This document provides guidance on maternal resuscitation. It outlines the goals of understanding maternal collapse, learning proper resuscitation techniques, and achieving competence in maternal resuscitation. It describes potential causes of maternal collapse including hypovolaemia, hypoxia, electrolyte imbalances, hypothermia, and thromboembolism. The document then details the steps of the ABCDE approach to maternal resuscitation - assessing responsiveness, opening the airway, checking breathing, performing high-quality chest compressions, providing ventilations, and addressing any reversible causes. It highlights challenges such as difficult intubation and aortocaval compression during CPR in pregnant women, and provides guidance on performing a resuscitative hyster

2. MATERNAL
RESUSCITATIO
N

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

4. 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

5. INTRODUCTION
CAUSES OF COLLAPSE
• 4 H’s
• Hypovolaemia
• Hypoxia
• Hypokalemia/electrolytes imbalance
• Hypothermia
• 4 T’s
• Thromboembolism
• Toxicity
• Tension pneumothorax
• Tamponade (cardiac)

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. DANGER
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

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 is safe and
comfortable to patient

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, 5 – 6 cm
Rate:
◦ At least 100 compressions 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
• 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. RESUSCITATIVE HYSTEROTOMY
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. RESUSCITATIVE HYSTEROTOMY
Quick!
No need to move to operating theatre
Just need a scalpel – little bleeding
Any incision …….