Parenteral opioid analgesia: Does it still have a role?
Parenteral opioids have been used in labour analgesia for many years, but the ideal opioid in this setting is yet to be found. We review the properties of currently used…
Uncategorized
Obstetric anaesthesia
Some anesthesiologists perceive obstetric anesthesiology as a “backwater” of anesthesia care. It is simple: place a needle in a laboring woman’s back and inject local anesthetic/opioid solution for labor analgesia…
Precipitous Labor and Emergency Department Delivery
HELPERR H Call for help E Evaluate for episiotomy L Legs (McRobert’s Maneuver by assistant) P Suprapubic pressure (by assistant) E Enter maneuvers/internal rotation (Rubin’s, Woods Corkscrew) R Remove posterior…
Evaluation and Treatment of Postpartum Hemorrhage
• Pregnancy with multiple fetuses • Fetal macrosomia • Fetal malpresentation • Prior uterine incision or myomectomy • Prolonged labor • Prolonged third stage (>20 min) • Previous postpartum hemorrhage • Placenta previa • Maternal obesity (BMI > 40)…
Cardiovascular Emergencies of Pregnancy
Fig. 9.1 Ultrasound image of decreased blood flow through right femoral vein DVT in transverse view. Reprinted with permission of the MedStar Georgetown University Hospital & MedStar Washington Hospital Center…
Bleeding in Late Pregnancy
Fig. 5.1 Placenta previa. Ultrasound image showing placenta covering cervical os (arrowheads). Image courtesy of Ian Suchet Management of placenta previa depends on gestational age and stability of the mother….
Imaging Considerations in Pregnancy
Gestational period Effects Estimated threshold dosea Before implantation (0–2 weeks after conception) Death of embryo or no consequence (all or none) 50–100 mGy Organogenesis (2–8 weeks after conception) Congenital anomalies…
Non-obstetric Abdominal Pain in Pregnancy
Gynecologic Genitourinary Gastrointestinal Ovarian torsion Urinary tract infection Appendicitis Ovarian cysts Pyelonephritis Cholelithiasis/cholecystitis Fibroids Urolithiasis Pancreatitis Round ligament pain – Diverticulosis/diverticulitis Vaginal infections – Bowel obstruction Pelvic inflammatory disease –…
Cardiac Arrest in the Pregnant Patient
Causes of cardiac arrest in pregnancy Obstetric Non-obstetric Iatrogenic Eclampsia Pulmonary embolism General anesthesia-induced Amniotic fluid embolism Sepsis Regional anesthesia-induced Postpartum hemorrhage Trauma Other medications (e.g., magnesium) Antepartum hemorrhage Myocardial…
Trauma in Pregnancy
Fig. 11.1 Anatomic and Physiologic Considerations of Pregnancy Emergency Department Evaluation and Management Primary Survey The general principles of Advanced Trauma Life Support (ATLS) apply to all pregnant trauma patients,…
