Review Note
Last Update: 03/02/2025 10:07 AM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
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Commit #292867SS_OB 1.19 Describe the anaesthetic management of early pregnancy conditions such as, termination,or miscarriage
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Commit #292867Miscarriage:
- Pregnancy loss before 20 weeks - threatened, incomplete, complete, missed
- Causes:
- Chromosomal abnormalities, immunological, infection, endocrine, uterine, cervical, trauma, environmental exposure
- Incomplete miscarriage most common > 8 weeks, usually treated with D&C
- Pre-op:
- Usual hx, ex, Ix
- Gestation, fasting status, volume status/bleeding history, signs of sepsis, GORD, airway examination
- Gain IV access and begin resuscitation, may need analgesia and anxiolytic
- G&H should be valid
- Intra-op
- Typically GA and LMA if fasted and low aspiration risk (usually low if <16 weeks)
- Can be performed under spinal +/- sedation if contraindication to GA
- If unfasted/nausea/opioids/GORD/later pregnancy may need RSI + ETT
- Short duration procedure that is intensely stimulating - alfentanil + multimodal analgesia (paracetamol, parecoxib) helpful
- Usually risk of PONV - 2x anti-emetics
- Oxytocin or ergometrine may be needed so should be available
- Potential for bleeding, uterine rupture, retained products, infection, uterine laceration
- Post-op
- Antiemetics
- IV opioids available
- Usually day case surgery
Termination:
- Same as miscarriage, D&C
- Pre-op
- Often significant anxiety - benefit from anxiolytic
- Usual pre-op assessment
- Intra-op
- Can be performed under neuraxial, sedation, GA
- In national womens typically performed under ‘deep sedation’ or essentially a GA without an airway (hudson or mask holding)
- Short stimulating procedure, short acting opioids and multi-modal advised
- Often need oxytocin following evacuation/suction
- Post-op
- Day stay surgery
- PONV