Maternal resuscitation

1. MATERNAL
RESUSCITATIO
N

2. GOALS…
1. To understand issues related to maternal collapse
2. To learn how to do proper resuscitation
3. To achieve competence on those skills

3. 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

4. INTRODUCTION
 CAUSES OF COLLAPSE
 THROMBOEMBOLISM
 AMNIOTIC FLUID EMBOLISM
 ANAPHYLAXIS SHOCK
 HYPOVOLEMIC SHOCK
 HEART FAILURE

5. NCORT
 National Committee for Resuscitation Training
 Created by Ministry Of Health Malaysia in 2006

7.  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

8. HIGHLIGHTS

9. CHALLENGES
 Difficult intubation in pregnant woman
 Increased risk of aspiration
 Diaphragmatic splinting in pregnant woman make the
ventilation difficult

10.  Protect self from danger including:
1. Wearing PPE; mask apron, and gloves
2. Avoiding spills of body fluid, sharps and
electrical wires at bedside
3. Determining unstable beds and trolleys
 Protect patient from danger
 Bring to safe environment for resuscitation
DANGER

11. 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

12. AIRWAY
 OPEN AIRWAY
 HEAD TILT, CHIN LIFT OR JAW THRUST
 SECURE AIRWAY BY USING ORAL-PHARYNGEAL
AIRWAY OR LARYNGEAL MASK AIRWAY

13. 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

14. IF BREATHING…
 IF BREATHING BUT UNCONCIOUS, TURN TO LEFT
LATERAL AND GIVE OXYGEN
 REGULARLY CHECK BP, PR, FHR
 ASSESS AND TREAT CAUSE OF COLLAPSE

15. 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

16. IF NOT BREATHING…..
 Start chest compression in the
absence of normal breathing

17. 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

18. 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%

19.  COMBINE RESCUE BREATHING WITH
A RATIO OF 30 COMPRESSIONS to 2
BREATHS
 CONTINUE TILL ADVANCED LIFE
SUPPORT ARRIVES

20. 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

21. ALGORITHM
 Adult BLS

23. 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

24. PERI MORTEM CS
 Quick!
 No need to move to operating theatre
 Just need a scalpel – little bleeding
 Any incision …….