Review Note

Last Update: 03/27/2025 09:30 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New Card (Unpublished)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 #309761

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

Back

Commit #309761

Premature Labour

Delivery at 24-37 weeks' gestation.
- Earlier births are referred to as miscarriages.
- Occasional survivors are seen after delivery at 23 weeks.

Incidence varies from 5-10% of all pregnancies.

Most common cause of neonatal mortality and morbidity in the developed world.

Risks of later disability and handicap are especially significant below 28 weeks' gestation.

Obstetric Management

Aim: Prolong pregnancy to allow time for:
- Administration of corticosteroids for fetal maturation.
- Treat underlying causes.
- Allow transfer of the mother to a tertiary centre.

Corticosteroid administration:
- Single dose (2 injections of betamethasone given 24 hours apart).
- To promote fetal lung maturation by stimulating alveolar cells to produce surfactant, reducing incidence of intraventricular haemorrhage and necrotizing enterocolitis (NEC) in the event of preterm labour.
- Maximum benefit from injection seen after 48 hours or within 7 days.
- Caution: In diabetes mellitus, as corticosteroids can precipitate hyperglycaemia; also maintain PDA (patent ductus arteriosus), so don’t give after 36 weeks.

Tocolytic agents to suppress labour:
- Indicated for threatened delivery < 32 weeks' gestation.
- Unlikely to be successful if cervical dilatation is > 3cm or preterm labour occurs early in the 2nd trimester.
- Options: Magnesium, beta agonists, NSAIDs, CCB (calcium channel blockers), nitrates, volatiles, atosiban.

Antibiotics:
- Benzylpenicillin: 3g bolus, then 1g hourly for at least 24-48 hours.

Anaesthetic Management

Delivery should be in a tertiary care centre.

Epidural analgesia is an ideal form of analgesia for the delivery of most premature neonates:
- Not associated with drug depression in the newborn.
- Enables a controlled, atraumatic vaginal delivery.
- Little interaction with tocolytics.
- Ideal for a trial of labour.
- Allows for an emergency LSCS.

A neonatologist needs to be present at the time of delivery.

Gold coast notes