Review Note
Last Update: 03/27/2025 09:13 PM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
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Front
Commit #309755
What were the 'New in Obstetrics' recommendations from Gerald Ostheimer lecture 2023
Back
Commit #309755- Treatment of opiate use disorder in pregnancy
- Buprenorphine has better neonatal outcomes , no difference in maternal outcomes
- Penicillin allergy testing in pregnancy
- Commonly used for strep infections in pregnancy, ~10% claim to have penecillin allergy but true prevalence ~1%
- Anaesthesia for cervical cerclage
- 50mg chlorprocaine cf to 2.5mg heavy marcaine, faster offset with clorprocaine by about 45mins
- Dural puncture labour epidurals in obesity.
- CSE with spinal needle through dura and then thread
- Faster onset, more unfiorm quality of anaesthesia. If epidural top up needed then faster onset of block. These advantages havent been found in morbidly obese.
- Ultra-low concentrration epidurals
- <0.1% less instrumental delivery, reduced motor block, <Csection
- No difference between Ultra low <0.8% and Low 0.8%-1.0%
- Ecbolic dosing
- No difference between 5iu then infusion and 0.5iu then infusion in low risk C section. In low risk sections.
- Inadequate analgesia during C section
- Epidural top up 30% vs SAB or CSE 10%
- IV dexamethason e for C section
- Antiemetic and analgesic, pain scores slightly lower ~1 with IV dex,
- Time for asking for 1st opioid longer in IV dex use
- Total opiod use ~10mg less
- Epidural blood patch success
- Less success if occurs in first 48hours.
- If dural puncture higher than L3 then epidural blood patch is less likely to be successful.