progeny july2012

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1 VOL XXVIII, NO. II July 2012 ALSO, ACLS OB, ObLS Obstetric life Support two patients (mother and fetus), coupled The stress of simultaneously caring for ing pregnancy make the management of with the physiologic changes in women dur maternal cardiopulmonary arrest complex and challenging. Although cardiopulmonary arrest is a rare occurrence in pregnant wo men, it is crucial that obstetrical healthcare nd respond to life thr eatening obstetrical providers are trained to quickly assess a emergencies and cardiac arrest There are specific causes of cardiac arrest that are unique to pregnant women. Those causes have obstetric and non-obs tetric etiologies. See table below Table 1 Obstetric Adverse events maternal Non-obstetric etiologies etiologies care Septic Shock Maternal Hemorrhage Magnesium Sulfate Toxicity Cardiovascular diseases Preeclampsia /Eclampsia Anesthetic Complications HELLP Syndrome Endocrine Disorders (diabetes, hyperthyroidism) Amniotic fluid /Pulmonary Collagen Vascular Diseases ( lupus) Embolus The physiologic changes occurring in pregnancy can complicate resuscitation efforts. During pregnancy the mucosal lining of the pharynx and larynx become edematous and the tissue is fragile making in tubation difficult. The enlarged uterus and hormonal changes cause GI reflux and prol onged gastric emptying, thus increasing the

2 risk for aspiration. The enlarged uterus at approximately 20 weeks gestation and beyond is heavy enough to compress the aorta and vena cava against the spine. This compression causes a decrease in venous return, stroke vo lume and cardiac output. Therefore, greater force will be needed during chest compressions to generate measureable output. Any of be profound and have a major impact on the ability to these physiologic changes can a pregnant woman. successfully resuscitate signed to train staff in obstetrical There are several programs that are de resuscitations. These programs differ from standard basic life support and advanced cardiac life support in that along with teaching cardiopulmonary resuscitation, drug therapies, and rhythm identification, these programs include training and skill acquisition SO, ACLS OB and ObLS are three such necessary for obstetrical emergencies. AL programs. These programs focus on obstetrical complications; malpresentations, labor dystocia, first and late trimester vaginal mplications surrounding bleeding. Along with co shoulder dystocia, vacuum and forceps post partum hemorrhage, cord prolapse, those with pre eclampsia or eclampsia is deliveries. Care of high risk patients like discussed along with teaching maternal and neonatal resuscitation and setting up for and performing perimortem cesarean delivery pregnancy require several additions to Anatomic and physiologic changes during the ACLS algorithm. Obstetrical healthcare pr oviders must be aware of these changes and how they affect the resuscitation. Since cardiac arrest is a rare on pregnancy on going drills, simulations and specialized obstetric focused advanced life saving programs will improve provider readiness and improve patient outcomes. ~ Rachel M. Woodard, RN BSN, RNC Further information can be found at: www.aafp.org/ALSO ALSO melpfennig (Meridian, ID) [email protected] ACLS OB Katie Schi ObLS Andrea Pu ck (Palo Alto, CA) [email protected] ________________________________ _____________________________ Send questions or comments to: Rachel M. Woodard RN, BSN, RNC-OB Obstetric Nurse Specialist Iowa’s Statewide Perinatal Care Program University of Iowa Hospitals and Clinics Department of Pediatrics 200 Hawkins Drive Iowa City, Iowa 52241 Office: 319-356-1854 [email protected]

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