OBSTETRIC COMPLICATIONS

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OBSTETRIC COMPLICATIONS

• DENNIS STEVENS CRNA, MSN, ARNP
• FEBRUARY 2006
• FLORIDA INTERNATIONAL UNIVERSITY
• PRINCIPLES ANESTHESIOLOGY NURSING II
• NGR 6093

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OBSTETRIC COMPLICATIONS

• Original lecture by
• DENNIS STEVENS CRNA, MSN, ARNP
• Modified by
• VICENTE GONZALEZ CRNA, MS

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OBJECTIVES

• Discuss physiologic changes that occur during
  pregnancy.
• Explain anesthetic treatment modalities for
  potential obstetrical complications in the
  parturient.
• Explain the indications and management of
  anesthesia for emergency cesarean section.

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REFERENCES

• Chestnut, D. H. (1999). Obstetric Anesthesia (2nd
  ed.).
• St. Louis, MO Mosby.
• Morgan, G.E., Mikhail, M.S., Murray, M.J.
  (2002). Clinical Anesthesiology (3rd ed.). New
  York, NY McGraw-Hill.

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INTRODUCTION

• The parturient is rarely in optimal condition at
  the time anesthetic care is to be administered
• During labor, emergencies and complications
  demand immediate obstetrical intervention that is
  most likely to require administration of
  appropriate anesthesia management
• The parturient is always considered to be a full
  stomach
• Obstetric history and health assessment

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OBSTETRIC COMPLICATIONS

• Umbilical Cord Prolapse
• Complicates 0.2-0.6 of deliveries
• Diagnosis
• Treatment
• Dystocia and Abnormal Fetal Presentations and
  Positions
• Related to
• Primary dysfunctional labor
• Breech presentation
• Abnormal vertex presentations

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OBSTETRIC COMPLICATIONS

• Multiple Gestations
• Commonly associated with
• Administration of anesthesia
• Antepartum Hemorrhage
• Placenta previa
• Abruptio placentae
• Uterine rupture
• Retained placenta
• Uterine atony

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OBSTETRIC COMPLICATIONS

• Premature Rupture of Membranes
• Present when leakage of amniotic fluid occurs
  prior to the onset of labor
• Incidence
• Predisposing factors
• Spontaneous labor commences within 24 hours of
  ruptured membranes in 90 of patients
• Management of PROM
• Chorioamnionitis
• Represents infection of chorionic and amniotic
  membranes
• Incidence and complications
• Diagnosis and management
• Administration of anesthesia

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OBSTETRIC COMPLICATIONS

• Preterm Labor
• Definition
• Incidence
• Contributory factors
• Treatment
• Administration of anesthesia
• PIH
• Definition and incidence
• HELLP syndrome
• Pathophysiology and manifestations
• Treatment and management of anesthesia

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OBSTETRIC COMPLICATIONS

• Heart Disease
• Incidence
• Management of anesthesia
• Amniotic Fluid Embolism
• Incidence and mortality
• Presentation
• Pathophysiologic manifestations
• Treatment

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OBSTETRIC COMPLICATIONS

• Postpartum Hemorrhage
• Definition and incidence
• Common causes and management

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ANESTHESIA FOR EMERGENCY CESAREAN SECTION

• Indications
• Close communication with obstetrician
• Management of anesthesia
• Regional versus general anesthesia