Flashcards
2A - Maternal Health Mortality
Cards in this deck (52)
- 1Obstetric complicationsAssessment skills are vital for identifying probelms:
Involves all senses
observation, palpatation, percussion, auscultation
thorough history taking of women and her family - 2Maternal mortalitydeath of a pregnant woman or within 42 days of delivery termination
- 3What to doaccess to quality care
skilled professional workforce
good hygiene
access to safe abortion
prevent unwanted pregnancies
access to contraception
oxytocin after birth
detection/management of pre-existing conditions
address inequalities in access and quality - 4Australia and SA incidencesAus 1.1/100,000 births in 2015
SA - 8.9/100,000 births
3 maternal deaths in 2015 - 5Abortion in South Australiamedical termination of pregnancy became legal in SA in 1970
SA was the first legal state to enable this - 6Abortion in South Australia\ stats in 2014notifications: 4439 notified, women 20-24 and 25-29 had highest rates, teens reducing over 10 years by 11.9%
reasons: mental health 95.6%, serious abnormality 3.8%, maternal condition 0.6%
complications: 115 reported cases, 89 retained conception prodcuts, 12 sepsis, 8 haemorrhage, 5 failed procedure, 1 perforation uterus - 7Maternal complications in SAremember 56.1% of pregnancies have no complications
most arise from
diabetes - 10.4%
HTN - 7.0%
Haemorrhage - 4.4%
other 22.10% combined - 8Gestational diabetes definition:carb intolerance of variable severity with onset or first recognition during pregnancy
at risk of maternal and foetal mortality/morbidity
large babies, difficult labour, hypertension, haemorrhage - 9Risk factors of gestational diabetesfamily history
obesity
previous GDM in pregnancy
previous baby weight 4500gms
maternal age over 25 years
multiple pregnancy - 10CHO metabolismglucagon needed to free glucose
insulin actively transports free glucose across cell membranes into cells
insufficient insulin - BGL increases - glycosuria
fats oxidised for energy - ketones a by product - 11Insulin sensitivity0-20 weeks progesterone and oestrogen stimulate beta cells in pancreas to increase insulin production - insulin sensitivity
increased glycogen synthesis and storage
enhanced glucose use in peripheries - leads to lower BGL
fat synthesis/storage increases
reduced BGL and insulin needs - 12Insulin resistancelate 2nd and 3rd trimester - pregnancy hormones (prog, prolactin) antagonise the effectiveness of insulin
glucose mobilised out of storage
peripheral use of glucose reduced which facilitates availability of glucose for foetus
increased BGL
increased insulin needs - 13Gestational diabetes cycleother hormones influence insulin
pancreas- low/effective insulin
blood stream-raised glucose level
high glucose level affects embryo
hormonal changes during pregnancy - 14pathophysiologyinsulin secretion does not overcome insulin resistance
gestational diabetes (type 3)
aggravated pre-existing diabetes mellitis type 1 2) - 15DiagnosisOGCT
taken 26-28 weeks gestation
non-fasting 50 gram glucose drink
one hour venous blood is taken
one hour blood glucose level of greater than 7.8mmol indicates need for an oral glucose tolerance test (OGTT) - 16OGTToral glucose tolerance test
ensure normal diet 300 gm carb at least 3 days before test
performed under 8 hr fasting
obtain fasting venous blood sample
75 gram glucose drink given
measure at 2 hours
fasting glucose - less than 5.5mmol or glucose less than 7.8mmol 2 hrs after drink - 17Managementreferral to high risk pregnancy and medical care
home blood glucose monitoring
education
insulin treatment
admission for further treatment if BGL over 11mmol or poor compliance with diet - 18Gestational diabetes follow upall gestational diabetes women should have a glucose tolerance test at 6-8 weeks post partum
education and advice given about risk of type 2 diabetes
maintain healthy diet and exercise - 19Hypertension in pregnancyarises in pregnancy at 20 weeks gestation
pre-eclampsia
