Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×

Online ordering will be unavailable from 17:00 GMT on Friday, April 25 until 17:00 GMT on Sunday, April 27 due to maintenance. We apologise for the inconvenience.

Hostname: page-component-669899f699-tpknm Total loading time: 0 Render date: 2025-04-27T06:23:31.972Z Has data issue: false hasContentIssue false

10 - Anaesthetic issues in preterm labour, and intensive care management of the sick parturient

Published online by Cambridge University Press:  07 August 2009

By
Anne May  and
Chris Elton
Edited by
Jane Norman  and
Ian Greer
Jane Norman
Affiliation:
University of Glasgow
Ian Greer
Affiliation:
University of Glasgow
Get access

Summary

Introduction

The anaesthetist is an essential part of the team caring for a woman who is to undergo a preterm delivery of her baby or babies. The anaesthetist is also involved in managing sick women and women who are at risk of a preterm delivery, and it is therefore important that the anaesthetist is involved in the care of these women early and that communication is excellent. This is a stressful time for the woman and her family and they are usually extremely anxious and are subjected to information from many sources. Inconsistency in this information can be disastrous. There are many situations where the obstetric team focus on preventing preterm labour and may be unwilling to discuss the scenario “what if this delivery is inevitable?” with the woman and her family. Management of the labour and delivery from the analgesic and anaesthetic point of view may become rushed, suboptimal and without adequate discussion of risks and benefits.

It is worthwhile mentioning the anaesthetic risks of pregnant women and, in particular, the increased risks associated with emergency general anaesthesia, especially when the woman is sick. Though the number of direct deaths due to anaesthesia has fallen as documented in successive Reports on the Confidential Enquiries into Maternal Deaths (CEMD) (Department of Health 1998, 2001) there are a significant number of indirect deaths where anaesthesia has contributed.

Type
Chapter
Information
Preterm Labour
Managing Risk in Clinical Practice
 , pp. 235 - 259
Publisher: Cambridge University Press
Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

