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3 results

  • Chapter 34 - Obstetric Anaesthesia

  • from Section 3 - Passing the Gas
  • William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey, Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London, Judith Dinsmore, St George's Hospital, London
  • Book:
    Robinson and Hall's How to Survive in Anaesthesia
    Published online:
    09 June 2025
    Print publication:
    26 June 2025, pp 196-201

  • Summary

    Obstetric anaesthesia is one of the high-risk areas of anaesthetic practice and is feared by many novices. Physiological differences of the pregnant patient are discussed.

    The anaesthetist may have three main functions in the labour ward: provision of support and analgesia for the parturient, care of the patient in the obstetric theatre and care of the patients in the maternity high-dependency unit. Effective labour analgesia requiring the support of an anaesthetist may include the use of Entonox, IV/IM medications, and placement of an epidural or spinal. Remifentanil PCAs may be preferred in patients with contraindications to regional intervention and set-up may follow strict protocols and meticulous monitoring. A caesarean section may be an emergency depending on the threat to the health of the mother or fetus and may require urgent timely intervention. Regional anaesthesia is frequently the first choice, but some cases may require a general anaesthetic. Both types of interventions may carry risks and complications. Failed tracheal intubation in the obstetric patient should follow the OAA and DAS management guidelines.

  • CHAPTER 11 - Intrapartum care for high-risk pregnancies

  • Edited by Tahir Mahmood, Philip Owen, Sabaratnam Arulkumaran, Charnjit Dhillon
  • Book:
    Models of Care in Maternity Services
    Published online:
    05 July 2014
    Print publication:
    01 November 2010, pp 100-109

  • Summary

    All women, regardless of whether their pregnancies are high or low risk, should be treated with respect and should be in control of and involved in what is happening to them in labour. Intrapartum causes of maternal mortality are extremely rare; nevertheless, good intrapartum care and monitoring of the woman with a high-risk pregnancy is essential in ensuring a good maternal and fetal outcome. In the UK, the National Institute for Health and Clinical Excellence (NICE) has published comprehensive guidelines on the intrapartum care of the woman at low risk at term. All maternity units and labour wards should have a lead named midwife, obstetrician, paediatrician and anaesthetist. It is imperative that staffing levels and competencies of staff on labour wards comply with national standards. Guidelines provide a framework from which healthcare providers can design clinical care pathways and organisational structures to improve care of the high-risk woman in labour.

  • CHAPTER 14 - Risk management on the labour ward

  • Edited by Tahir Mahmood, Philip Owen, Sabaratnam Arulkumaran, Charnjit Dhillon
  • Book:
    Models of Care in Maternity Services
    Published online:
    05 July 2014
    Print publication:
    01 November 2010, pp 131-139

  • Summary

    Risk management aims to reduce poor outcomes by first identifying adverse events, creating a database to identify common patterns, and developing a system of accountability to prevent future incidents. Staffing of the labour ward may be the single most important risk. Birthrate Plus is a tool for assessing midwifery staffing that can identify shortfalls. Healthcare trusts collect a large sample of data on births related to their complexity, ranging from a simple, straightforward birth to an emergency caesarean section, and the average birth time is measured. Training may be the single most effective part of system implementation for reactive and proactive risk management. Training for staff in the core skills needed to handle emergency situations makes an important contribution to safety, although Towards Better Births found that there was a wide variation in trusts' training programmes, including the multiprofessional nature and attendance levels.