Review Note

Last Update: 03/27/2025 09:27 PM

Current Deck: ACG Part 2::Obstetrics

New Card (Unpublished)

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Front

SS_OB 1.34 Discuss the anaesthetic management of problems that may arise with labour and delivery, including the following situations:
- Breech

Back

Breech Presentation

3% of presentations at or near term

Entrance of the fetal lower extremities into the maternal pelvic inlet.

Fetal lie – the relation of the long axis of the fetus to the long axis of the mother:
- Longitudinal (cephalic or breech), transverse, and oblique.

Different Types of Breech Presentation

Frank breech (60%) – both fetal lower extremities are flexed at the hips and extended at the knees.

Complete breech (10%) – hips and knees are flexed.

Incomplete or footling breech (30%) – one or both hips are extended, and a foot or knee hangs below the breech.

Issues with Breech

Increased requirement for emergency intervention and emergency LSCS for cord prolapse or fetal distress.

Postpartum infection.

Uterine atony and postpartum haemorrhage.

Cervical trauma and manipulation.

Placental praevia.

Uterine anomalies.

Use of uterine relaxants – GTN.

Perinatal morbidity and mortality resulting from difficult delivery.

Low birth weight.

Growth restriction from pre-term delivery.

Fetal anomalies.

Anaesthetic Management

Pre-op
- ECV (External Cephalic Version)
  - May be involved in ECV for breech presentation to reduce need for LSCS.
  - Pre-op evaluation prior to ECV to identify patients at increased risk for GA in case of an emergent LSCS.

Techniques
- Spinal anaesthesia increases the success rate and reduces pain for both primary and re-attempts of ECV; relaxation of the abdominal muscles improves outcomes for ECV.
- IV analgesia using remifentanil – reduces pain only.
- Epidural – associated with improved success of ECV; a functioning epidural can rapidly be extended to provide surgical anaesthesia.

After ECV – increased incidence of urgent or emergent LSCS.

Labour

Epidural anaesthesia may be offered – better neonatal outcomes, though longer labours.

Prepare for potential complications.

Intra-op

May require an emergency LSCS for:
- Umbilical cord prolapse.
- Placental abruption.
- Fetal head entrapment.

Have available tocolytics – GTN (50-100mcg boluses) which provide uterine relaxation within 30-90 seconds, magnesium, salbutamol, volatiles, atosiban.

Gold coast notes