1.9 Non-Obstetric Surgery in Pregnancy

Question 1

Complications for 26 week

Answer 1

Maternal:

Consequences of pregnancy - modify maternal physiology

GA response diff:

CNS:
Sensitivity to opiates and volatiles
Probability delayed recovery

Resp:
Displacement diaphragm
Less FRC + increase O2 consumption
Faster desat on induction

Increased incidence failed ETT

GI
CVS
MSK
HAEM

Question 2

Maternal complications continued

Answer 2

GI:
Probabilty aspiration:
Relax LOS
delayed gastric empyting

CVS:
Aortocaval compression
drop in VR
= hypotension

MSK:
Ligament laxity - Progesterone
Joint hyperextension

Haem:
Increased clotting factors peri and post op thrombosis

Question 3

Risks Fetal

Answer 3

1. Miscarriage - 1.4-5.9% during 2/3
   No discrim in site of surgery and risk elevation
2. Prem Labour
   22/40 increase risk
   Risks w/ Abdo and pelvic surgery

Question 4

Anaesthetic options

Answer 4

1, Postponement if at all possible all elective surgery during pregnancy

2. Perform operation with obs services:
   aware of patient
   ?perio FHR and CTG w/ trained person to interpret
3. Discuss prem labour patient
   aware risks
4. Consult obs team
   ?Steroid fetal mate
5. Senior surgical and anaes present -
   Limit duration surgery

Question 5

Anaesthetic options

Answer 5

6. Drugs safe to use in pregnancy
   - NSAIDs avoid
7. Concern over airway
   ?AFOI
   avoid cocaine for topicilisation nose
8. RSI
9. Left lateral tilt - aortocaval compression
10. Avoid nose: temp and NG
    High risk epistaxis vessel engorgement / congestion

Question 6

Anaesthetic options

Answer 6

11. Ventilate to normal EtCO2 for preg
    4kPa
    Increase TV and not RR
    Consider PEEP
12. Aim to maintain placental perfusion
    Strict BP control periop
13. Laparoscopic surgery planned:
    A line - accurate monitoring BP PaCO2
    Limit pressure in pneumoperitoneum <15
14. Ensure prophylactic prevention VTE
    Calf compressors / stockings
    Post op prevention - hydration physio and anticoag