Women’s Medicine Crises
Obstetric and Gynaecological Emergencies 389(ii) Place hands higher on the chest wall, slightly above the centre of
the sternum when performing external cardiac compressions.
(iii) Effective external chest compression is more difficult due to
flared ribs, raised diaphragm, breast enlargement and inferior
vena caval compression.
(iv) Remember, defibrillation shocks are not a risk to the fetus.3 Modifications to advanced life support (ALS):
(i) Hypoxaemia is common due to reduced functional residual
capacity and increased oxygen demand.
(ii) Intubation is more difficult during pregnancy secondary to some
of the physical factors outlined in (2) (iii) above
(a) be prepared to use an endotracheal tube that is 0.5–1.0 mm
smaller in diameter than expected, as the airway may be
narrower secondary to laryngeal oedema.
(iii) Do not use the femoral veins for venous access. Drugs
administered via this route may not reach the maternal heart
until after the fetus has been delivered.
(iv) Continue to use all the usual recommended resuscitation
procedures and drugs for circulatory support.
4 Consider immediate caesarean section if the resuscitation is not rapidly
successful, having called the obstetric and paediatric teams on the arrival of
the patient.
(i) Ideally, surgical intervention should be within 5 min of cardiac
arrest for optimum maternal and neonatal survival.
(ii) Continue cardiopulmonary resuscitation throughout the
procedure and afterwards until a stable rhythm with a sustained
cardiac output is obtained.
WOMEN’S MEDICINE CRISES
Post-coital contraception
Occasionally, patients present for emergency contraceptive measures after
unprotected intercourse. There are two possibilities:
1 Intrauterine contraceptive device (IUCD)
(i) A copper device may be used up to 5 days after unprotected
intercourse and is more effective than hormonal methods of
emergency contraception.
(ii) Test for sexually transmitted diseases on IUCD insertion and
consider a single dose of azithromycin 1 g orally prophylactically
in the casual sexual encounter, if the patient is worried.