Maternal collapse includes a variety of acute life threatening events involving maternal cardiorespiratory or central nervous systems. Maternal resuscitation follows standard Advanced Cardiac Life Support (ACLS) guidelines with a limited number of pregnancy-specific alterations. The primary variation from non-pregnancy guidelines is the requirement to displace the gravid uterus laterally to increase cardiac output. Cardiac output during closed chest massage in cardiopulmonary resuscitation (CPR) is approximately 30% of normal. Traditionally, displacement of the gravid uterus has been done by maternal tilt from 15° to 30° to facilitate increased venous return and cardiac output. Immediate awareness of the need to perform perimortem cesarean delivery 4 minutes after persistent cardiopulmonary arrest and the availability of an emergency kit for surgery can result in faster delivery of the baby, faster return of the maternal circulation, and better clinical outcomes for both mother and child.

This chapter discusses the maternal and fetal implications, diagnostic signs, and management strategies for amniotic fluid embolus (AFE). Pulmonary oedema, acute respiratory distress syndrome, disseminated intravascular coagulopathy (DIC), pulmonary embolus, haemorrhage, right then let cardiac failure, cerebrovascular events, cardiorespiratory arrest, death are maternal implications of AFE. The first-line management involves resuscitation strategies. The main aim of early delivery is to facilitate and improve outcome of maternal resuscitation. The second-line management includes diagnosis and supportive care. The purpose of ICU is to monitor observations, maintain haemodynamic instability and reduce iatrogenic and disease complications. Options of treatment include diuretics, inotropes and steroids. Plasma exchange, haemofiltration and extracorporeal membrane oxygenation have been used in treatment. Regular fire drills involving maternal collapse on the labour ward can ensure that a robust system is in place for the acute management of AFE.

Maternal collapse is an acute life-threatening event where the mother becomes unconscious due to cardiorespiratory or neurological compromise at any stage in pregnancy or up to 6 weeks postpartum. During resuscitation, aortocaval compression reduces cardiac output during chest compression. The risk of aspiration during resuscitation is increased due to a more relaxed lower oesophageal sphincter muscle and elevated gastric acid volume production. Amniotic fluid embolism (AFE) can also lead to fetal collapse of unknown origin that precedes maternal collapse. Uncontrolled hypertension can lead to intracranial haemorrhage. Typical clinical signs are severe, never-experienced headache preceding maternal collapse. Hypervolaemia, hypoxia, hyperkalaemia/metabolic disorders, hypothermia, thromboembolism, toxicity, cardiac tamponade, tension pneumothorax are some of reversible causes for maternal cardiac arrest. A cardiac arrest trolley and defibrillator, including wedge for left lateral tilt should be available on all maternity units and checked daily.