Obstetric anaesthesia and analgesia

2021 ◽  
pp. 837-898
Author(s):  
James Eldridge ◽  
Nicola Cox ◽  
Alisha Allana ◽  
Heidi Lightfoot
Keyword(s):  
Pregnant Patient ◽  
Anaesthetic Management ◽  
Labour Analgesia ◽  
Failed Intubation ◽  
Obstetric Anaesthesia ◽  
Obstetric Haemorrhage ◽  
Elevated Liver Enzymes ◽  
Maternal Sepsis ◽  
Obstetric Surgery ◽  
In Pregnancy

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications, such as post dural puncture headache (PDPH). It describes anaesthesia for Caesarean section (both regional and general); failed intubation; antacid prophylaxis; postoperative analgesia; retained placenta; in utero fetal death; hypertensive disease of pregnancy (pre-eclampsia, eclampsia and the hypertension, elevated liver enzymes and low platelets (HELLP) syndrome); massive obstetric haemorrhage; placenta praevia and morbidly adherent placenta (placenta accreta, increta and percreta); amniotic fluid embolism (AFE); maternal sepsis, and maternal resuscitation. It discusses comorbidity in pregnancy such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breast-feeding.

Obstetric anaesthesia and analgesia

2018 ◽  
Author(s):  
James Eldridge ◽  
Maq Jaffer
Keyword(s):  
Pregnant Patient ◽  
Anaesthetic Management ◽  
Labour Analgesia ◽  
Obstetric Anaesthesia ◽  
Obstetric Haemorrhage ◽  
Elevated Liver Enzymes ◽  
Co Morbidity ◽  
Maternal Sepsis ◽  
Obstetric Surgery ◽  
In Pregnancy

This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications such as post-dural puncture headache. It describes anaesthesia for Caesarean section (both regional and general), failed intubation, antacid prophylaxis, post-operative analgesia, retained placenta, in utero fetal death, hypertensive disease of pregnancy (pre-eclampsia, eclampsia, and the hypertension, elevated liver enzymes, and low platelets (HELLP) syndrome), massive obstetric haemorrhage, placenta praevia and morbidly adherent placenta (placenta accreta, increta, and percreta), amniotic fluid embolism, maternal sepsis, and maternal resuscitation. It discusses co-morbidity in pregnancy, such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breastfeeding.

Obstetrics and Gynaecology

2020 ◽  
pp. 157-196
Author(s):  
Rachel Collis ◽  
Rebecca Jones ◽  
Sarah O’Neill
Keyword(s):  
Caesarean Section ◽  
Neonatal Resuscitation ◽  
Pregnant Patient ◽  
Practical Advice ◽  
Low Resource Settings ◽  
Obstetric Anaesthesia ◽  
Low Resource ◽  
Obstetrics And Gynaecology ◽  
Obstetric Haemorrhage ◽  
Obstetric Surgery

In low-resource settings, obstetrics and gynaecology frequently forms a large part of the anaesthetist’s workload. The chapter serves both as an aide-memoire for those who are not regular practitioners in obstetric anaesthesia and as a guide to adapting your practice in low-resource settings. It contains practical advice on analgesia in labour and anaesthesia for Caesarean section, including spinal, general anaesthesia, and local anaesthesia techniques. It contains advice on drug alternatives in the absence of commonly used obstetric drugs, e.g. spinal bupivacaine. There are also sections on management of pre-eclampsia and obstetric haemorrhage, both of which are commonly encountered in low-resource settings. Neonatal resuscitation and non-obstetric surgery in the pregnant patient are also covered.

424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A168-A168
Author(s):  
Mihaela Bazalakova ◽  
Abigail Wiedmer ◽  
Lauren Rice ◽  
Sakshi Bajaj ◽  
Natalie Jacobson ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Gestational Age ◽  
Retrospective Chart Review ◽  
Pregnant Patient ◽  
Clinic Visit ◽  
Early Screening ◽  
Home Sleep Apnea Testing ◽  
Living Children ◽  
Apnea Testing ◽  
In Pregnancy

Abstract Introduction Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. Methods We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. Results The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing. Conclusion We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with >50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy. Support (if any) None

Evaluation of safety and foeto‐maternal outcome following non‐obstetric surgery in pregnancy: a retrospective single‐site Australian study

2021 ◽  
Vol 91 (4) ◽  
pp. 627-632
Author(s):  
Ho Nam Choi ◽  
Bertrand Ren Joon Ng ◽  
Yasser Arafat ◽  
Balapuwaduge A. S. Mendis ◽  
Anoj Dharmawardhane ◽  
...  
Keyword(s):  
Maternal Outcome ◽  
Single Site ◽  
Australian Study ◽  
Obstetric Surgery ◽  
In Pregnancy

