Recognising an emergency in pregnancy

Causes of maternal cardiac arrest may include haemorrhage, pulmonary embolism, amniotic fluid embolism, placental abruption, eclampsia and drug toxicity. Physiological changes occur during pregnancy and these must be considered during an emergency.

• Gastric emptying is delayed after the first trimester of pregnancy and there may be an increased risk of pulmonary aspiration of gastric contents.

• Anatomical changes such as breast enlargement, obesity of the neck and glottic oedema may make airway management difficult. Also, in later stages of pregnancy, the diaphragm is splinted by a large uterus and higher than normal inflation pressures may be needed to achieve effective ventilation.

• Cardiovascular problems may occur because the uterus presses down against the inferior vena cava and reduces or blocks blood flow to the heart.

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