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Chapter 22 - Fundamentals of Emergency Obstetric Care

Published online by Cambridge University Press:  18 August 2022

By
Victoria Cadman  and
Rebecca Helen Lowes
Edited by
Daniel Rodger ,
Kevin Henshaw ,
Paul Rawling  and
Scott Miller
Daniel Rodger
Affiliation:
Senior Lecturer in Perioperative Practice, London South Bank University
Kevin Henshaw
Affiliation:
Associate Head of Allied Health Professions, Edge Hill University, Ormskirk
Paul Rawling
Affiliation:
Senior Lecturer in Perioperative Practice, Edge Hill University, Ormskirk
Scott Miller
Affiliation:
Consultant Anaesthetist, St Helens and Knowsley Hospitals NHS Trust
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Summary

This chapter discusses the management of obstetric patients undergoing anaesthesia and surgery. First, it outlines the distinct challenges of emergency obstetric anaesthesia and surgery. Second, it discusses pregnancy related changes to anatomy and physiology, common obstetric procedures, and drugs specific to the obstetric speciality. Finally, it highlights the advancements in care and medical technology and draws upon some of the moral and legal dilemmas faced by multidisciplinary teams in the obstetric setting.

Keywords

ObstetricsEmergencyPregnancyAnaesthesiaSurgeryFoetal SurgeryAnatomy and PhysiologyMaternityRisk
Type
Chapter
Information
Fundamentals of Operating Department Practice , pp. 242 - 254
Publisher: Cambridge University Press
Print publication year: 2022

