Review Note
Last Update: 03/02/2025 10:03 AM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
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Commit #292865
SS_OB 1.18 Outline the indications for referral of the high-risk pregnant woman to more specialised centres of obstetric care
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Commit #292865- CVS: congenital heart disease, arrhythmias, valvular heart disease, IHD, HTN
- Resp: asthma, OSA, PHTN, restrictive lung disease
- Neuro: Epilepsy, MS, muscular dystrophy, myopathies (myasthenia, myotonia)
- Endocrine: DM, steroid therapy, acromegaly, addisons, pheochromocytoma
- Renal: ESRF
- Haematological: thrombocytopenia, anticoagulant therapy, haemoglobinopathies (sickle cell, thalassaemia), porphyria, history of VTE in pregnancy, hypercoagulability(AT3, protein C/S deficiency) or coagulopathies (von villebrand)
- Connective tissue disorders: RA, scleroderma, SLE, antiphospholipid syndrome
- Transplant recipients
- Infectious diseases
- Medical problems that occur during pregnancy:
- Poorly controlled GDM
- >3x previous LSCS
- Placenta praevia, percreta
- HTN/PET/eclampsia
- Conditions that may complicate anaesthesia:
- Spinal abnormalities - spina bifida occulta, previous spinal surgery, longstanding back pain, disc prolapse
- Previous head/neck or major thoraco-lumbar surgery
- Morbid obesity BMI >40 with other comorbidities, or >45
- Previous anaesthetic complications - known difficult airway, allergy/anaphylaxis, anaesthetic awareness, MH, failed intubation, tracheostomy etc
- Prior obstetric complications
- Placenta disorders, PPH
- Advanced maternal age - may have coexisting comorbidities - IHD, CVA, HTN, T2DM
- Other:
- JW
- Needle phobia
- Substance abuse
- These cases should all be discussed within a multidisciplinary team including anaesthesia, obstetrics, midwifery, neonatology, medical/surgical specialists, ICU regarding most appropriate delivery location, and also take into account patient factors such as travel times, family support and isolation.