CPR in pregnancy

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Presentation Transcript

CPR in pregnancy : 

CPR in pregnancy Directed by: Farnaz Mohammadzadeh M.D. Obstetrician & Gynecologist Behdad Bazargani M.D. Anesthesiologist

Physiologic changes : 

Physiologic changes Compensate for increased metabolic demands Prepare for blood loss at time of delivery Alter presentation of injured woman Pregnant woman is more vulnerable Mask severity of injury

Cardiovascular system : 

Cardiovascular system Increase in cardiac output (20-30%) Increase in heart rate (10-15 bpm) Decrease in systolic and diastolic pressure (10-15 mmhg) Increase in red blood cells and plasma (45%) Relative anemia Increase in blood flow to uterus (up to 20%)

Respiratory system : 

Respiratory system Increase in RR due to upward pressure of uterus Decrease in PCO2 Decrease in tidal volume

Gi/gu : 

Gi/gu Delayed GI emptying Movement of abdominal organs Uterus is the largest abdominal organ

shock : 

shock Body protects the mother : Uterine vasoconstriction 20-30% decrease in blood flow to uterus Loss of 30-35% of blood volume before developing hypotension slower onset of sign/symptom in mother But fetus is vulnerable to mild hypotension

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Resuscitation of pregnant women in cardiac arrest : 

Resuscitation of pregnant women in cardiac arrest

Slide 9: 

Always ABC Focus on maternal resuscitation Remember that signs of shock are late Evaluate and treat hypovolemia aggressively

Modifications in bls : 

Modifications in bls Position Airway and breathing Circulation defibrillation

position : 

position

Airway and breathing : 

Airway and breathing

circulation : 

circulation

defibrillation : 

defibrillation

Modificatoins in acls : 

Modificatoins in acls Airway (early , size of tube ) Breathing ( FRC , O2 demand) Circulation

Differential diagnosis : 

Differential diagnosis Excess magnesium sulfate Acute coronary syndromes Preeclampsia/Eclampsia Aortic dissection Amniotic fluid embolism Trauma and drug overdose

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Emergency hysterotomy : 

Emergency hysterotomy 24 – 25 weeks 5 min 98% 6-15 83% 16-25 33% 25-35 25% CHILD BIRTH

Decision making for emergency hysterotomy : 

Decision making for emergency hysterotomy Gestational age: < 20 weeks 20- 23 weeks >24- 25 weeks

Slide 22: 

Features of cardiac arrest: - Interval -Pre arrest hypoxia -Fetal distress -Effective resuscitative efforts -NICU

Slide 23: 

Professional setting: -equipment -experience -neonatal personnel -obstetric personnel

summary : 

summary Excellent CPR with some modifications in BLS and ACLS By 20 weeks,relieve the pressure by positioning the woman Defibrillation and medication the same Consider the need for emergency hysterotomy

Slide 25: 

Any Question?