Obstetric Anaesthesia

2020 ◽  
Keyword(s):  
Maternal Obesity ◽  
Point Of Care ◽  
Neonatal Resuscitation ◽  
Neurological Complications ◽  
National Guidelines ◽  
Obstetric Anaesthesia ◽  
Reference Guide ◽  
Exam Preparation ◽  
Labour Ward ◽  
Anaesthetic Assessment

Starting work on the labour ward is very challenging for all junior anaesthetists. This handbook is an easily navigated practical reference guide for anaesthetists new to this environment, as well as other members of the labour ward multi-disciplinary team; midwives, obstetricians, and Consultant Anaesthetists who visit labour ward less frequently or only when on-call. It covers all aspects of obstetric anaesthesia that the trainee anaesthetist will encounter during their obstetric training module, and is essential reading for FRCA exam preparation. Since the first edition, there is no doubt that the pregnant population has become more complex, with increasing maternal age and BMI, and challenging co-morbidities presenting more frequently. As well as providing updates from recent MBRRACE reports and national guidelines, new techniques, drugs, and technology, such as point of care testing have been included. New chapters covering the application of ultrasound in obstetric anaesthesia, recognition of the sick and septic patient, maternal obesity and neonatal resuscitation have been introduced. Previous chapters, e.g. haemorrhage, have been extensively updated, with the latest management protocols and algorithms based on recent published research in obstetric bleeding. We have retained our practical guides to performing, managing, and trouble-shooting regional techniques that are more problematic on labour ward, and our extensive A–Z of rarer conditions has updated references. More conventional chapters on maternal physiology and pathophysiology provide readers with essential examination material. The importance of anticipating risk in the antenatal period through high risk anaesthetic assessment clinics and postpartum management of tricky neurological complications is also well covered.

Oxford Handbook of Midwifery

2017 ◽  
Keyword(s):  
Royal College ◽  
Care Pathway ◽  
Multidisciplinary Care ◽  
National Guidelines ◽  
Reference Guide ◽  
Uterine Inversion ◽  
Independent Prescribing ◽  
Cochrane Database ◽  
The Uk ◽  
Guidelines And Recommendations

The third edition of the popular Oxford Handbook of Midwifery has been extensively revised using the latest evidence-based guidelines and national recommendations. Continuing to give a complete picture of the role of the midwife in multidisciplinary care for childbearing women, the handbook reflects the mother's journey through pregnancy, birth, and beyond, with care of the newborn, newborn feeding, and postnatal care in a precise and logical approach. Three newly configured chapters on infections and sepsis, obesity, and hypertensive disorders of pregnancy are offered to help readers find information in one location. There are new mini-sections on independent prescribing, fetal programing, uterine inversion and uterine rupture, the introduction of doulas into the care pathway, and breast feeding innovations such as breast crawl. Included are updated resources and national guidelines and recommendations from trusted bodies such as the National Institute for Health and Care Excellence, the Royal College of Midwives, and the Royal College of Obstetricians and Gynaecologists, along with relevant Cochrane database evidence. The midwife’s changing role in contributing to women's health and public health issues is acknowledged and lastly there is notice of the impending changes to midwifery regulation in the UK. The book is presented in an easily readable style with clear headings and key facts delivered in bullet points. The book is intended for students, practising midwives, educators, and anyone who needs a handy quick reference guide to aid their contribution to maternity care.

scholarly journals Pragmatic multicentre randomised controlled trial evaluating the impact of a routine molecular point-of-care ‘test-and-treat’ strategy for influenza in adults hospitalised with acute respiratory illness (FluPOC): trial protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031674 ◽  
Author(s):  
Kate Beard ◽  
Nathan Brendish ◽  
Ahalya Malachira ◽  
Samuel Mills ◽  
Cathleen Chan ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Point Of Care ◽  
Controlled Trial ◽  
Clinical Care ◽  
Respiratory Illness ◽  
Acute Respiratory Illness ◽  
National Guidelines ◽  
South Central ◽  
Randomised Controlled ◽  
The Impact

BackgroundInfluenza infections often remain undiagnosed in patients admitted to hospital due to lack of routine testing. When tested for, the diagnosis and treatment of influenza are often delayed due to the slow turnaround times of centralised laboratory PCR testing. Newer molecular systems, have comparable accuracy to laboratory PCR testing, and can generate a result in under 1 hour, making them potentially deployable as point-of-care tests (POCTs). High-quality evidence for the impact of routine POCT for influenza on clinical outcomes is, however, currently lacking. This large pragmatic multicentre randomised controlled trial aims to address this evidence gap.Methods and analysisThe FluPOC trial is a pragmatic, multicentre, randomised controlled trial evaluating adults admitted to a large teaching hospital and a district general hospital with an acute respiratory illness, during influenza season and defined by Public Health England. Up to 840 patients will be recruited over up to three influenza seasons, and randomised (1:1) to receive either POCT using the FilmArray respiratory panel, or routine clinical care. Clinical and infection control teams will be informed of the results in real time and where influenza is detected clinical teams will be encouraged to offer neuraminidase inhibitor (NAI) treatment in accordance with national guidelines. Those allocated to standard clinical care will have a swab taken for later analysis to allow assessment of missed diagnoses. The outcomes assessment will be by retrospective case note analysis. The outcome measures include the proportion of influenza-positive patients detected and appropriately treated with NAIs, isolation facility use, antibiotic use, length of hospital stay, complications and mortality.Ethics and disseminationPrior to commencing the study, approval was obtained from the South Central Hampshire A Ethics Committee (reference 17/SC/0368, granted 7 September 2017). Results generated from this protocol will be published in peer-reviewed scientific journals and presented at national and international conferences.Trial registration numberISRCTN17197293

