Listas de chequeo en obstetricia: ayudas cognitivas que salvan vidas

Objective: To propose the use of eight checklists in the country’s obstetric emergency rooms. Methods: An interdisciplinary team was established with physicians specializing in obstetrics and gynecology, perinatology, fetal maternal medicine, critical medicine, anesthesiology, infectology and neonatology. Upon determination of the main pathologies affecting maternal mortality in Venezuela, multiple checklists used in different centers worldwide, publications available in databases and expert opinions were reviewed. They adapted to the realities of the country and medical availability and prioritized medical actions, laboratory tests, drug treatment and diagnostic elements. Results: Checklists for postpartum hemorrhage, obstetric sepsis, hypertensive pregnancy disorders (preeclampsia with signs of severity and eclampsia), magnesium sulfate poisoning, placental acretism, maternal cardiopulmonary resuscitation, and trauma and pregnancy are presented. Conclusion: The checklists resulting from the initiative of the Society of Obstetrics and Gynecology of Venezuela are available to all health personnel who require them for implementation in educational simulation scenarios and in clinical practice, as an additional tool for finding better outcomes in patients who require high complexity management in maternity rooms. Keywords: Checklist, Postpartum hemorrhage, Obstetric sepsis, Hypertensive pregnancy disorders, Magnesium sulfate poisoning, Placental acretism, Maternal cardiopulmonary resuscitation, Trauma and pregnancy

Obstetric Emergencies (DRAFT)

An obstetric rapid response team (RRT) should ideally include the readily available presence of an obstetrician and a well-established system for escalation of care and management of the fetus where applicable. During the evaluation of an obstetric patient, the RRT team should be familiar with the unique changes in maternal pregnant physiology and their influence on the presentation and management of common maternal emergencies. Postpartum hemorrhage, pre-eclampsia related complications, and sepsis together form the bulk of causes for maternal RRT calls. The knowledge of, and competence with, left lateral displacement of the uterus and the timing and execution of perimortem cesarean section are essential during maternal cardiopulmonary resuscitation. In this chapter, we review common maternal emergencies during RRT activation and their management.

Comparisons of the Pentax-AWS, Glidescope, and Macintosh Laryngoscopes for Intubation Performance during Mechanical Chest Compressions in Left Lateral Tilt: A Randomized Simulation Study of Maternal Cardiopulmonary Resuscitation

Purpose. Rapid advanced airway management is important in maternal cardiopulmonary resuscitation (CPR). This study aimed to compare intubation performances among Pentax-AWS (AWS), Glidescope (GVL), and Macintosh laryngoscope (MCL) during mechanical chest compression in 15° and 30° left lateral tilt.Methods. In 19 emergency physicians, a prospective randomized crossover study was conducted to examine the three laryngoscopes. Primary outcomes were the intubation time and the success rate for intubation.Results. The median intubation time using AWS was shorter than that of GVL and MCL in both tilt degrees. The time to visualize the glottic view in GVL and AWS was significantly lower than that of MCL (allP<0.05), whereas there was no significant difference between the two video laryngoscopes (in 15° tilt,P=1; in 30° tilt,P=0.71). The progression of tracheal tube using AWS was faster than that of MCL and GVL in both degrees (allP<0.001). Intubations using AWS and GVL showed higher success rate than that of Macintosh laryngoscopes.Conclusions. The AWS could be an appropriate laryngoscope for airway management of pregnant women in tilt CPR considering intubation time and success rate.