Key Clinical Triad: Sudden onset of respiratory distress, cardiovascular collapse, and altered mental status during labor, delivery, or immediately postpartum. The classic presentation includes acute pulmonary edema with frothy pink sputum, severe hypotension unresponsive to fluids, and rapid progression to cardiac arrest.
Immediate Nursing Actions:
- Activate the obstetric emergency response team immediately upon suspicion.
- Administer high-flow oxygen via a non-rebreather mask to address severe hypoxia; prepare for rapid sequence intubation as respiratory failure is imminent.
- Position the patient in a left lateral tilt to relieve aortocaval compression and optimize venous return.
- Establish two large-bore intravenous lines for fluid resuscitation and vasopressor administration, typically per institutional massive transfusion protocol.
- Prepare for emergent cesarean delivery if the patient is undelivered, as delivery is critical to removing the antigenic source and facilitating maternal resuscitation.
Ongoing Monitoring and Support:
- Continuously monitor cardiac rhythm, blood pressure, oxygen saturation, and urine output. Insert a Foley catheter for accurate output measurement.
- Anticipate the development of disseminated intravascular coagulation (DIC) and massive hemorrhage; prepare blood products including packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelets.
- Monitor for signs of right heart failure and pulmonary hypertension, which drive the initial cardiovascular collapse.
- Provide emotional support to the patient and family, explaining interventions in clear, calm terms while maintaining a sense of urgency.
Post-Resuscitation Care: Transfer to an intensive care unit for continued hemodynamic support, mechanical ventilation management, and correction of coagulopathy. Neurological assessment is crucial due to the high risk of hypoxic brain injury.