Cardiac Disease in the Obstetric Patient
3. Left heart obstruction (mitral valve area <2 cm2, aortic valve area <1.5 cm2, or peak left ventricular outflow tract gradient >30 mm Hg by echocardiography) 4. Reduced left ventricular function (ejection…
ANESTHESIA
Neurologic Deficits Following Labor and Delivery
2. Despite the very low incidence of neurologic injury, it represents a significant contributor to malpractice litigation. Davies et al.11 performed an obstetric anesthesia closed claims analysis of 426 claims from…
Thrombophilias/Coagulopathies
Vascular spasm, mediated by vasoconstrictor substances released from platelets, reduces blood flow and occurs in the first stages of hemostasis. Damaged endothelium attracts platelets, which adhere to it, forming a…
Newborn Resuscitation
2. Fetal lung development takes place throughout pregnancy, and lung maturation continues well into the neonatal period. The pulmonary transition that occurs in the fetus is initiated before labor begins. Cortisol…
Renal and Hepatic Disease in the Pregnant Patient
C. Assessment of renal function during pregnancy 1. Renal function is commonly assessed by two techniques. The first measures serum levels of creatinine and BUN. However, these serum values will not…
Difficult Airway Management in the Pregnant Patient
B. Factors contributing to the difficult airway. Difficult mask ventilation, difficult laryngoscopy, and difficult intubation are factors that contribute to a difficult airway. 1. Difficult mask ventilation and difficult laryngoscopy occurs…
Fetal Assessment and Monitoring
6. Individualized risk assessment determines choice of modality. The risk of iatrogenic premature delivery, prompted by false-positive testing results, must be considered. B. Screening ultrasound survey 1. A screening ultrasound exam is commonly…
Neurologic and Neuromuscular Disease
(1) The Cobb angle measures the degree of spinal curvature (see Fig. 26.2). Minor curves (10 to 20 degrees) occur in approximately 2% of adolescents in the United States. These are…
Choice of Neuraxial Analgesia and Local Anesthetics
B. First stage of labor. Pain during the first stage of labor is essentially visceral in nature and occurs due to a combination of both uterine contractions and endocervical dilation. Although…
Obstetric Emergencies
a. Decreased maternal O2 tension is an uncommon cause of intrapartum fetal asphyxia. Clinical situations that may result in decreased maternal O2 tension and fetal hypoxia include anemia, pulmonary edema, smoking,…
