Managing acute collapse in pregnant women

Abstract

Keywords:acute collapse pulmonary embolism amniotic fluid embolism acute coronary syndrome mechanical prosthetic heart valves acute aortic dissection cerebrovascular incidents and anaesthetic complications failed intubation anaphylaxisThe most important causes of acute collapse in pregnancy are pulmonary embolism, amniotic fluid embolism, acute coronary syndrome, thrombosed mechanical prosthetic heart valves, acute aortic dissection, cerebrovascular incidents and anaesthetic complications like failed intubation, anaphylaxis, and problems relating to regional or local anaesthetic agents. The management is based on supporting the different organ systems that are affected. The diagnosis of pulmonary embolism is based on a clinical suspicion supported by certain diagnostic test. Tests like D-dimers have their limitations and cannot be used alone to exclude the diagnosis especially when there is a high clinical suspicion. The choice of the best diagnostic tool is based upon weighing longterm risks to both mother and foetus on the one side and delaying the diagnosis on the other side. The management of acute coronary syndrome is based on immediate angiography and percutaneous coronary intervention. Although there are reports of the use of clopidrogel in pregnancy, there are few data on its effect on the foetus. There is no clinical evidence for fibrinolytic therapy as a reperfusion strategy in pregnancy and it is best avoided as the risk of haemorrhage outweighs the possible benefit of treatment. Patients with a prosthetic heart valve that present with a disappearance of the prosthetic heart sounds or a new murmur should get an urgent cardiac ultrasound to rule out a thrombosed prosthetic valve. Anaesthesia-related causes are an increasing cause of maternal morbidity and mortality.

Anaphylaxis during pregnancy

“…1 Maternal cardiac arrest is potentially devastating to the fetus and mandates immediate cesarean delivery. 38,47 Although 90% of neonates delivered within 5 minutes are neurologically intact, fewer than 60% of those delivered within 15 minutes are likely to be neurologically intact.…”

“…They are also found in patients with myocardial infarction and amniotic fluid embolism (AFE), both of which need to be considered in the differential diagnosis of anaphylaxis during labor and delivery (Table IV). 1,4,10,31,[33][34][35][36][37][38][39][40][41][42][43][44] Moreover, total tryptase levels within the normal reference range of 1 to 11.4 ng/mL cannot be used to refute the clinical diagnosis of anaphylaxis because tryptase levels are seldom increased in patients with food-induced anaphylaxis or those in whom blood pressure remains normal during anaphylaxis. 10,32 During the first 3 trimesters, before labor and delivery, the differential diagnosis of anaphylaxis in pregnancy is similar to the differential diagnosis of anaphylaxis in nonpregnant patients.…”

“…4,31,[37][38][39][40][41][42][43][44] Laryngeal obstruction, a frequent and potentially life-threatening symptom of anaphylaxis, must be differentiated from laryngopathia gravidarum, particularly the acute form that occurs immediately before parturition in women with preeclampsia. 4 In patients with laryngopathia gravidarum, onset of laryngeal symptoms is typically slower than in those with anaphylaxis, and the correct diagnosis is supported by the presence of hypertension, peripheral edema, urinary abnormalities, or a history of preeclampsia.…”

Spontaneous Acute Aortic Dissection in Pregnancy

“…2 When one considers occurrence of the dissecting process in women younger than 40 years, apart from Turner syndrome, 5 one must remember that AAD is a rare, although not unheard of, complication of pregnancy, which at times is responsible for acute cardiovascular deterioration. 6 Half of all AADs in young women occur during pregnancy, an observation made by Schniter et al in 1944 3 ; this is often a result of the common risk factors, compounded by increasing maternal age, pregnancyinduced hypertension, and preeclampsia or eclampsia. 3 Our patient did not have grossly visible clinical features of the known risk factors.…”

Immediate postpartum cardiorespiratory collapse: a management quandary

“…The most important causes include pulmonary embolism and amniotic fluid embolism (AFE) [1]. The postpartum period carries the greatest risk for pulmonary embolism along with AFE account for the commonest cause of direct maternal deaths [1,2]. In Malaysia, pulmonary embolism accounts for 16.6% of all maternal deaths [3].…”