Obstetric Anaesthesia

Question 1

Five H’s  leading causes of death in SA:

Answer 1

• HIV
• Hypertension
• Haemorrhage
• Health care worker training
• Health system strengthening

Question 2

Respiratory changes

Answer 2

• decr FRC 20%
• incr VO2  oxygen consumption
• incr RR
• Resp alkalosis
• mucosal engorgement
• difficult airway

Question 3

Reflux in pregnancy why?

Answer 3

In pregnancy, progesterone is responsible for decreased LES pressure.
diaphragm pushes up
o Reflux  delayed gastric emptying
o Aspiration risk

Question 4

Preoperative Rx before caesarean section

Answer 4

• Premedication = sodium citrate, metoclopramide, Kefsol (for surgical site infections = give 30 mins before CS)

Cefazolin = 1st generation cephalosporin

o Pencil point spinal needle ≥25G (decreased risk of dural puncture headaches post-op)  NB!

Question 5

Complications post C/S

Answer 5

• Hypovolaemia & hypotension
• PDPH  post dural puncture headaches due to leak from CSF
  o Conservative  lie down immediately
  o Blood patch
• Epidural abscess / haematoma  rare due to hypercoagulable state of patients
  o Haematoma must be drained within 6 hours, otherwise permanent paralysis

Question 6

Premedicate before general anaesthesia

Answer 6

Premedicate  sodium citrate (improve stomach pH), metoclopramide (promote stomach emptying), antibiotics