Assessment and Consent

Question 1

Which patients are considered high-risk for anaesthesia?

Answer 1

• patients with pre-existing illness which affects or is affected by the pregnancy (eg diabetics/Jehovah’s witnesses)
• patients that develop obstetric complications
• patients that may be complicated to anaesthetise for other reasons
• physiological and hormonal changes that occur in pregnancy may cause decompensation of a previously well-controlled illness

Question 2

What 4 complications cause concern for the anaesthetist in pregnancy and should be referred as early as possible for assessment?

Answer 2

• pre-eclampsia/eclampsia
  
  • due to hypertensive response to laryngoscopy and airway oedema
  • if platelet count <80 increased risk of spinal haematoma
• HELLP syndrome (low platelets/impaired clotting - can progress to liver failure)
• placenta previa
  
  • blood loss can be massive
• ante-partum haemorrhage
  
  • placental abruption
  • placenta previa
  • uterine rupture

Question 3

What is sodium citrate?

Answer 3

Oral non-particulate alkalinizing agent - raises pH for 20 mins.

Question 4

What are intra-uterine fetal resuscitation measures?

Answer 4

• stop augmentation of labour if in progress
• high flow O2 via non-rebreathing mask
• turn mother into full left lateral to relieve aorto-caval compression
• give fluid bolus of 1L IV fluid
• implement tocolysis (stop contractions)

Question 5

What do you do with a patient with spina bifida in pregnancy?

Answer 5

• MRI for cutaneous or neurological manifestations of spina bifida incase of spinal cord tethering
• document any existing neurological abnormality in the lower limbs
• risk of nerve damage is higher than average
• discuss with senior colleague
• may need to speak to neurology team

Question 6

What should you do for a pregnant woman in active labour with a compromised fetus in need of urgent delivery?

Answer 6

• institute IUFR measures to improve O2 delivery to fetus
• give antacid prophylaxis
• call for senior help

Question 7

When should ranitidine be given in an elective LSCS?

Answer 7

Ranitidine 150mg the evening before and on the morning of.

Question 8

Is the birth plan an advance decision?

Answer 8

Yes, but it can be changed at any time.