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References

Royal College of Obstetricians and Gynaecologists. RCOG statement on emergency Caesarean section rates, 2013. Available from:www.rcog.org.uk/en/news/rcog-statement-on-emergency-caesarean-section-rates/.Google Scholar
National Confidential Enquiry into Patient Outcome and Death. The NCEPOD classification of intervention, 2004. Available from: www.ncepod.org.uk.Google Scholar
American Society of Anaesthesiologists. ASA Physical Status Classification System. Available from: www.asahq.org/standards-and-guidelines/asa-physical-status-classification-system (accessed August 2020).Google Scholar
Birenbaum, A., Hajage, D., Roche, S., et al. Effects of cricoid pressure compared with a sham procedure in the rapid sequence induction of anaesthesia. The IRIS randomized clinical trial. Journal of the American Medical Association, Surgery 2019; 154: 9–17.Google ScholarPubMed
Algie, C. M., Mahar, R. K., Tan, H. B., et al. Effectiveness and risks of cricoid pressure during rapid sequence induction for endotracheal intubation. Cochrane Database of Systematic Reviews 2015; 11: CD011656.Google Scholar
Butler, J. and Sen, A.. Cricoid pressure in emergency rapid sequence induction. Emergency Medicine Journal 2005; 22: 815–816.Google Scholar
Desai, N., Wicker, J., Sajayan, A., and Mendonca, C.. A survey of practice of rapid sequence induction for Caesarean section in England. International Journal of Obstetric Anesthesia 2018; 36: 3–10.CrossRefGoogle ScholarPubMed
Metodiev, Y. and Mushambi, M.. Supraglottic airway devices for Caesarean delivery under general anaesthesia: for all, for none, or for some? British Journal of Anaesthesia 2020; 125: E7–E11.Google Scholar
Yanamandra, N. and Chandraharan, E.. Anatomical and physiological changes in pregnancy and their implications in clinical practice. In Chandraharan, E. and Arulkumaran, S. (eds.), Obstetric and Intrapartum Emergencies: A Practical Guide to Management. Cambridge: Cambridge University Press, 2013, pp. 1–8.Google Scholar
National Institute for Health and Care Excellence. Caesarean section clinical guideline [CG132]. Available from: www.nice.org.uk/guidance/cg132.Google Scholar
Royal College of Obstetricians and Gynaecologists. A to Z of medical terms. Available from: https://www.rcog.org.uk/for-the-public/a-z-of-medical-terms/.Google Scholar
Allam, J., Malhotra, S, Hemingway, C., et al. Epidural lidocaine–bicarbonate–adrenaline vs levobupivacaine for emergency Caesarean section: a randomised controlled trial. Anaesthesia 2008; 63: 243–249.Google Scholar
Pan, P. H., Bogard, T. D., and Owen, M. D.. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. International Journal of Obstetric Anesthesia 2004; 13: 227–233.CrossRefGoogle Scholar
Kinsella, S. M., Girgirah, K., and Scrutton, M. J. L.. Rapid sequence spinal anaesthesia for category-1 urgency Caesarean section: a case series. Anaesthesia 2010; 65: 664–669.CrossRefGoogle ScholarPubMed
Hignett, R., Fernando, R, McGlennan, A., et al. A randomized crossover study to determine the effect of a 30° head-up versus a supine position on the functional residual capacity of term parturients. Anaesthesia and Analgesia 2011; 113: 1098–1102.CrossRefGoogle ScholarPubMed
Mushambi, M. C., Kinsella, S. M., Popat, M., et al. Obstetric Anaesthetists’ Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2015; 70: 1286–1306.CrossRefGoogle Scholar
Sheffield Teaching Hospitals NHS Foundation Trust. Obstetric GA induction checklist: are you HAPPY to continue? Available from: https://sheffieldteachinghospitals.github.io/SODA-course/documents/2018/I%20AM%20HAPPY%202017%20(5).pdf.Google Scholar
Champaneria, R., Shah, L., Wilson, M. J., et al. Clinical effectiveness of transversus abdominus plane (TAP) blocks for pain relief after Caesarean section: a meta-analysis. International Journal Obstetric Anesthesia 2016; 28: 45–60.CrossRefGoogle Scholar
Pandit, J. J., Andrade, J., Bogod, D. G., et al. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. Anaesthesia 2014; 69: 1089–1101.CrossRefGoogle Scholar
Yentis, S. and Clyburn, P., and Knight, M., on behalf of the MBRRACE-UK anaesthetic chapter writing group. Lessons for anaesthesia. In Knight, M., Kenyon, S., Brocklehurst, P., et al. (eds.) on behalf of MBRRACE-UK, Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Future Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–12. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2014, pp. 65–71.Google Scholar
Plaat, F., Lucas, N., and Bogod, D. G.. AAGA in obstetric anaesthesia. In Pandit, J. J. and Cook, T. M. (eds.), NAP5. 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Accidental Awareness during General Anaesthesia in the United Kingdom and Ireland. Report and Findings. London: The Royal College of Anaesthetists, 2014, pp. 133–143.Google Scholar
Kosinova, M., Stourac, P., Adamus, M., et al. Rocuronium versus suxamethonium for rapid sequence induction of general anaesthesia for Caesarean section: influence on neonatal outcomes. International Journal of Obstetric Anesthesia 2017; 32: 4–10.Google Scholar
Boerma, T., Ronsmans, C., Melesse, D. Y, et al. Optimising Caesarean section use 1. Global epidemiology of use and disparities in Caesarean sections. Lancet 2018; 392: 1341–1348.Google Scholar
Lucas, D. N., Yentis, S. M, and Kinsella, S. M.. Urgency of Caesarean section: a new classification. Journal of the Royal Society of Medicine 2000; 93: 346–350.CrossRefGoogle ScholarPubMed
Cluver, C., Novikova, N., Hofmeyr, G. Justus, and Hall., D. R. Maternal position during Caesarean section for preventing maternal and neonatal complications. Cochrane Database of Systematic Reviews 2013; 3: CD007623.Google Scholar
UK Cell Salvage Action Group. Intraoperative cell salvage in obstetrics: ICS Technical Factsheet 8. Available from: www.transfusionguidelines.org/transfusion-practice/uk-cell-salvage-action-group/technical-factsheets-and-frequently-asked-questions-faq.Google Scholar
Wahlberg, Å, Andreen Sachs, M., Johannesson, K., et al. Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric event: a cross-sectional retrospective survey. BJOG 2017; 124: 1264–1271.Google Scholar
Organisation for Economic Co-operation and Development. Glossary of statistical terms: maternal death: Available from: https://stats.oecd.org/glossary/detail.asp?ID=6332.Google Scholar
World Health Organization. Maternal mortality. Available from: www.who.int/news-room/fact-sheets/detail/maternal-mortality (accessed August 2020).Google Scholar
Knight, M., Bunch, K., Tuffnell, D., et al. (eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care: Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014–16. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2018.Google Scholar
MBRRACE-UK. Saving lives, improving mother’ care: lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into maternal deaths and morbidity 2016–18. Available from: www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2020/MBRRACE-UK_Maternal_Report_Dec_2020_v10_ONLINE_VERSION_1404.pdf.Google Scholar
Royal College of Obstetricians and Gynaecologists. Late intrauterine fetal death and stillbirth (Green-top Guideline No. 55). Available from: www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg55/.Google Scholar
Cao, K. X., Booth, A., Ourselin, S., et al. The legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States. Prenatal Diagnosis 2018; 38: 475–481.CrossRefGoogle ScholarPubMed

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