Update Obstetric Anaesthesia

Caesarean section (LSCS) is one of the commonest operations performed in the developing world and is often carried out in difficult circumstances. As with any operation, the anaesthetist should first think about all the problems that may occur as it is always better to be prepared for trouble than to be taken by surprise.Anaesthesia for Caesarian Section – December 1, 1998

This article is based on our experience in a district hospital in Malawi where we transfused the patient’s own blood (autotransfusion) collected from the peritoneal cavity in 25 cases of ruptured ectopic pregnancy. All of them survived without adverse effects.Autologous Blood Transfusion in Ruptured Ectopic Pregnancy – June 1, 2003

Maternal physiology undergoes many changes during pregnancy. These changes, which are largely secondary to the effects of progesterone and oestrogen, begin as early as 4 weeks gestation and are progressive. In the first 12 weeks of pregnancy progesterone and oestrogen are produced predominately by the ovary and thereafter by the placenta. These changes both enable the fetus and placenta to grow and prepare the mother and baby for childbirth.Changes in Maternal Physiology During Pregnancy (Update 20) – June 1, 2005

Pre-eclampsia is a complex multi-system disorder that may sometimes precede eclampsia. The essential aspects of management are discussed with particular attention to the pharmacological management techniques available.Eclampsia and Preeclampsia – Pharmacological Management – June 1, 2006

This article presents modified basic and advanced life support algorithms for use in pregnant women suffering cardiac or respiratory arrest. The indications and timing for perimortem caesarian section are discussed.Emergency management of maternal collapse and arrest – December 1, 2009

Epidural anaesthesia is a central neuraxial block technique with many applications. Improvements in equipment, drugs and technique have made it a popular and versatile anaesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anaesthetic, as an analgesic adjuvant to general anaesthesia, and for postoperative analgesia in procedures involving the lower limbs, perineum, pelvis, abdomen and thorax. Epidural Anaesthesia – June 1, 2001

Assess the airway before induction of anaesthesia. Check all intubation equipment daily and be familiar with its use.
Position the patient correctly before induction. Remember that oxygenation is more important than intubation. Call for help early. Maternal welfare is paramount and takes priority over foetal considerations.Failed intubation in obstetrics – December 1, 2009

This article reviews the pathophysiology, diagnosis, terminology and anesthetic management of the compromised fetus.Foetal Compromise – June 1, 2006

Caesarean sections can be performed under general anaesthesia, regional anaesthesia or local infiltration. This article will consider only general anaesthesia: regional and local techniques are described in a subsequent articles.
General Anaesthesia for Caesarean Section – July 1, 2003

This term, used in the Reports on Confidential Enquiries into Maternal Deaths in the United Kingdom, covers the spectrum of disorders encompassing pre-eclampsia, eclampsia, and the syndrome of haemolysis, elevated liver enzymes and low platelets (HELLP). Acute fatty liver of pregnancy and other microangiopathies of pregnancy are related disorders that can arise simultaneously.Hypertensive Disorders of Pregnancy – December 1, 2003

This article proposes an algorithm guiding management of unanticipated high regional block in obsteric anaesthesia.Management of high regional block in obstetrics – December 1, 2009

This article is a case-based discussion of the management of patinets with severe pre-eclampsia and eclampsia. An algorithm for the administration of magnesium sulphate is included.Management of severe pre-eclampsia and eclampsia – December 1, 2009

This article contains an algorithm to guide management of obstetric patients with major haemorrhage. The algorithm is explained in detail.Managment of obstetric haemorrhage – December 1, 2009

Maternal collapse is a non-specific description that can be applied to a variety of medical conditions, ranging from a simple faint through to cardiac arrest. The clinical outcome is largely determined by the promptness of management of the collapse. The fetal outcome is directly related to the wellbeing of the mother.
Maternal collapse can occur from direct obstetric complications, indirectly from pre-existing medical conditions exaggerated by the pregnancy, or from conditions unrelated to the pregnancy.
Maternal Collapse and Perimortem Caesarian Section – December 1, 2007

Recommendations for monitoring during Caesarean section (CS) have been developed by the American Board of Anesthesiologists and the Obstetric Anaesthetists Association (OAA) in the UK. Not all anaesthetists have access to complex equipment, but every anaesthetist should be aware of the potential problems that may be encountered and make appropriate use of the monitors they do have. The requirements for regional and general anaesthetics are different and so considered separately. Monitoring During Caesarian Section – June 1, 2000

Hemorrhage is a leading cause of maternal mortality. It is the underlying cause in at least 25% of maternal deaths in the developing world. Clinical evaluation and management are discussed in detail.Obstetric Haemorrhage – June 1, 2006

Giving birth is a painful process. This applies to all social and ethnic groups and has probably been so since mankind walked upright. It is very difficult to measure pain which is recognised via the signals carried through the nervous system and the woman’s intellectual response to the stimulus.
Pain Relief in Labour – Review Article – June 1, 2004

