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  • Print publication year: 2005
  • Online publication date: August 2009

10 - Anaesthetic issues in preterm labour, and intensive care management of the sick parturient

Summary

Introduction

The anaesthetist is an essential part of the team caring for a woman who is to undergo a preterm delivery of her baby or babies. The anaesthetist is also involved in managing sick women and women who are at risk of a preterm delivery, and it is therefore important that the anaesthetist is involved in the care of these women early and that communication is excellent. This is a stressful time for the woman and her family and they are usually extremely anxious and are subjected to information from many sources. Inconsistency in this information can be disastrous. There are many situations where the obstetric team focus on preventing preterm labour and may be unwilling to discuss the scenario “what if this delivery is inevitable?” with the woman and her family. Management of the labour and delivery from the analgesic and anaesthetic point of view may become rushed, suboptimal and without adequate discussion of risks and benefits.

It is worthwhile mentioning the anaesthetic risks of pregnant women and, in particular, the increased risks associated with emergency general anaesthesia, especially when the woman is sick. Though the number of direct deaths due to anaesthesia has fallen as documented in successive Reports on the Confidential Enquiries into Maternal Deaths (CEMD) (Department of Health 1998, 2001) there are a significant number of indirect deaths where anaesthesia has contributed.

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