THE PRESSURE IS ON
Pathogenesis of preeclampsia
Impaired angiogenesis of spiral arteries (terminal branches of the uterine artery), leading to placental ischemia and release of antiangiogenic factors to maternal circulation, leading to systemic endothelial dysfunction
Widespread endothelial dysfunction → vasospasm → ↑SVR and capillary leak → relative intravascular depletion.
The most common cause of postpartum hemorrhage
What is uterine atony
AFE should be suspected when this triad appears during labor or delivery
What is hypoxia, hypotension, and coagulopathy?
Before starting chest compressions in a patient in late pregnancy, it’s important to do this maneuver
what is manual left uterine displacement?
xTeaching Point: Aortocaval compression decreases venous return; manual displacement is faster than tilting the table.
Reflexes are typically absent when the magnesium serum level reaches this range
8-10
Rapid IV bolus of this drug can cause hypotension during anesthesia, requiring careful titration
What is oxytocin?
Teaching Point: Oxytocin bolus → systemic vasodilation → hypotension; slow infusion or small boluses reduce risk.
The definitive management principle for AFE can be summarized as this two-word phrase.
supportive care
Defibrillation in pregnancy should be performed using these settings
standard adult energy levels, pads placed as usual
Rapid lowering of BP below this threshold can compromise uteroplacental perfusion, risking fetal hypoxia
140/90
as redefined by ACOG in 2017, this is the volume of blood loss during delivery (both vaginal and cesarean that is defined as Postpartum Hemorrhage
1,000 mL or more within 24 hours of delivery
In the differential diagnosis of intraoperative cardiovascular collapse, AFE can be distinguished from anaphylaxis by this key difference
Consumptive coagulopathy or DIC
During a maternal code, epinephrine should be given at this dose and frequency.”
What is 1 mg IV every 3–5 minutes?
💬 Teaching Point: Same as standard ACLS—do not reduce dose for pregnancy.
Despite being intravascularly depleted, preeclamptic patients are prone to pulmonary edema after fluid boluses because of this vascular phenomenon
What is increased capillary permeability?
This laboratory value falls first in postpartum hemorrhage and predicts severity in hemorrhage
What is fibrinogen?
Fibrinogen <200 mg/dL signals severe hemorrhage; early replacement improves hemostasis.
This early hemodynamic event in AFE explains why patients first present with sudden hypoxia and cardiovascular collapse.
What is acute pulmonary vasoconstriction leading to right ventricular failure?
Teaching Point:
The pulmonary vasospasm → ↑PVR → ↓LV preload → ↓CO → hypotension and hypoxia; later, LV dysfunction may follow from myocardial depression and hypoxia.
This is the time goal to initiate perimortem cesarean after maternal cardiac arrest
What is within 4 minutes of arrest?
💬 Teaching Point: Aim for delivery by 5 minutes—improves maternal venous return and oxygenati
Neuraxial anesthesia contraindication in severe preeclampsia
Platelets <70,000 or active DIC
This antifibrinolytic medication reduces mortality from postpartum hemorrhage if given within 3 hours of bleeding onset.
Tranexamic acid (TXA)
During an AFE arrest, TEE reveals this distinctive pattern of cardiac dysfunction that guides hemodynamic management.
What is acute right ventricular dilation with underfilled left ventricle?
Teaching Pearl:
TEE confirms the diagnosis and distinguishes RV failure from LV collapse — guide therapy toward RV unloading
Name two anesthetic complications that can directly cause maternal cardiac arrest on L&D
What are high spinal block and local anesthetic toxicity (LAST)?
💬 Teaching Point: Recognize early—bradycardia, apnea, and hypotension can precede arrest