Managing Medical and Obstetric Emergencies and Trauma

This manual is a goldmine of information concerning the pathophysiology and management of emergencies concerning the pregnant (or recently pregnant) woman. It is practical, with useful tips and algorithms, as well as giving depth of knowledge with logical explanations to aid understanding. Whilst it forms part of the mMOET pre‐course reading it also stands alone as an excellent text for all clinicians practicing in this specialty.

Don’t be unprepared: read, learn, practice and teach what is here, expect the unexpected, and you will keep women and their babies safe.

Sara Paterson‐Brown FRCS FRCOG

We have the honour of participating in the miracle of birth and sharing the experiences of families worldwide, but with that honour comes the responsibility of keeping our women and babies safe.

MOET was the brainchild of passionate Obstetricians and Anaesthetists who recognised that, whilst our specialty is very rewarding, it carries high risk for some of our women. By training and studying together, we can improve our practice and their outcomes. Since 1997, through MOET, we have trained over 8380 clinicians and we have around 720 instructors. We have shared our approach worldwide by taking the course overseas to Liberia, Switzerland, Australia, the Netherlands and Iran, to name but a few.

Over the last 24 years, the course has naturally evolved, as has our specialty. In recognition of this, acknowledging the recent national changes in trauma management, as well as the increasing number of medical complexities that we are all seeing in our local units, MOET wanted to change too. By developing the trauma aspect and maternal medicine content, we hope to improve care delivered by Obstetricians and Anaesthetists working on the front line with our Midwifery colleagues.

Teaching around pre‐eclampsia and haemorrhage has been prioritised over the last few decades and maternal death from these causes has fallen accordingly. Now we need to address the new medical complications and emergencies that we are all experiencing in our day‐to‐day working lives. Recent MBRRACE‐UK reports reveal that cardiac disease, thromboembolism and neurological disease are now the three leading causes of maternal deaths. Subsequently, MOET became mMOET to acknowledge that we are ‘Managing Medical and Obstetric Emergencies and Trauma’ and to address these challenges.

We have worked with our colleagues in the emergency services and thoroughly rejuvenated the trauma content of the course. Being called to your ED in the middle of the night to a pregnant trauma victim can be daunting. We hope that this manual will help prepare you, to understand what your role is within the attending Trauma team and give you the confidence to acknowledge how you can contribute to the vital emergency care that the patient requires with your very specialised knowledge. If we can help give you the tools needed to address the next emergency you have to tackle, then we will have achieved what we set out to do.

To all the current and future generations of Obstetricians and Anaesthetists, we hope this manual and the mMOET course will inspire you to keep learning, to do your very best in some of the most difficult situations and to give our women and their babies the highest quality of care.

Kara Dent and Rosamunde BurnsMay 2022

A great many people have put a lot of hard work into the production of this book and the accompanying course. The editors would like to thank all the contributors for their efforts and all the mMOET providers and instructors who took the time to send their comments during the development of the text and the course.

Some of the material used in this text is from other Advanced Life Support Group (ALSG) publications, in particular from the books Advanced Paediatric Life Support: The Practical Approach , Neonatal, Adult and Paediatric Safe Transfer and Retrieval: The Practical Approach and Major Incident Medical Management and Support: The Practical Approach in the Hospital .

The chapters on resuscitation have been informed by the new international guidelines produced by an evidence‐based process from the collaboration of many international experts under the umbrella of the International Liaison Committee on Resuscitation (ILCOR, 2020).

We would also like to thank members of our mMOET Trauma Review Group for all of their work in reviewing and updating the trauma section:

We would like to thank Catherine Giaquinto for the algorithm design, and Helen Carruthers and Kate Wieteska for their work on many of the line drawings within the text. We would also like to thank the following organisations for the shared use of their figures, tables and algorithms:

Alma Medical

American Journal of Obstetrics and Gynecology

Arrow

Association of Anaesthetists

COBIS

Difficult Airway Society (DAS)

Freelance Surgical

MBRRACE‐UK

Northern Neonatal Network

Obstetric Anaesthetists’ Association (OAA)

Omega Healthcare

Resuscitation Council UK

Royal College of Physicians

Scottish Patient Safety Programme Maternity and Children Quality Improvement Programme

The American Civil Defense Association (TACDA)Victoria Health

VBM

Wiley

World Health Organization

We also thank the BMJ for the Trauma Timeline, Laura May for the TRAUMATIC mnemonic, Tim Nutbeam and Ron Daniels on behalf of the UK Sepsis Trust, and Gareth Owens on behalf of the ‘Think Aorta’ Campaign for kindly sharing their resources.

We would like to thank, in advance, those of you who will attend the Managing Medical Obstetric Emergencies and Trauma (mMOET) course and others using this text for your continued constructive comments regarding the future development of both the course and the manual.

ALSG: www.alsg.org

For details on ALSG courses visit the website or contact:

Advanced Life Support Group

ALSG Centre for Training and Development

29–31 Ellesmere Street

Swinton, Manchester

M27 0LA

Tel: +44 (0) 161 794 1999

Fax: +44 (0) 161 794 9111

Email: enquiries@alsg.org

The material contained within this book is updated on approximately a 4‐yearly cycle. However, practice may change in the interim period. We will post any changes on the ALSG website, so we advise you to visit the website regularly to check for updates (www.alsg.org).