RT Book, Section
A1 Gaiser, Robert
A2 Longnecker, David E.
A2 Brown, David L.
A2 Newman, Mark F.
A2 Zapol, Warren M.
SR Print(0)
ID 56627384
T1 Chapter 22. Evaluation of the Pregnant Patient
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56627384
RD 2024/04/23
AB Unlike  other  operations  in  which  the  patient  is  primarily  concerned  with  himself  or  herself,  the  pregnant  woman  is  usually  concerned  for  her  infant's  welfare.The  anesthesia  provider  must  be  aware  of  the  various  physiologic  changes  of  pregnancy  and  incorporate  them  into  the  anesthetic  plan.  These  changes  may  affect  various  concurrent  diseases  if  present.The  central  nervous  system  effects  of  pregnancy  include  a  reduced  local  anesthetic  requirement  when  these  agents  are  administered  intrathecally  or  epidurally.Pregnant  patients  in  the  third  trimester  and  symptomatic  patients  in  the  first/second  trimester  should  be  considered  at  risk  for  aspiration  during  general  anesthesia.There  is  extremely  weak  evidence  that  surgery  during  the  first  trimester  is  linked  to  central  nervous  system  defects  in  the  fetus.Fetal  heart  rate  monitoring  is  possible  during  some  surgical  procedures,  but  it  is  not  universally  applied  in  the  United  States.Preterm  labor  and  delivery  remain  the  leading  cause  of  perinatal  morbidity  and  mortality  in  the  United  States.  Preterm  labor  is  difficult  to  control  with  medication,  with  the  most  promising  being  the  calcium  channel  blocking  drugs.  Magnesium  sulfate  is  frequently  used  for  neuroprotection  in  the  preterm  neonate.The  etiology  of  preeclampsia  remains  to  be  elucidated,  but  it  is  believed  to  be  triggered  by  a  paternal  antigen  in  a  susceptible  mother.Magnesium  sulfate  is  the  most  effective  medication  for  the  prevention  of  seizures  in  those  with  preeclampsia.Labetalol  is  the  preferred  drug  for  the  control  of  blood  pressure  in  mothers  with  preeclampsia.  Antihypertensive  medication  does  not  treat  the  disease  process;  rather  it  is  used  to  prevent  intracerebral  hemorrhage.The  2  causes  of  antepartum  hemorrhage  are  placenta  previa  and  placental  abruption.  With  the  increase  in  cesarean  deliveries,  there  is  a  high  risk  of  placenta  accreta  in  patients  with  previous  cesarean  delivery  and  placenta  previa.The  perinatal  transmission  of  human  immunodeficiency  virus  (HIV)  is  low  if  the  viral  load  is  less  than  1000  copies/mL  and  these  patients  do  not  require  cesarean  delivery.  If  the  viral  load  is  greater,  cesarean  delivery  may  decrease  the  risk  of  perinatal  transmission.Aggressive  treatment  of  gestational  diabetes  mellitus,  even  mild  gestational  diabetes,  with  diet  modification,  oral  agents,  and  insulin,  is  associated  with  improved  maternal  and  neonatal  outcome.