Thinking about obstetric anaesthesia

2020 ◽  
pp. 1-28
Author(s):  
Rachel Collis
Keyword(s):  
The Other ◽  
High Quality ◽  
Obstetric Anaesthesia ◽  
Efficient Management ◽  
English Speaking ◽  
Labour Ward ◽  
New Challenges ◽  
Obstetric Anaesthetist ◽  
Difficult Situations ◽  
High Quality Service

The labour ward can be a stressful and demanding experience for all anaesthetists, junior and senior alike. Therefore, starting to working on a labour ward presents a number of new challenges to the novice obstetric anaesthetist, in an environment which many may not have spent any time visiting or working within since medical school. A helpful A–Z of survival is set out, where although no point is more important than the other, it is a useful tool to guide you through your first weeks or months. The chapter also offers resources to help with non-English speaking mothers and suggested advice of how to deal with difficult situations or behaviour. The principles of conducting audit, research and quality improvement work, which are an integral part of improving service delivery and facilitating efficient management of a high quality service, are also described.

Anaesthetics

2019 ◽  
pp. 165-176
Keyword(s):  
Anaesthetic Machine ◽  
World Health ◽  
General Anaesthetic ◽  
Airway Control ◽  
Obstetric Anaesthesia ◽  
Anaesthetic Agents ◽  
Mallampati Score ◽  
The World ◽  
Anaesthetic Assessment ◽  
Health Organization

Anaesthesia is the field of medicine specializing in modifications of sensation or awareness, in particular in the setting of surgery and labour. Anaesthesia can be general, regional, or local. The chapter outlines preoperative anaesthetic assessment including the Mallampati score, fasting history, medication review, and risk stratification. Anaesthetic agents (inhaled/intravenous) are summarized, as well as the functions (and safety checks) of the anaesthetic machine. A standardized approach to the general anaesthetic is described including induction, airway control, intubation, maintenance, and emergence. An overview of regional and obstetric anaesthesia is also included, in addition to the principles of safe administration of local anaesthesia. The World Health Organization pain ladder is also described. Critical incidents and anaesthetic emergencies (the difficult airway, anaphylaxis, malignant hyperthermia) are explained.

scholarly journals Identifying ‘at risk’ women and the impact of maternal obesity on National Health Service maternity services

2011 ◽  
Vol 70 (4) ◽  
pp. 439-449 ◽  
Author(s):  
Nicola Heslehurst
Keyword(s):  
Maternal Obesity ◽  
Perinatal Care ◽  
Epidemiological Data ◽  
Health Concern ◽  
Individual Choice ◽  
National Guidelines ◽  
Maternity Services ◽  
Published Evidence ◽  
Increased Risk ◽  
The Impact

Obesity is a public health concern worldwide, arising from multifaceted and complex causes that relate to individual choice and lifestyle, and the influences of wider society. In addition to a long-standing focus on both childhood and adult obesity, there has been more recent concern relating to maternal obesity. This review explores the published evidence relating to maternal obesity incidence and associated inequalities, the impact of obesity on maternity services, and associated guidelines. Epidemiological data comprising three national maternal obesity datasets within the UK have identified a significant increase in maternal obesity in recent years, and reflect broad socio-demographic inequalities particularly deprivation, ethnicity and unemployment. Obese pregnancies present increased risk of complications that require more resource intensive antenatal and perinatal care, such as caesarean deliveries, gestational diabetes, haemorrhage, infections and congenital anomalies. Healthcare professionals also face difficulties when managing the care of women in pregnancy as obesity is an emotive and stigmatising topic. There is a lack of good-quality evidence for effective interventions to tackle maternal obesity. Recently published national guidelines for the clinical management and weight management of maternal obesity offer advice for professionals, but acknowledge the limitations of the evidence base. The consequence of these difficulties is an absence of support services available for women. Further evaluative research is thus required to assess the effectiveness of interventions with women before, during and after pregnancy. Qualitative work with women will also be needed to help inform the development of more sensitive risk communication and women-centred services.

scholarly journals Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
I. P. L. Houben ◽  
C. J. L. Y. van Berlo ◽  
O. Bekers ◽  
E. C. Nijssen ◽  
M. B. I. Lobbes ◽  
...  
Keyword(s):  
Potential Risk ◽  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Venous Blood ◽  
National Guidelines ◽  
Contrast Induced Nephropathy ◽  
Risk Patients ◽  
Finger Stick ◽  
Media Delivery

Purpose. To evaluate whether a handheld point-of-care (POC) device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN) prior to iodine-based contrast media delivery. Methods and Materials. Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM) with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT) and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. Results. A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m2, necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%), leading to (at that stage) unwanted contrast administration. Two patients subsequently developed CIN after 2–5 days, which was self-limiting after 30 days. Conclusion. The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.

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