Case of the Month #9 - pre-eclampsia

Published 03/02/2022

How do physiological and anatomical changes in pregnancy impact resuscitation?

  • Aortocaval compression 
    • From 20 weeks the gravid uterus reduces venous return in the supine position by up to 30-40% 
  • Respiratory  
    • Changes in lung function, diaphragmatic splinting, decreased Functional Residual Capacity and increased oxygen consumption make ventilation more difficult and hypoxia more rapid.  
  • Intubation 
    • Increased breast size, laryngeal odema and weight gain in pregnancy can make intubation more difficult. Along with an increased risk of aspiration due to a progesterone mediated decrease in Lower Oesophageal Sphincter tone and increased intra-abdominal pressure. 
  • Cardiovascular 
    • Increased plasma volume by up to 50% causes dilutional anaemia. Decreased Systemic Vascular Resistance and increased Heart Rate and Cardiac Output increases circulation demands. Uterine blood flow is approximately 10% of Cardiac Output at term resulting in potential for massive haemorrhage.  

This patient experienced a major placental abruption with associated severe concealed antepartum haemorrhage. She had risk factors including increasing age, smoking and pre-eclampsia. Following emergency delivery of the fetus to control bleeding she is taken to intensive care for ongoing management of hypovolaemic shock, coagulopathy and pre-eclampsia.