O&G

Question 1

[21B02] A patient is admitted to hospital following diagnosis of intrauterine fetal death at 35 weeks gestation. Discuss your considerations for the anaesthetic management of her labour and delivery.

IUFD

Answer 1

5-7/1000 deliveries
Causes:
Ante: malf, inf, APH, PET, DM
Intra: abruption, infection, prolapse, rupture

Placental
Cord
Infection
Uterus

1. Distressing
   - Quiet room, isolated
   - 1:1 midw care
2. Pain
   - Entonox
   - Parenteral opioids
   - Epidural (excl coag)
   - Other
3. Causing/timing
   - ?ix
   - ?genetic counselling
4. ? sepsis and coagulopathy
   - FBC/Coags/CHEM20/CRP
5. Mode
   - GA usually best option

Ex Report:
Distressing
Welfare
Multidisciplinary
Causes/timing
Sepsis and coag

Question 2

[20B06] A 30-year old woman at full term collapses in early labour and is unresponsive.
a) List the most likely cause of her collapse (30%)
b) A presumptive Dx of AFE is made. Describe the immediate and ongoing MNG of this patient (70%)
[09A08] Outline the features and clinical management of AFE

AFE

Answer 2

Causes of maternal collapse (early labour)
- common - vasovagal, high NA, LAST, haem, HTN
- uncommon - PE, AFE, uterine rup, cardiac, cerebral, anaphylaxis

V S L H H

AFE:

Ex report:
1. use of mag
2. BP monitoring/control
3. appropriate ix
4. mod GA - blunting resp to intubation, managing emergence/extu