Maternal Morbidity and Mortality
1. Cardiac disease is the leading cause of maternal death in both the United States and the United Kingdom.2,5 a. The combination of cardiovascular disease and cardiomyopathy caused 26% of maternal…
Anesthesia for Multiple Gestation and Breech Presentation
CLINICAL PEARLMultiple gestation delivery is high risk, associated with CD, preterm birth, and obstetric conditions such as preeclampsia. II.National Guidelines These U.S. guidelines present practice recommendations related to current evidence…
Endocrine Disorders
2. Oral hypoglycemic agents a. Women with pregestational type 2 DM who require oral agents for glucose control should ideally be changed to insulin before pregnancy. Although there is no evidence to…
Management of the Opioid Dependent Parturient
II.Obstetric management (see Fig. 31.3) A. Risks of opioid dependence in pregnancy 1. Opioid dependence in pregnancy is associated with poor maternal and fetal outcomes including miscarriage, preterm labor, preterm delivery,…
Anesthetic Considerations for Women Receiving Cesarean Delivery
III.Surgical considerations A. Technical aspects 1. CD involves the delivery of the fetus through an incision created in the maternal abdomen. For CD, either neuraxial or general anesthesia is used. Anesthetic…
Postcesarean Analgesia
g. The demand-only IV PCA incorporates several safety features to minimize the possibility of a patient receiving unsafe doses of IV opioid. First, the PCA pump is programmed to limit the…
Physiologic Changes of Pregnancy
b. Blood volume does not return to the prepregnancy level for greater than 6 weeks’ postpartum. 2. Cardiac output4 (Table 1.2) a. Cardiac output (CO) begins to increase at 10 weeks’ gestation, peaking…
Local Anesthetics and Toxicity
B. Local anesthetics with an ester bond linking the aromatic ring to the hydrocarbon chain are classified as amino-ester local anesthetics. These include procaine, 2-chloroprocaine, tetracaine, and cocaine (see Table…
Uteroplacental Anatomy, Blood Flow, Respiratory Gas Exchange, Drug Transfer, and Teratogenicity
A. Anatomic and physiologic changes. Maternal anatomic and physiologic changes occur during pregnancy to ensure enough blood flow is delivered to the uterus. Uterine blood flow occurs through two routes. 1. …
Trauma in the Obstetric Patient
CLINICAL PEARL A severely injured unstable pregnant trauma patient should be treated similarly to any other unstable trauma patient. 1. Pregnancy workup. Maternal pelvic examination should include abdominal palpation of the…
