RT Book, Section
A1 Soens, Mieke A.
A1 Tsen, Lawrence C.
A2 Santos, Alan C.
A2 Epstein, Jonathan N.
A2 Chaudhuri, Kallol
SR Print(0)
ID 1108523194
T1 Anesthesia for Obstetric Procedures not Involving Delivery
T2 Obstetric Anesthesia
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071786133
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1108523194
RD 2024/10/07
AB Clinical  obstetric  anesthesia  is  most  commonly  associated  with  delivery  of  an  infant;  however,  there  are  a  number  of  other  obstetric  procedures  and  surgeries  where  the  use  of  anesthesia  can  optimize  maternal  and  fetal  outcomes.  Miscarriage  or  termination  of  pregnancy  may  occur  in  up  to  30%  of  pregnancies,  and  when  accompanied  by  retained  fetal  or  placental  tissues,  removal  is  accomplished  with  a  dilation  and  curettage  (D&C)  or  dilation  and  evacuation  (D&E);  these  typically  occur  within  the  first  12  weeks  following  conception.  Between  1%  and  2%  of  pregnancies  are  associated  with  an  incompetent  cervix;  a  minority  of  these  cases  will  require  cervical  cerclage,  which  is  typically  placed  during  the  second  trimester.  Percutaneous  umbilical  blood  sampling  (PUBS)  is  most  commonly  performed  in  the  second  or  third  trimester  for  fetal  indications,  and  late  in  the  third  trimester,  external  cephalic  version  may  be  attempted  to  turn  a  breech  fetus  into  the  cephalic  position.  Tubal  ligations  are  most  frequently  performed  within  the  first  48  hours’  postpartum,  with  a  second  peak  occurrence  at  6  to  8  weeks’  postpartum,  when  most  of  the  pregnancy-related  changes  have  resolved.  Knowledge  of  the  anatomic  and  physiologic  alterations  with  different  stages  of  pregnancy,  as  well  as  the  relevant  innervation  (Figure  13-1),  can  optimize  the  planning  and  conduct  of  anesthesia;  such  knowledge  will  improve  the  ability  of  these  procedures  to  be  conducted  safely  and  successfully,  and  augment  the  patients’  experience,  comfort,  and  satisfaction.