EMed

Collapse in Pregnancy

Circulatory Failure

  • massive blood loss from
    • abruption  
    • praevia
    • genital tract injuries, including ruptured uterus
    • atonic uterus
  • septicaemic shock
  • acute uterine inversion
  • myocardial failure
    • myocardial infarction
    • cardiomyopathy of pregnancy

Intracranial pathology

  • eclampsia
  • epilepsy
  • CVA
  • SAH
  • acute withdrawal in drug users

Respiratory compromise

  • amniotic fluid embolism
  • pulmonary embolism
  • pulmonary oedema
  • aspiration (Mendelson's syndrome)

Metabolic disturbances

  • hypoglycaemia
  • keto-acidotic coma
  • water intoxication
  • acute withdrawal from steroids
  • acute hepatic failure
  • anaphylaxis

Management

  • ABCs (remember check blood group with IV access - Anti-D?)
  • Call for help
  • In addition to standard life support measures remember:
    • The gravid uterus causes supine hypotension from aorto-caval compression and the women should be placed in the left lateral or at least on a 15° tilt
    • If advanced life support does not restore cardiopulmonary function within 5 minutes then consider delivery of the baby by caesarean section to improve venous return and save the mother's life

Content by Dr Íomhar O' Sullivan 23/06/2003. Reviewed by Dr ÍOS 10/07/2004, 12/12/2005, 30/05/2007. Last review Dr ÍOS 23/04/22