Review Note
Last Update: 03/02/2025 09:58 AM
Current Deck: ACG Part 2::Obstetrics
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Commit #292860
SS_OB 1.16 Describe the pre-anaesthetic assessment of a pregnant woman
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Commit #292860Importance:
- Identify mothers at higher risk of complications during pregnancy and delivery
- Minimise risk for patients by planning their care in advance (i.e. if assistance or tertiary care needed)
- Improve patients experience by relieving anxiety and answering questions
Who should have an anaesthetic assessment?
- All patients requiring anaesthetic intervention - GA or regional
- If time does not permit a full assessment a brief assessment should be completed
When?
- As early as possible - high risk patients should be seen between 30-34 weeks
- Elective LSCS patients can be seen in the days preceding or DOS
- If pregnant patient for non-obstetric surgery as early as possible for MDT planning
Pre-assessment:
- History:
- Obstetric Hx: Gravida, para, current gestation, intra-partum problems, past obstetric problems
- PMHx
- Medications
- Allergies
- Anaesthetic history
- Fasting stats
- GORD
- Systems review, especially screening for co-existing disease e.g.cardiac, respiratory, obesity, endocrine (DM, thyroid), haematological (thrombosis, VTE, thrombophilia), neurological (spina bifida, myasthenia gravis, epilepsy, multiple sclerosis, tumour), MSK (Pre-existing back pain etc), psychiatric
- Examination:
- Vitals
- BMI
- CVS/Resp
- Airway
- Examination of spine
- Fluid status/signs of haemorrhage
- Signs of obstetric complications e.g.:
- PET/eclampsia - GCS. clonus, liver tenderness, Papilloedema
- GDM
- Investigations
- Bloods - FBC, esp Hb, plts, coags where relevant, G&H, U&E’s
- Obstetric USS: Baby presenting part, placenta location
- Consent:
- Discuss anaesthetic intervention (GA, epidural, spinal, CSE), IV access, blood products and risks and benefits
Can use the modified WHO or CARPEG for risk predictions