Obstetric anaesthesia Flashcards
1
Q
Stages of labour?
A
- There are 3 stages
- First stage is from beginning of dilatation to complete dilatation
- The second stage is from complete dilatation to delivery
2
Q
First stage of labour?
A
- Affecting T10 - L1 segements
- Visceral pain
- Pain transmission via A-delta and C-fibres to the dorsal horn of the spinal cord.
3
Q
Second stage of labour?
A
- Foetal descent and delivery
- Pudendal nerve S2-S4
- Somatic pain at the perineum
4
Q
CS categories
A
I. Emergency - immediate threat to mother or foetus
II. Maternal or foetal compromise which is not immediately life threatening
III. Needing early delivery but no maternal or foetal compromise
IV. At a time to suit the woman and maternity team
5
Q
Pressors for low BP?
A
- Phenylephrine is preferred as an infusion
- Umbillical artery pH was higher in those treated with vasopressors
- Low dose norepinephrine could be used as well
6
Q
Prophylaxis for aspiration?
A
- Sodium citrate 0.3 M pH=8.4 - 30 mins prior
- H2 receptor anatagonists
3.
7
Q
Pre-eclampsia?
A
- SBP > 140 and DBP > 90 after 20wk of gestation
2. Proteinuria > 300mg/d
8
Q
Eclampsia ?
A
- Seizure present
9
Q
HELLP syndrome ?
A
- Haemolysis
- Elevated liver enzymes
- Low platelets
10
Q
Mx of pre-eclampsia?
A
- Labetalol 5-10mg IV
- Hydralazine 5mg IV
- Mg 4g IV loading dose
- About 1-3g/hr maintenance
- Therapeutic levels 4-6 mEq/L
11
Q
PPH?
A
- Considered if EBL > 500ml in 24 hrs
- Severe PPH > 1000ml
- Life threatening > 2.5L with signs of shock
12
Q
Risk factors for PPH?
A
- Multiple pregnancies
- H/O PPH
- Chorioamnionitis
- Episiotomy
- Pre-labout CS
- CS during labour
- Macrosomia
- Operative vaginal delivery
- Pregnancy induced HTN
13
Q
Uterotonics for Mx of PPH?
A
- Oxytocin
- Ergometrine
- Prostaglandins (Misoprostol)
14
Q
REBOA?
A
Resuscitative endovascular balloon occlusion of aorta to manage haemorrhage
Risk of distal ischaemia
