Most common overall cause of maternal death IN CEMACH

report.?
KEY#Cardiac
Most common direct cause in the last CEMACH report
KEY#Thromboembolism
Maternal mortality rate in U.K.
A 3.2/ 1000
b 14/ 100000
c 2.1 / 1000
d 16/ 1000
KEY#B

Incidence of amniotic fluid embolism

a 15/100000
b 2/100000
c 1/100000
d 16/100000
KEY#B
Perinatal mortality due to Amniotic fluid embolism is
A)125/1000

B)135/1000
C)140/1000
D)150/1000
E)160/1000
KEY#B

In respiratory system during pregnancy

T/F
1.Tidal volume increases
2.Minute ventilation decreased
3.Residual capacity decreases by 20%
4.Arterial pco2 increases
5.Oxygen consumption increases by 25%
KEY#TFFFF

Dose of IM adrenalin in anaphylaxis shock

1)0.05mg 1in 10,000
2)0.25mg 1 in 10,000
3)0.2mg 1 in 1000
4)500mcg 1 in 1000
5)0.1mg 1 in 1000

KEY#D

TRUE/FALSE

Uterus recieves 15% cardiac output at

termT/F------------------------------------------------------F(10%)
IN non pregnant woman chest compressions achieve around 40%
of the normal cardiac output T/F------------------F (30%)
Left lateral tilt of 20 degrees on a firm surface will relieve
aortocaval compression in majority of the pregnant woman and
still allow effective chest compression.T/F------------F(15degree)
Mortality due to anaphylaxis is around 2%
T/F--------------------------------------------------------------F( >1%)
And the incidence is between 3-10/1000
T/F-------------------------------------------------------------T

Regards perimortem c section

It should be considered as a resuscitative procedure to be
performed primarily in the interest of fetal, not maternal survival
T/F-------------------------------------------------F

The doctrine of best interest of the patient would apply to conduct

this procedure being carried out with consent T/F------------F

Compression should be performed at a ratio of 30:2 ventilations

when the patient is intubated T/F-------------------F

A.Reversible causes of maternal collapse can be remembered by the four Hs and four Ts.
The four Ts stand for:
Thromboembolism, toxicity, tamponade and trauma
Thromboembolism, toxicity, tamponade, tension pneumothorax
Transient ischaemic attack, toxicity, tamponade, trauma
Transient ischaemic attack, trauma, thromboembolism, tension pneumothorax
Thromboembolism, toxic shock, trauma, tension pneumothorax
The answer is thromboembolism, toxicity, tamponade, tension pneumothorax.
2.Perimortem caesarean section is recommended mainly because:
It increases the circulating volume
It increases sensitivity to defibrillation
It reduces aortocaval compression
It improves ventilation
The baby may survive even if the mother doesnt
Correct
The correct answer is that it increases the circulating volume.
Note that aortocaval compression can be achieved by manual displacement,
and ventilation may be improved in later gestations but not in earlier gestations.

3.The most common cause of maternal collapse is:

Cardiac disease
Eclampsia
Epilepsy
Haemorrhage
Pulmonary embolism
The correct answer is epilepsy.
NOTE ( that cardiac disease is the most common cause of maternal death,
but not collapse.)

4.In anaphylaxis the primary treatment is with:

Adrenaline
Atropine
Clopheniramine
Hydrocortisone
Prochlorperazine
The correct answer is adrenaline.
Atropine is used for bradycardias; clopheniramine and hydrocortisone are
supportive treatments but not primary treatments; prochlorperazine is an
antiemetic.

B.35-year-old primigravida with an unremarkable past medical and obstetric history was
admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks
of gestation. She is found collapsed and unresponsive in the corridor. The midwife who
found her has called for the emergency team. You are the next person to arrive on the
scene.
You have established that the airway is clear but breathing is absent. There are
no signs of life and you cannot palpate a carotid pulse.
Which is the most appropriate initial management option?
Administer intravenous adrenaline
Administer intravenous atropine
Administer two rescue breaths and re-assess maternal condition

Commence cardiopulmonary resuscitation (CPR)

Immediate defibrillation
Correct
The correct answer is commence cardiopulmonary resuscitation (CPR). Green Top Guideline 56 and
the Resuscitation Council (UK) guidelines dictate that chest compressions should be
commenced as soon as possible. Though defibrillation and adrenaline may have
a role later in the management of this case, CPR is the first priority. Atropine and
'rescue breaths' no longer feature in the resuscitation algorithm for the pulseless
patient.

