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O&G CasesCritical care — maternal resuscitation

O&G Cases · Critical care — maternal resuscitation

Collapse on the postnatal ward — maternal resuscitation station

Timed team-based resuscitation station: undifferentiated maternal collapse at 26 weeks with two competing iatrogenic causes. Tests declared leadership, the pregnancy-adapted four H and four T search, CPR modifications, antidote selection with doses, the fundal-height hysterotomy decision, and family communication. Includes a minute-by-minute assessor timeline, marking domains, assessor key and fail criteria.

resus6 min readVerification in progress

Target exams

FRANZCOGMRCOGABOG
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Target exams

FRANZCOGMRCOGABOG
Prompt
A 39-year-old G3P3 is 26 weeks pregnant with a dichorionic twin pregnancy and has been admitted for pain relief after a fall. At 05:10 the midwife finds her unresponsive in bed, grey, with agonal breathing. She had a therapeutic epidural top-up 30 minutes ago for intractable symphyseal pain and is also receiving intravenous magnesium sulfate for suspected pre-eclampsia. You are the obstetric registrar, first doctor on the scene, with one midwife and a healthcare assistant.

Station brief

Format. Emergency resuscitation station, 12 minutes, run against a clock. You are the obstetric registrar and the first doctor on scene. The assessor runs the timeline, plays the arriving anaesthetist and feeds you observations and laboratory results at fixed intervals. [3][1]

Candidate instruction. Lead the resuscitation of a collapsed pregnant woman of uncertain cause. Verbalise every action, every drug with its dose and route, every escalation trigger and every piece of communication. Two iatrogenic causes are in the room; the assessor is watching whether you find them. [1][4]

Obstetrics & Gynaecology Pro

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References9ShowHide
  1. [1]Chu J, Johnston TA, Geoghegan J Maternal Collapse in Pregnancy and the Puerperium: Green-top Guideline No. 56 BJOG, 2020.PMID 31845507
  2. [2]Jeejeebhoy FM, Zelop CM, Lipman S, et al. Cardiac Arrest in Pregnancy: A Scientific Statement From the American Heart Association Circulation, 2015.PMID 26443610
  3. [3]Lipman S, Cohen S, Einav S, et al. The Society for Obstetric Anesthesia and Perinatology consensus statement on the management of cardiac arrest in pregnancy Anesth Analg, 2014.PMID 24781570
  4. [4]Neal JM, Neal EJ, Weinberg GL American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version Reg Anesth Pain Med, 2021.PMID 33148630
  5. [5]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
  6. [6]Enomoto N, Yamashita T, Furuta M, Tanaka H, Ng ESW, Matsunaga S, Sakurai A Effect of maternal positioning during cardiopulmonary resuscitation: a systematic review and meta-analyses BMC Pregnancy Childbirth, 2022.PMID 35216559
  7. [7]Beckett VA, Knight M, Sharpe P The CAPS Study: incidence, management and outcomes of cardiac arrest in pregnancy in the UK: a prospective, descriptive study BJOG, 2017.PMID 28233414
  8. [8]Katz VL, Dotters DJ, Droegemueller W Perimortem cesarean delivery Obstet Gynecol, 1986.PMID 3528956
  9. [9]Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances Resuscitation, 2021.PMID 33773826
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