Anesthesia For Operative Delivery pt1 (Exam 3) Flashcards
What is Macrosomia?
Fetus/Newborn w/ excessive birth weight
What is TOLAC?
Trial of Labor after Cesarean
What is VBAC?
Vaginal Birth after Cesarean
What is PPH?
Post-partum Hemorrhage
What is SAB?
Spontaneous Abortion
Or subarachnoid block.
What are indicators for operative vaginal delivery? (using forceps/vacuum assist)
- Bad FHR variability
- Maternal exhaustion
- Arrested Descent
op vaginal delivery is not very common these days
If a denser sensory block is necessary for operative vaginal delivery, what medications can be used in a preexisting epidural?
in-situ Epidural:
- 5-10mls Lidocaine 2%
- 5-10mls Chloroprocaine 2-3%
What is the most common majory surgery in the USA?
Cesarean section
national delivery rate ~30%
Maternal mortality is _____ times greater with a c-section vs vaginal delivery.
10x greater mortality
What are anesthesia complications that can contribute to mortality in converting to a C-section from a vaginal birth?
- Pulmonary aspiration
- Edematous/friable airways = failed intubation
- Inadequate ventilation when requiring GETA
- maternal hemorrhage
What factors are contributing to an increased national rate of c-sections?
- ↑ maternal age
- Obesity
- Fetal macrosomia
- ↓ TOLAC attempts
- less instrumented vaginal delivery
- technological advancement (FHR monitoring)
What are the grades of emergency cesarean section?
What are the maternal indications for c-section?
- Failed labor induction
- arrested labor
- chorioamnionitis
- active HSV lesions
- Multiple gestation
- Classical incision/previous uterine sx
- maternal request
- peripartum hemorrhage
- Deteriorating maternal condition
What are the fetal indications for c-section?
- Malpresentation (breech)
- Macrosomia/anomaly
- Fetal intolerance to labor
- Non-reassuring FHR
- Premature
- Prolapsed cord
What type of c-section incision is used for emergencies?
Low vertical/Midline incisions
- rapid access
Umbilicial to pubic symphysis.
What are the three different types of c-section incisions?
- Low Transverse (best if possible)
- Vertical
- Classical (highest risk)
What is the most common, least painful C-sx incision with the lower incidence of dehiscence or uterine rupture?
Low transverse
With what type of c-section incision is TOLAC contraindicated?
Classical incision
With what type of c-section incision is TOLAC possible?
Low-Transverse Incision
Why does GETA potentiate blood loss?
Due to GETA vasodilation.
What primary risks are associated with classical C-sx incisions?
- risk of abdominal adhesions
- risk of uterine rupture (~10%)
What is the most common c-section complication?
Hemorrhage
Usually due to uterine atony → oozy uterus.
What are the four main causes of cesarean hemorrhage?
Four T’s
- tone
- trauma
- tissue (retained)
- thrombin (coag status)
What complications (other than hemorrhage) can happen in c-sections?
- Infection
- Uterine/cervical lacerations
- Bladder damage
- Fetal damage
- Hysterectomy (last resort)