C.35-year-old primigravida with an unremarkable past medical and obstetric history was
admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks
of gestation.
She is found collapsed and unresponsive in the corridor. The midwife who found her has
called for the emergency team. You are the next person to arrive on the scene.
What is the first most appropriate step in her care?
Immediate defibrillation with 200 joules
Manual displacement of the uterus to maternal left
Manual displacement of the uterus to maternal right
Open and assess the airway, protecting the cervical spine
Palpate for a radial pulse
Correct
The correct answer is open and assess the airway, protecting the cervical spine. In the
collapsed and unresponsive patient the ABC approach should be adopted.
Though displacement of the uterus is an important consideration it would not
take priority over airway management. See Resuscitation Council (UK)
guidelines.

D.A 35-year-old primigravida with an unremarkable past medical and obstetric history was
admitted to the antenatal ward for investigation of a suspected lower limb DVT at 32 weeks
of gestation. She is found collapsed and unresponsive in the corridor.

The obstetric emergency team has arrived and cardiopulmonary resuscitation

(CPR) according to Resuscitation Council (UK) guidelines have been ongoing for
4 minutes.
What is the most appropriate course of action?

You are preparing to suture a perineum following a forceps delivery by infiltrating the area
with lignocaine when the woman starts complaining of numbness around her mouth and
feeling short of breath.
What is the next most appropriate action?
Administer intramuscular adrenaline
Call for help
Lie the woman flat
Perform observations pulse, blood pressure and oxygen saturations
Stop infiltrating the anaesthetic
Correct
The correct answer is stop infiltrating the anaesthetic. The woman could be
suffering from lignocaine toxicity or anaphylaxis but in either case it is important
to stop administering the agent immediately. The other actions then follow by
calling for help and performing observations .

1.It should be performed after 4 minutes of unsuccessful CPR

True
False
The answer is true.
2.CPR should be discontinued to facilitate surgery
True
False

The answer is false. CPR must be uninterrupted.

3.Has a good outcome for the fetus
True
False
The answer is false.
4.Is best performed through the lower segment of uterus to minimise bleeding
True
False
The answer is false. Classical incision is the best for speed.
5.Viability of the baby must be given due consideration
True
False
The answer is false. This is an attempt to save the maternal life.
1.Adrenaline (epinephrine) should only be given to patients with asystolic cardiac arrest
True
False
The answer is false. Adrenaline is given in both VF/VT and non-VF/VT.
2.A ratio of five ventilations to 15 cardiac compressions is correct
True
False
The answer is false. The correct ratio is 30 chest compressions to two ventilations.
3.The airway should be opened by flexing the neck

True
False
The answer is false. The airway is made patent by extending the neck. Care should be
taken if there is suspicion of cervical spine trauma.
4.Drugs are best administered by the intracardiac rather than intravenous route
True
False
The answer is false. The intravenous route is preferred.
5.Oxygen should not be given until arterial blood gas samples have been taken
True
False
The answer is false. Oxygen must not be withheld and the inspired oxygen can be 'allowed'
for in interpreting blood gas results.
6.In the term pregnant woman it is imperative that the woman is tilted to the right, or that the
uterus is displaced manually to the right, in order for CPR to be effective
True
False
The answer is false. The uterus should be tilted or displaced to the left.
7.In the term pregnant woman early intubation is important.
True
False
The answer is true.
8.Intubation in the pregnant woman is technically easier than in the non-pregnant woman
True
False
The answer is false.

9.Cricoid pressure is not necessary if the patient is unconscious

True
False
The answer is false. Cricoid pressure is required where a patient has a high risk of
regurgitation (as in pregnancy) and obtunded laryngeal reflexes (as in the unconscious or
severely hypotensive patient).
10.Ventilation may be easier if the woman is placed head down
True
False
The answer is false. This would make ventilation more difficult.

KEY#

HMGA

KEY# G A N H J P

KEY# J B C H

KEY#

JGDCK

K ITU adm
B arterial blood gas
A antibiotics iv
H emergency c sec
F crystalloid inf
Key#

KEY# M N G L D A
Uterine inversion
Uterine rupture
Intracranial Infarction
Sepsis
Anaphylaxis
Abruption

KEY#AB

KEY#F..(Tension pneumothorax)

KEY# L J M G K

KEY#

NBMJC