Ch. 15 Anesthesia for Multiple Gestation and Breech

Question 1

T/F: multiple gestation pregnancies are becoming more common

Answer 1

true

Question 2

what high-risk complications are associated with multiple gestation delivery? (3)

Answer 2

• c-section delivery
• preterm birth
• obstetric conditions (ex. preeclampsia)

Question 3

CP: MTP is useful for post-partum hemorrhage and practice drills improve implementation of MTPs and institution-specific strategies.

Answer 3

.

Question 4

CP: fetal surgery isn’t performed everywhere. special training and multidisciplinary protocols may be required for institution-specific strategies.

Answer 4

.

Question 5

what is associated with a rise in maternal mortality?

Answer 5

multiple gestation pregnancies and the maternal morbidities that come with them

Question 6

T/F: twins should be delivered in the OR or have an anesthesia provider in the birthing suite

Answer 6

false - no specific recommendations for this

but, anesthesia providers attending twin deliveries should be prepared for possible emergency transfer to the OR

Question 7

three indications when c-section is prefered over vaginal delivery

Answer 7

• second vertex twin delivery in cephalic disproportion
• fetal bradycardia
• cord prolapse

Question 8

CP: with breech presentation, emergency induction and GA may be required at any point during fetal extraction.
Preparation for IV drugs, maternal hemorrhage from lacerations, or uterine atony should be considered prior to delivery.

Answer 8

.

Question 9

major anesthetic consideration for a woman attempting to vaginally deliver a breech presentation baby

Answer 9

mom should receive early labor epidural analgesia

• vaginal breech delivery is rare

Question 10

what should be readily available in the labor suite for women attempting a vaginal breech delivery?

Answer 10

• uterine relaxation agents

- “can facilitate delivery of the after-coming head” ???

Question 11

women presenting with umbilical cord prolapse may require what type of anesthesia intervention?

Answer 11

immediate c-section under GA with RSI

Question 12

CP: an antenatal assessment for a woman presenting with umbilical cord prolapse must include consideration of equipment for safe airway management - even if v brief assessment

Answer 12

.

Question 13

AGOG recommendations regarding ECV

Answer 13

they should be performed in an area where facilities for c-section can be readily accessed

*does not have to be in OR

Question 14

neuraxial technique that is useful due to versatile ability whether c-section or vaginal delivery if ECV is successful

Answer 14

CSE

Question 15

what complication should be anticipated in mothers delivering multiples?

Answer 15

post-partum hemorrhage

Question 16

majority of twins deliver before what age gestation?

Answer 16

before 37 weeks

Question 17

multiple gestation is associated with what two fetal conditions that may impact delivery route?

Answer 17

• fetal malpresentation

- congenital anomalies

Question 18

what is the prevalent delivery mode for breech presentation?

Answer 18

c-section

Question 19

perinatal mortality risk with vaginal delivery is significantly increased with what fetal malpresentation?

Answer 19

breech