Green-top Guideline no. 56 Maternal Collapse in Pregnancy and the Puerperium

00:00:28 Executive Summary 00:16:11 1. Purpose and Scope 00:17:02 2. Introduction and background epidemiology 00:21:57 3. Identification and assessment of evidence 00:23:44 4. Clinical issues 00:23:47 4.1. Can women at risk of collapse be identified early? 00:29:15 4.2. What are the causes of maternal collapse? 00:31:13 4.2.1. Haemorrhage 00:32:40 4.4.2. Thromboembolism 00:33:21 4.2.3. Amniotic fluid embolism 00:36:03 4.2.4. Cardiac Disease 00:38:43 4.2.5. Sepsis 00:39:34 4.2.6. Drug toxicity and overdose 00:42:01 4.2.7. Eclampsia 00:42:41 4.2.8. Intracranial haemorrhage 00:43:09 4.2.9. Anaphylaxis 00:46:03 4.2.10. Other causes 00:47:01 4.3. What are the physiological and anatomical changes in pregnancy that affect resuscitation? 00:48:45 4.3.1. Aortocaval compression 00:50:36 4.3.2. Respiratory changes 00:51:54 4.3.3. Intubation 00:52:33 4.3.2. Aspiration 00:53:51 4.3.5. Circulation 00:55:02 4.4. What is the optimal initial management of maternal collapse? 00:55:10 4.4.1. Resuscitation in maternal collapse 01:00:00 4.4.2 Relieving aorto-caval compression 01:03:58 4.4.3 Airway 01:07:11 4.4.4 Breathing 01:08:58 4.4.5 Circulation 01:15:25 4.4.6 Drugs 01:15:47 4.4.7 Other considerations 01:16:59 4.5 When, where and how should perimortem caesarean section (PMCS) be performed? 01:25:27 4.6 What does the ongoing management consist of? 01:26:47 4.6.1 Haemorrhage 01:29:31 4.6.2 Venous thromboembolism 01:30:36 4.6.3 Amniotic fluid embolism 01:34:28 4.6.4 Cardiac disease 01:35:44 4.6.5 Sepsis 01:39:48 4.6.6 Drug overdose and toxicity 01:40:27 4.6.6.1 Magnesium sulphate 01:41:23 4.6.6.2 Local anaesthetic agents 01:46:18 4.6.7 Eclampsia 01:46:58 4.6.8 Intracranial haemorrhage 01:47:54 4.6.9 Anaphylaxis 01:50:29 4.7 What are the outcomes for mother and baby? 01:57:28 4.8 Who should be on the team? 02:00:59 5 Clinical governance 02:01:03 5.1 Documentation 02:02:05 5.2 Incident reporting 02:03:57 5.3 Training 02:07:27 5.4 Debriefing 02:08:26 6 Recommendations for future research 02:09:01 7 Auditable topics 02:10:05 8 Useful links and support groups 02:12:04 Disclosures of interest 02:12:15 Funding 02:13:13 Appendix 1: Explanation of guidelines and evidence levels 02:14:35 Appendix 2: Causes of maternal collapse 02:17:04 Appendix 3: Physiological and physical changes in pregnancy 02:20:52 Appendix 4: Maternal collapse algorithm 02:21:23 Appendix 5: Recommended airway equipment 02:21:57 Appendix 6: Post collapse management 02:22:25 References