Maternal emergencies during pregnancy, labour, and postnatally

Maternal emergencies during pregnancy, labour, birth, and the postnatal period are covered. Blood tests during pregnancy and detecting deviations from the norm are included. Maternal emergencies and their management considered include: major obstetric haemorrhage, uterine rupture, eclampsia, emboli (pulmonary embolus and amniotic fluid embolus), HELLP syndrome, disseminated intravascular coagulation, uterine inversion, shock, and maternal resuscitation. Guidelines for admission to a high-dependency unit and current maternal morbidity and mortality data are included.

Amniotic fluid embolism (anaphylactoid syndrome of pregnancy)

Amniotic fluid embolus (AFE) is a rare occurrence but consistently remains one of the leading causes of maternal death in the developed world each year. Incidence in the United Kingdom is approximately 1 in 50,000 maternities and this seems to have stayed roughly stable. Quoted survival rates are improving, which may be a reflection of improved understanding and better care. This chapter aims to give an epidemiological background, outline the principles which are believed to underpin the pathophysiological changes which occur in episodes of AFE, and give readers a guide to treatment immediately following a maternal collapse due to AFE and ongoing supportive care thereafter.

Obstetric anaesthesia

This chapter covers the knowledge required for higher training in obstetric anaesthesia. Physiological changes of pregnancy, along with their relevance to anaesthetic management are highlighted. Common maternal comorbidity and the impact on antenatal course, delivery and anaesthesia are summarized. Modern labour analgesia techniques are compared. Anaesthetic management of common obstetric emergencies e.g. fetal distress, preeclampsia, massive haemorrhage, abnormal placentation, amniotic fluid embolus and uterine inversion are described. Finally, the recent Confidential Enquiry into Maternal Death is summarized along with the role of early warning scores to improve future care.

Obstetrics

Maternal collapse 146 Intrauterine fetal resuscitation 150 Severe haemorrhage 152 Amniotic fluid embolus 155 Severe pre-eclampsia 156 Eclampsia 159 Total spinal 160 Accidental dural puncture 162 Category 1 Caesarean section 164 Problems during Caesarean section 168 Failed intubation—obstetrics 170 Placenta praevia 174 Retained placenta 176...