINUE TILL ADVANCED LIFE SUPPORT ARRIVES

VENTILATION Ventilate using Bag Valve Mask/ ambubag Each breath given within one second inspiratory time

until a chest rise observed Mouth to mouth in areas without ambubag Use Protective devices for Mouth to mouth ventilation

ALGORITHM

Adult BLS

PERI MORTEM CS Is part of resuscitation Performed to try to save the mother Improves Circulation because takes weight of

baby away from vena cava Prepare for this … Carry out if resuscitation has no effect after 5

minutes

PERI MORTEM CS

Quick!

No need to move to operating theatre

Just need a scalpel – little bleeding

Any incision …….

QUESTIONS??