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  • Summary Obstetric CBD

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    lim sj
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    This document summarizes the case of a 39-year-old pregnant patient at 38 weeks gestation who requires an emergency lower segment cesarean section (LSCS) for a previous cesarean scar. Key issues include the risks of aspiration, aortocaval compression, difficult airway, obesity, placenta accreta due to previous scar, postpartum hemorrhage, asthma, and hepatitis B. The patient requires assessment and surgery at a tertiary obstetric center with obstetric and neonatal intensive care support. Preoperative evaluation and planning addresses anesthesia considerations as well as obstetric risks. Intraoperative protocols are outlined to manage potential complications including postpartum hemorrhage, cardiac

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    This document summarizes the case of a 39-year-old pregnant patient at 38 weeks gestation who requires an emergency lower segment cesarean section (LSCS) for a previous cesarean scar. Key issues include the risks of aspiration, aortocaval compression, difficult airway, obesity, placenta accreta due to previous scar, postpartum hemorrhage, asthma, and hepatitis B. The patient requires assessment and surgery at a tertiary obstetric center with obstetric and neonatal intensive care support. Preoperative evaluation and planning addresses anesthesia considerations as well as obstetric risks. Intraoperative protocols are outlined to manage potential complications including postpartum hemorrhage, cardiac

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    © All Rights Reserved
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    11 views3 pages

    Summary Obstetric CBD

    Uploaded by

    lim sj
    This document summarizes the case of a 39-year-old pregnant patient at 38 weeks gestation who requires an emergency lower segment cesarean section (LSCS) for a previous cesarean scar. Key issues include the risks of aspiration, aortocaval compression, difficult airway, obesity, placenta accreta due to previous scar, postpartum hemorrhage, asthma, and hepatitis B. The patient requires assessment and surgery at a tertiary obstetric center with obstetric and neonatal intensive care support. Preoperative evaluation and planning addresses anesthesia considerations as well as obstetric risks. Intraoperative protocols are outlined to manage potential complications including postpartum hemorrhage, cardiac

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 3

    Summary

    This is a 39 year old G6P3 +2 @ 38weeks (3 rd trimester)


    Undergoing a major surgery- EMLSCS for 1 previous scar in labor

    Issues:
    1) Obstetric/Maternal patient
    -risk of aspiration- RSI, premedication
    -aortocaval compression- left lateral tilt
    -difficult airway trolley
    Fetal- maintain uteroplacental perfusion, FHR assessment
    2) Maternal obesity-BMI 39
    -central or peripheral
    -STOP BANG
    3) 1 previous scar
    -Risk of accreta with each cesarean- 3%, 11%, 40%, 60%, 67%
    4) Risk of PPH
    5) Bronchial asthma
    6) Chronic Hep B
    7) Emergency surgery

    She requires tertiary obstetric centre, with obstetrician, NICU

    Patient assessment

    Category and indication of LSCS

    Pre op:
    History
    Examination
    Investigation
    Reviewing all previous notes
    - Past anaes/Fhx/PONV
    - Past medical history
    - Effort tolerance
    - Allergies
    - Medication
    - Smoking/ETOH
    - Reflux/fasting status
    - Airway assessment
    - Examination of airway/auscultation/dentition
    - Review investigations

    Suitability
    Consultation
    Premedication
    Consent

    Aside from my usual obstetric assessment


    - Location of placenta
    - GSH and antibodies
    - Hb and plts

    SSCCT
    - Severity and stability
    - Cause/risk factors
    - Complications
    - Treatment/Management

    Intra op:
    Positioning-ramp, tilt
    Resus
    IV
    Monitoring

    Intraoperative problem solving


    Phase 1 safety CHeSS
    - Check reading
    - Help
    - Scan
    - Stop surgery
    Phase 2 Temporisation
    Phase 3 Cause
    - It is most likely
    - Serious differentials I must rule out are
    Phase 4
    - Treatment
    - CRM

    1) PPH
    -Resuscitation and blood products, activate MTP
    -Uterine contraction
    2) Cardiac arrest
    -ALS

    ALS
    -allocate team member to perform chest compression 120/min, 1/3 AP diameter, regularly
    interchanging
    -defib pads rhythm check
    -BMV
    -IV access- 1mg adrenaline
    -scribe, timekeeper and runner
    -look for reversible causes
    4H/4T

    Anaesthetic complications:
    - High blocks
    - LAST

    PET/Eclampsia -MgSO4 toxicity


    Hypovolaemia- PPH
    APH- PP, abruptio, uterine rupture
    Embolism- PE/VAE/AFE

    Pregnancy:
    - Left lateral tilt/manual displace uterus
    - Early intubation- risk of aspiration
    - Perimortem CS- call obstetrics and paediatrics early
    start CS at 4 min- baby out by 5 min

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