This is soon followed by return of spontaneous respiratory effort and some purposeful movement in the upper limbs. Causes specific to pregnancy are likely to be responsibleĪpproximately 2 minutes later a palpable pulse is restored corresponding with a sinus tachycardia on the defibrillation monitor.Transfer to the nearest operating theatre for a peri-mortem caesarean delivery if there is no response to CPR after 4 minutes.Remove fetal monitoring devices prior to defibrillation.Secure the airway early because of a higher risk of aspiration.Apply lateral tilt or manual uterine displacement if over 20 weeks gestation.Which of the following are key differences in the resuscitation of pregnant women? (True or False) The defibrillation pads are just being applied.ġ. She is not making any respiratory effort and no pulse is detectable. On arrival you find the response team performing CPR on a 35 year old parturient (G 2P 0) of 41 weeks and 6 days gestation who presented in spontaneous labour earlier in the day. The answers can be found at the end of the article.Īs the anaesthetist covering the delivery suite you are called to attend urgently because a patient has just collapsed. This scenario is based on an actual case report of an amniotic fluid embolism. All rights reserved.Before reading this tutorial, try to answer the questions found within the following scenario. Excessive fluid administration should be avoided (GRADE 1C) and (7) because coagulopathy may follow cardiovascular collapse with amniotic fluid embolism, we recommend the early assessment of clotting status and early aggressive management of clinical bleeding with standard massive transfusion protocols (GRADE 1C).Īmniotic fluid embolism cardiorespiratory arrest pregnancy.Ĭopyright © 2016 Elsevier Inc. We recommend the following: (1) we recommend consideration of amniotic fluid embolism in the differential diagnosis of sudden cardiorespiratory collapse in the laboring or recently delivered woman (GRADE 1C) (2) we do not recommend the use of any specific diagnostic laboratory test to either confirm or refute the diagnosis of amniotic fluid embolism at the present time, amniotic fluid embolism remains a clinical diagnosis (GRADE 1C) (3) we recommend the provision of immediate high-quality cardiopulmonary resuscitation with standard basic cardiac life support and advanced cardiac life support protocols in patients who develop cardiac arrest associated with amniotic fluid embolism (GRADE 1C) (4) we recommend that a multidisciplinary team including anesthesia, respiratory therapy, critical care, and maternal-fetal medicine should be involved in the ongoing care of women with AFE (Best Practice) (5) following cardiac arrest with amniotic fluid embolism, we recommend immediate delivery in the presence of a fetus ≥23 weeks of gestation (GRADE 2C) (6) we recommend the provision of adequate oxygenation and ventilation and, when indicated by hemodynamic status, the use of vasopressors and inotropic agents in the initial management of amniotic fluid embolism. Consistent with US Preventive Task Force guidelines, references were evaluated for quality based on the highest level of evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used for defining the strength of recommendations and rating quality of the evidence. Evidence reports and published guidelines were also reviewed, and additional studies were located by reviewing bibliographies of identified articles. Abstracts of research presented at symposia and scientific conferences were not considered adequate for inclusion. Priority was given to articles reporting original research, in particular randomized controlled trials, although review articles and commentaries were consulted. The search was restricted to English-language articles published from 1966 through March 2015. We sought to provide evidence-based guidelines regarding the diagnosis and management of amniotic fluid embolism.Ī systematic literature review was performed using MEDLINE, PubMed, EMBASE, and the Cochrane Library.
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