classic triad of symptoms: HTN 140/90, proteinuria 300mg/24 hours, oedema
rapid weight gain is supported - 20Pre-eclampsia diagnosisPE is a multisystem disorder potentially affecting both mother and baby
usually detected by measurement of an elevated bP - 21pathophysiologyIntense vasospasm -
In pregnancies complication by PE - blood vessel constrict leading to vasospasm and reduction in blood flow causing maternal organ damage
damage to endothelium of vessels
release of inflammatory factors
coagulation factors
placental hypoxia - 22Clinical course of pre-eclampsiaeye- retinal haemorrhage, arteriolar spasm
resp - pulmonary oedema, ARDS
liver - hepatic rupture, haemorrhage
CNS - seizures, CVA
Pancreas - ischaemia
kidneys - ARF
Uteroplacental circulation - Abruption, fetal compromise - 23Management of mild pre-eclampsiaexpectant management at home with visits in hospital
bed rest with care of DVT
careful checking of BP, urine protein and foetal activity
monitoring of liver and renal function - 24Diagnostic criteria of severe pre-eclampsiaheadaches, visual disturbances, pulmonary oedema, oliguria, elevated creatinine, proteinuria, systolic 160-180
diastolic 110 above - 25Management of severe pre-eclampsiaadmit to high dependency, monitor closely
prevent seizures
lower BP to prevent cerebral haemorrhage
assess for delivery, balance mother and baby conditions - 26Magnesium sulfatepreferred anticonvulsant
slows neuromuscular activity and decreased CNS irritability
no significant effects on BP
4-6gm load, followed by infusion of 1-3gms/hr
levels monitored for toxicity - 27Antihypertensive medicationgoal: diastolic 90/110mm/hg
choice of agent - beta blockers, vasodilators
oral alternatives (slower onset) - CCB, methydopa - 28Postpartum managementimprovement rapid after birth
risk of seizures greatest in first 24 hours
mag sulfate continued for first 24 hours
all monitored and continued for 24 hours
watch for signs of fluid overload - 29Eclampsiaappearance of seizures in a woman with PE
aetiology uncertain, cerebral oedema, ischaemia, possible causes
BP often significantly elevated
can occur berfore, during, after birth
develops quickly:
facial congestion
frothing at mouth
period of apnoea
deepening loss of consciousness
tonic phase of muscular rigidity
usually lasts 60-70 secs
women regains consciousness quickly - 30management of eclampsiamore than 50% occur out of hospital
if seizure happens:
call for help
prevent injury/aspiratin
give oxygen via hudson mask
evaluate airway, pulse, BP, CPR
secure IV access ASAP
stable plan for birth
may need ICU for monitoring respirations and CVS systems - 31Maternal physiology - cardiovascualrreduction in blood volume by 30-50% before shock becomes evident
HR normally higher
BP lower to mask symptoms
decreased vascular resistance - may not be clammy
reduce ratio of RBC to plasma
higher coagulability
high clotting factors
reflex vasoconstriction - reduced uteroplacental perfusion - 32Maternal physiology - gastrointestinal respiratorygastro- reduced motility and emptying, higher risk of aspiration
resp - high tidal volume, low PC02, high oxygen requirements, maternal/foetal hypoxia - 33Physiological changes of pregnancy that affect resuscitation/traumauterine blood flow determined by perfusion pressure with drop in maternal BP
uterus receives 20-30% of CO
Aortocaval compression causes 30% CO to be sequestered to lower body - 27% tilt during resuscitation
haemorrhage of 1000-1500mls can occur before the woman shows signs of hypovolaemic shock
increased oxygen consumption - maintain above 90% - 34Primary assessment maternal and foetalmaternal: stabilisation, life support, resuscitation, ABCs, oxygen, fluid support, initial physical examination, baseline maternal VS
Foetal: fundal height (gestation), uterine activity (contractions), foetal HR, movement, assess for vaginal bleeding, ruptured membrans, US - 35Secondary assessmentsx-rays, USS, lab investigations, CVP, urine output, complete physical examination
