This the updated maternal collapse guideline 2019 discussed last week in our obs and gyn department teaching session. focusing on definitions timing and diagnosis

1. YAZID JIBREL

2. MATERNAL COLLAPSE
acute event involving the cardiorespiratory systems and/or central nervous systems, resulting in
a reduced or absent conscious level (and potentially cardiac arrest and death), at any stage in
pregnancy and up to 6 weeks after birth.
if maternal collapse which is not as the result of cardiac arrest is not treated effectively, maternal
cardiac arrest can then occur

3. QUESTIONS

7. CARDIAC ARREST IN PREGNANCY

8. CARDIAC ARREST IN PREGNANCY

9. OF CARDIAC ARRESTS IN PREGNANCY WERE SECONDARY TO ANAESTHESIA

10. M&M
The data showed a severe maternal morbidity rate of 7.3 in 1000 (730 in 100 000) maternities in
2012
This is likely to reflect the changing demographics of women and better reporting, rather than a
decline in care
maternal mortality rate was 8.5 in 100 000 in the UK

11. PHYSIOLOGY
CHANGES IN PREGNANCY

12. CARDIOVASCULAR

13. RESPIRATORY

14. OTHER CHANGES

22. AORTOCAVAL COMPRESSION SIGNIFICANTLY REDUCES CARDIAC
OUTPUT ONWARDS AND THE EFFICACY OF CHEST COMPRESSIONS
DURING RESUSCITATION FROM 20 WEEKS OF GESTATION

23. LEFT LATERAL TILT OF THE WOMAN FROM HEAD TO TOE AT AN ANGLE OF
15–30 ON A fiRM SURFACE WILL RELIEVE AORTOCAVAL COMPRESSION IN
THE MAJORITY OF PREGNANT WOMEN AND STILL ALLOW EFFECTIVE CHEST
COMPRESSIONS TO BE PERFORMED IN THE EVENT OF CARDIAC ARREST

24. WHEN WHERE HOW

25. The concept of perimortem caesarean section was introduced in 1986
along with the recommendation that it be initiated after 4 minutes of maternal cardiopulmonary
arrest if resuscitation is ineffective, and be achieved within 5 minutes of collapse.
The rationale for this timescale is that the pregnant woman becomes hypoxic more quickly than
the non pregnant woman, and irreversible brain damage can ensue within 4–6 minutes.

26. Time should not be wasted by moving the woman to an operating theatre; a perimortem caesarean
section can be performed anywhere, with a scalpel being the only essential equipment required

28. The operator should use the incision, which will facilitate the most rapid access. This may be a
midline vertical incision or a suprapubic transverse incision

29. In women over 20 weeks of gestation, if there is no response to correctly performed CPR within
4 minutes of maternal collapse or if resuscitation is continued beyond this, then PMCS should be
undertaken to assist maternal resuscitation. Ideally, this should be achieved within 5 minutes of
the collapse.
PMCS should not be delayed by moving the woman. It should be performed where maternal
collapse has occurred and resuscitation is taking place.

30. ANSWERS

34. THANK YOU