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O&G CasesIntrapartum care — obstetric emergencies

O&G Cases · Intrapartum care — obstetric emergencies

Collapse in second stage — amniotic fluid embolism resuscitation station

Timed team-based resuscitation station: intrapartum collapse from amniotic fluid embolism. Tests declared leadership, pregnancy-modified CPR, the four-minute hysterotomy commitment, right-ventricular-protective haemodynamic support, product-targeted correction of consumptive coagulopathy, and breaking catastrophic news. Includes a minute-by-minute assessor timeline, marking domains, assessor key and fail criteria.

resus5 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 33-year-old G2P1 at 39+6 weeks is pushing in the second stage after induction for post-dates. She suddenly says she cannot breathe and that something is terribly wrong, then becomes unresponsive. Peripheral oxygen saturation is 71%, blood pressure unrecordable, and the fetal heart rate falls to 55 bpm. You are the obstetric registrar; the consultant is 20 minutes away and has been called. A midwife, a student midwife and an anaesthetic registrar are with you.

Station brief

Format. Emergency resuscitation station, 12 minutes, run against a clock. You are the obstetric registrar in a labour room. The assessor runs the timeline, plays the anaesthetic registrar and feeds you new observations at fixed intervals. [2][4]

Candidate instruction. Lead the resuscitation of a woman who has collapsed in the second stage of labour. Verbalise every action, every drug order with its dose, every escalation trigger, and every communication with your team and the family. You will be marked on leadership behaviour as well as clinical content. [2][4]

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References8ShowHide
  1. [1]Pacheco LD, Saade G, Hankins GD, Clark SL Amniotic fluid embolism: diagnosis and management Am J Obstet Gynecol, 2016.PMID 26987420
  2. [2]Combs CA, Montgomery DM, Toner LE, Dildy GA Society for Maternal-Fetal Medicine Special Statement: Checklist for initial management of amniotic fluid embolism Am J Obstet Gynecol, 2021.PMID 33417901
  3. [3]Pacheco LD, Clark SL, Klassen M, Hankins GDV Amniotic fluid embolism: principles of early clinical management Am J Obstet Gynecol, 2020.PMID 31376394
  4. [4]Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26443610
  5. [5]Erez O, Mastrolia SA, Thachil J Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management Am J Obstet Gynecol, 2015.PMID 25840271
  6. [6]Leighton BL, Wall MH, Lockhart EM, Phillips LE, Zatta AJ Use of recombinant factor VIIa in patients with amniotic fluid embolism: a systematic review of case reports Anesthesiology, 2011.PMID 21720243
  7. [7]Katz VL, Dotters DJ, Droegemueller W Perimortem cesarean delivery Obstet Gynecol, 1986.PMID 3528956
  8. [8]Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study BJOG, 2016.PMID 25683758
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