- 36Definitive careconsider need for:
emergency delivery
ongoing fetal surveillance
tocolytics
antibiotic cover
anti-d - 37Obstetric haemorrhagecan occur during:
antenatal - miscarriage, placenta praevia, placental abruption
intrapartum during birth - placental abruption or trauma to birth canal
postpartum - post partum haemorrhage - 38Placenta Praeviaimplantation of placenta inside the uterus near or over the opening of the cervix
grade 1 - placenta mostly in upper segment of uterus but encroaching on lower segment
grade 2 -reaches but doesnt cover the internal os
grade 3 - covers internal os when its closed but not completely when its dilated
grade 4 - placenta completely covers the internal os - 39Risk factors for placenta praeviaprevious c-section
previous instrumental birth
older mother
smoking
multiple gestation - 40Placenta praeviapainless bleeding - 2/3 trimester or at term
often following intercourse, may have preterm contractions
on presentation: vital signs, FHS, determine gestation
Lab, Gp and X match (have 2 units of whole blood in dept, coags)
US to confirm placement
management - no intercourse
late pregnancy bleeding - assess for premature labour, corticosteriods, tocolysis - 41Placental abruptionpremature seperation of placenta uterine wall
-partial or complete, revealed, concealed, mixed
foetal compromise, prematurity, restriction, stillbirth - 42Risk factors for abruptionHTN, smoking, substance use, trauma, MVA, over distension of uterus, chorioamnionitis
- 43placental abruptionvaginal bleeding is usually associated with abdominal pain, uterine contractions, tenderness
faint, collapse, signs of haemorrhagic shock
* consider consealed abruption if abdominal or back pain is present - 44Management of abruptiondepends on severity
maternal resuscitation if needed
monitor FHR, pain, contractions
management of fluids, IVT 2 lines, oxyegn, USS - 45Postpartum haemorrhangebleeding occurs following 2nd stage
causes:
poor uterine tone
tissue present in uterus - membranes
trauma from birth (cevix, vaginal tear)
primary - within 24 hours of birth
secondary - within 7-10 days postpartum - 46PPH risk factorsantepartum: pre-eclampsia, multiple gestation, previous PPH
Intrapartum: lacerations of vaginal, cervical, perineal, assisted birth, forceps, vacuum - 47Post partum haemorrhageup to 6% of vaginal births
definition over 500mls blood loss
25% of maternal deaths
causes:
tone 70%
tissue
trauma
thrombin - 48PPH - managementkeep woman warm
uterine mssage - encourage uterine contractions
inspect lacerations and repair
oxytocics
-1st line - syntocinon
- 2nd line - ergometrine
- 3rd line - prostaglandin F2 alpha - intramyometrial
surgical intervention - manual placenta, retain products, repair of trauma - 49Amniotic fluid embolismoccurs in 1 in 2 pregnancies
maternal mortality 85% with ICU management 26.4%
risk factors:
multiparity
abruption
IUFD - 50AFE what and whenwhat: amniotic fluid force into the maternal circulation via uterine sinuses of the placental bed due to increased pressure
When: close to term, during labour, immediately post partum - 51Clinical presentation of AFEgradual or sudden chest pain, dyspnoea, resp distress, nausea and vomiting, seizures, blood stained sputum, anaphylactic reaction common, DIC, coma, death
- 52AFE maternal assessmentinitial event:
oxygen 100%
intubation
ventilation
PEEP to avoid alveolar collapse
invasive haemodynaic monitoring
central line
two large bore IV - aggressive fluid replacement
urine output monitored
CXR and ECG
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- User has deleted their subject information Flashcards on 2A - Maternal Health Mortality, created by Deleted user on 14/06/2018.
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- Deleted user · Jun 2018
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- Created by Elizabeth Then · Jun 14, 2018
- Copied by Elizabeth Then · Jun 14, 2018
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