Review Note
Last Update: 03/27/2025 09:29 PM
Current Deck: ACG Part 2::Obstetrics
New Card (Unpublished)Currently Published Content
Front
Back
No published tags.
Pending Suggestions
Field Change Suggestions:
Front
Commit #309760
SS_OB 1.34 Discuss the anaesthetic management of problems that may arise with labour and delivery, including the following situations:
- Assisted vaginal birth
- Assisted vaginal birth
Back
Commit #309760Assisted Vaginal Birth
-
Vacuum and forceps-assisted vaginal deliveries account for 11% of deliveries.
-
Appropriate analgesia should be used.
-
If failure to deliver, LSCS (Lower Segment Caesarean Section) may need to be performed to deliver the baby.
Indications for Assisted Vaginal Birth
-
Fetal compromise suspected or anticipated.
-
Delay in second stage of labour.
-
Maternal effort contraindicated – in conditions such as:
-
Cerebral aneurysm.
-
Risk of aortic dissection.
-
Proliferative retinopathy.
-
Severe hypertension.
-
Cardiac failure.
-
Fetal Complications
-
Shoulder dystocia.
-
Subaponeurotic/subgaleal haemorrhage.
-
Facial nerve palsy, corneal abrasion, and retinal haemorrhage.
-
Skull fracture and/or intracranial haemorrhage.
-
Cervical spine injury.
Maternal Complications
-
Vaginal trauma.
-
Anal sphincter damage.
-
Postpartum haemorrhage.
Anaesthetic Management
-
Pre-op
-
Some instrumental deliveries may be performed in theatre with a view to proceeding to LSCS if there is concern.
-
Neuraxial anaesthesia (epidural or spinal anaesthesia) may be required by the obstetric team to facilitate instrumental delivery.
-
Prepare for the possibility of LSCS and potential haemorrhage.
-
Notify theatre team and neonatologist.
-
IV access and pre-op bloods.
-
-
Intra-op
-
If failure to deliver, LSCS may need to be performed to deliver the baby