Use of Magnesium Sulphate in the Anaesthetic Management of Pheochromocytoma in Pregnancy

1988 ◽  
Vol 8 (3) ◽  
pp. 149
Author(s):  
M. F.M. James ◽  
K. R.L. Huddle ◽  
A. D. Owen ◽  
B. W. Van der Veen
Keyword(s):  
Magnesium Sulphate ◽  
Anaesthetic Management ◽  
In Pregnancy

Aetiology and Use of Antibiotics in Pregnancy-Related Infections: Results of the WHO Global Maternal Sepsis Study (GLOSS), One-Week Inception Cohort

2021 ◽  
Author(s):  
Carolina C. Ribeiro-do-Valle ◽  
Mercedes Bonet ◽  
Vanessa Brizuela ◽  
Edgardo Abalos ◽  
Adama Baguiya ◽  
...  
Keyword(s):  
Inception Cohort ◽  
Maternal Sepsis ◽  
In Pregnancy

The Pregnant Surgical Patient

2015 ◽  
Author(s):  
Nina Tamirisa ◽  
Sami Kilic ◽  
Mostafa Borahay
Keyword(s):  
Critical Care ◽  
Abdominal Pain ◽  
Imaging Modality ◽  
Pregnant Patient ◽  
Surgical Patient ◽  
Changes In Pregnancy ◽  
Surgical Conditions ◽  
Laboratory Changes ◽  
In Pregnancy

The most vulnerable time for a fetus is during embryogenesis in the first 8 to 10 weeks of pregnancy, when women may be unaware of their pregnancy. Once pregnancy is established, a standard approach to the pregnant patient is the optimal way to ensure medical and surgical decisions are made within the context of maintaining the safety of both mother and fetus. This review describes the approach to the pregnant patient for surgical conditions within the context of physiologic changes of the patient and fetus at each trimester, anesthesia and critical care in pregnancy, imaging and drugs safe for use in pregnancy, and nongynecologic surgery in the pregnant patient and specific surgical conditions. Tables outline the classification of abortion, the assessment of pregnancy viability, physiologic changes in pregnancy, laboratory changes in pregnancy, imaging modality and radiation dose, and antibiotics and safety in pregnancy. Figures include a diagram of types of hysterectomy, respiratory changes in pregnancy, and enlargement of the uterus. Algorithms outline the approach to abdominal pain in the pregnant patient and diagnosis and management of ectopic pregnancy. This review contains 5 figures, 6 tables, and 85 references.

Rheumatology

2020 ◽  
pp. 263-306
Author(s):  
Charlotte Frise ◽  
Sally Collins
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Systemic Sclerosis ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Lupus Erythematosus ◽  
Pregnant Patient ◽  
Systemic Lupus ◽  
Musculoskeletal Problems ◽  
In Pregnancy

This chapter covers rheumatic diseases in the pregnant patient. It gives background, clinical features, and management in the pregnant patient for rheumatoid arthritis, Sjögren’s syndrome, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and ankylosing spondylitis among others. It also covers systemic sclerosis, osteoporosis, and other musculoskeletal problems. Medications and the use of biologics in pregnancy are also discussed, with reference to breastfeeding.

The Obstetric Patient for Cardiac Surgery

2019 ◽  
pp. 335-340
Author(s):  
Lauren Powlovich ◽  
Amanda M. Kleiman
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Disease ◽  
Medical Management ◽  
Heart Defects ◽  
Pregnant Patient ◽  
Developed Countries ◽  
Peripartum Hemorrhage ◽  
In Pregnancy

Cardiac disease is the second leading cause of morbidity and mortality in pregnancy behind peripartum hemorrhage. In developed countries, a majority of cardiac disease in pregnancy is secondary to congenital heart defects, whereas in developing countries, mitral stenosis secondary to rheumatic fever prevails as the leading cause of cardiac disease during pregnancy. There is added workload on the heart during pregnancy due to the increased blood volume and cardiac output of the parturient. In patients with preexisting cardiac disease, this added workload may lead to decompensated congestive heart failure. Alternatively, such physiologic changes may unmask an unknown cardiac lesion in an unsuspecting patient. Medical management is always the first-line treatment of the pregnant patient with decompensated heart failure. However, if medical management has failed, cardiac surgery with cardiopulmonary bypass may be necessary. Due to the unique maternal physiology and the presence of not only one but also two patients, anesthesia, cardiac surgery, and cardiopulmonary bypass come with specific challenges, hemodynamic goals, and ethical dilemmas.

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