Placental abruption is defined as separation of the placenta from the decidua basalis before delivery of the fetus. Bleeding occurs from the exposed decidual vessels, and may be extensive. However, because haemorrhage is often occult – with blood collecting around the placenta and fetus or in the myometrium and broad ligaments, the amount of blood lost is easily underestimated. Fetal distress occurs because of loss of area for maternal-fetal gas exchange. Abruption is an important cause of intrauterine growth retardation, premature labour and fetal death.Placental Abruption – June 1, 2002

PDPH has the potential to cause considerable morbidity and is a complication that should not to be treated lightly. PDPH is usually a self-limiting process. If left untreated, 75% resolve within the first week and 88% resolve by 6 weeks. PDPH continues to be a common morbidity despite several innovations in equipment and techniques used for spinal (subarachnoid) and epidural (extradural) anaesthesia.Post Dural Puncture Headache – June 1, 2008

Pre-eclampsia is a major cause of maternal mortality and morbidity, and fetal loss worldwide, but particularly in developing countries.
Anaesthetists may be required to assist with pain management in labour, to provide anaesthesia for Caesarean Section and to assist in the Intensive Care Management of life-threatening complications which may arise from this condition.
Preeclampsia – The Role of the Anaesthetist – December 1, 1998

Download – Pregnancy – Physiological Changes Physiological and anatomical alterations develop in many organ systems during the course of pregnancy and delivery. Early changes are due, in part, to the metabolic demands brought on by the fetus, placenta and uterus and to the increasing levels of pregnancy hormones. Later changes, starting in mid-pregnancy, are anatomical […]Pregnancy – Physiological Changes – December 1, 2008

This article reviews current best practice for delivery of safe anaesthesia for obstetric services. Many of the recommendations are based on standards set within the UK, and the vast majority of these are relevant to practice in any country around the world. Resource limitations may make adherence to some suggested practices impossible, but these are included for educational value.Recent Developments in Anaesthesia for Caesarian Section – June 1, 2007

The Resuscitation Council’s guidelines on neonatal life support are presented and discussed.A floppy baby is unconscious – a baby with good tone is not. Good airway management and effective rescue breaths are key to achieving oxygenation of fluid-filled lungs. Chest compressions and drug administration are rarely needed.
Resuscitation at birth – December 1, 2009

For most newborn babies a clear airway and a warm environment are all that is required. However, 25% of all deliveries are at increased risk of requiring resuscitation, and a further number of babies require resuscitation after a normal birth with no apparent risk factors. For these babies effective and efficient basic and advanced life support must be readily available.Resuscitation of the Newborn – June 1, 1994

The third stage of labour is delivery of the placenta. This is often overlooked because of excitement following the birth of the baby. The retroplacental myometrium must contract to allow the placenta to shear away from its bed and be expelled. Signs of separation are listed in the table below. Retained placenta complicates 2% of deliveries world-wide and is a significant cause of maternal mortality and morbidity. In the developing world the associated mortality approaches 10%. If retention does occur, prompt appropriate treatment can prove life saving.Retained Placenta – Anaesthetic Considerations – December 1, 2004

Spinal anaesthesia is induced by injecting small amounts of local anaesthetic into the cerebro-spinal fluid (CSF). The injection is usually made in the lumbar spine below the level at which the spinal cord ends (L2). Spinal anaesthesia is easy to perform and has the potential to provide excellent operating conditions for surgery below the umbilicus. Spinal Anaesthesia – a Practical Guide – December 1, 2000

Spinal anaesthesia has the advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anaesthetic. In the following article the factors that influence how the local anaesthetic spreads within the CSF, determining the extent of the block, are discussed. Spinal Anaesthesia – Assessment of Block – June 1, 2007

This article will detail the factors that determine how local anaesthetic spreads within the CSF, therefore determining the extent of the block.Spinal Anaesthetic Spread – December 1, 2007

Valvular heart disease in pregnancy poses additional risk to both mother and fetus. Although there is an ever-decreasing prevalence of rheumatic heart disease in developed nations, it is still occasionally encountered. In the developing world it remains a significant problem.The Pregnant Patient with Acquired Valvular Heart Disease – December 1, 2004

Despite recent studies which suggest that spinal anaesthesia may not be the safest option for the fetus when caesarean section is required, it has, for many years, been the preferred technique for the majority of anaesthetists. This is primarily due to the benefits conveyed to the mother. There are, however, a variety of complications and side effects associated with central neuraxial blockade in the pregnant patient, the commonest being maternal hypotension which is believed to occur in up to 95% of patients. How important is this, and what should we be doing to prevent it?Vasopressors For Subarachnoid Anaesthesia in Obstetrics – June 1, 2005