,Anonymous (1996) Pre conception pregnancy and prescribing. Drug zTher. Bull. 34, 25–7.CrossRefGoogle Scholar
Beilin, Y., Zahn, J. and Comerford, M. (1997) Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm(− 3). Anesth. Analg. 85, 385–8.Google Scholar
Bhatia, P. and Bhatia, K. (2000) Pregnancy and the Lungs. Postgrad. Med. J. 76, 683–6.CrossRefGoogle ScholarPubMed
Brodsky, J. B., Cohen, E., Brown, B. J., Wu, M. and Whitcher, C. (1980) Surgery during pregnancy and fetal outcome. Am. J. Obstet. Gynecol. 138, 1165–7.CrossRefGoogle ScholarPubMed
Brown, M. A. and Buddle, M. L. (1997) What's in a name? Problems with the classification of hypertension in pregnancy. J. Hypertens. 15, 1049–54.CrossRefGoogle Scholar
Camann, W. (1999) Intrapartum epidural analgesia and neonatal sepsis evaluations. a casual or causal association?Anesthesiology 90, 1250–2.CrossRefGoogle ScholarPubMed
Churchill, D. and Duley, L. (2002) Interventionist versus expectant care for severe pre-eclampsia before term. Cochrane Database Syst. Rev. 3, CD003106.CrossRefGoogle Scholar
Cruz, A. M., Southerland, L. C., Duke, T.et al. (1996) Intraabdominal carbon insufflation in the pregnant ewe: uterine blood flow, intraamniotic pressure, and cardiopulmonary effects. Anesthesiology 85, 1395–402.CrossRefGoogle ScholarPubMed
Department of Health. (1998) Why Mothers Die. Report on Confidential Enquiries into Maternal Deaths In the United Kingdom 1994–1996.
Department of Health. (2001) Why Mothers Die. Report on Confidential Enquiries into Maternal Deaths In the United Kingdom, 1997–1999.
Fusi, L., Steer, P. J., Maresh, M. J. and Beard, R. W. (1989) Maternal pyrexia associated with epidural analgesia in labour. Lancet i, 1250–2.CrossRefGoogle Scholar
Haddad, B., Barton, J. R., Livingston, J. C., Chahine, R. and Sibai, B. M. (2000) Risk Factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated lives enzymes, and low platelet count) syndrome. Am. J. obstet. Gynecol. 183, 444–8.CrossRefGoogle Scholar
Hall, D. (1959) The effects of magnesium therapy on the duration of labor. Am. J. Obstet. Gynecol. 78, 27–32.CrossRefGoogle ScholarPubMed
Holdcroft, A., Konje, J. C. and May, A. (2003) Special report. Small babies and substandard anaesthesia: the Confidential Enquiries into Stillbirths and Deaths in Infancy 27/28 report. Int. J. Obstet. Anesth. 12, 271–4.CrossRefGoogle Scholar
Hood, D. D. and Curry, R. (1999) Spinal versus epidural anesthesia for cesarean section in severely preeclamptic patients: a retrospective survey. Anesthesiology 90, 1276–82.CrossRefGoogle ScholarPubMed
Immer-Bansi, A., Immer, F. F., Henle, S., Sporri, S. and Petersen-Felix, S. (2001) Unnecessary emergency Caesarean section due to silent CTG during anaesthesia?Br. J. Anaesth. 87, 791–3.CrossRefGoogle ScholarPubMed
James, M. F. M. (1998) Magnesium in obstetric anaesthesia. Int. J. Obstet. Anesth 7, 115–23.CrossRefGoogle Scholar
Kotani, N., Kushikata, T., Hashimoto, H.et al. (2001) Rebound perioperative hyperkalaemia in six patients after cessation of ritodrine for premature labor. Anesth. Analg. 93, 709–11.CrossRefGoogle ScholarPubMed
Lieberman, E., Lang, J. M., Frigoletto, F. Jr.et al. (1997) Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics 99, 415–19CrossRefGoogle ScholarPubMed
Lucas, D. N., Yentis, S. M., Kinsella, S. M.et al. (2000) Urgency of Caesarean Section: a new classification. J. R. Soc. Med. 93, 346–50.CrossRefGoogle ScholarPubMed
Luciani, G., Bossola, M., Tazza, L.et al. (2003) Pregnancy during chronic haemodialysis. a single dialysis-unit experience with five cases. Ren. Fail. 24, 853–62CrossRefGoogle Scholar
McGrory, C. H., McCloskey, L. J., DeHoratius, R. J.et al. (2003) Pregnancy outcomes in female renal recipients: a comparison of systemic lupus erythematosus with other diagnoses. Am. J. Transplant 3, 35–42.CrossRefGoogle ScholarPubMed
Macintosh, M. (Ed.) (2003 Project 27/28 CESDI. An Enquiry into Quality of Care and its Effects on the Survival of Babies Born at 27–28 weeks. London: The Stationary Office.Google Scholar
MacKenzie, I. Z. and Cooke, I. (2001) Prospective 12 month study of 30 minute decision delivery intervals for “emergency” Caesarean section. BMJ 322, 1334–5.CrossRefGoogle ScholarPubMed
Magee, L. A., Ornstein, M. P. and Dadelszen, P. (1999) Fortnightly review: Management of hypertension in pregnancy. BMJ 318, 1332–6.CrossRefGoogle ScholarPubMed
Magpie Collaborative Group. (2002) Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate. The Magpie Trial: a randomised placebo controlled trial. Lancet 359, 1877–90.CrossRef
Maternal and Child Health Research Consortium. (2000) Confidential Enquiry into Stillbirths and Deaths in Infancy, 7thAnnual Report. Available at www.cemach.org.uk/publications
Mercier, F. J. and Benhamou, D. (1997) Hyperthermia related to epidural analgesia in labour. Int. J. Obstet. Anesth. 6, 19–24.CrossRefGoogle Scholar
Muir, H. A., McGrath, J. M. and Chestnut, D. H. (1999) Preterm delivery and labour. In D. H. Chestnut, ed., Obstetric Anaesthesia Principles and Practice, 2nd edn. Mowsby, pp. 665–93.
Negishi, C., Lenhardt, R., Ozaki, M.et al. (2001) Opioids inhibit febrile responses in humans, whereas epidural analgesia does not: an explanation for hyperthermia during epidural analgesia. Anesthesiology 94, 218–22.CrossRefGoogle Scholar
Philip, J., Alexander, J. M., Sharma, S. K.et al. (1999) Epidural analgesia during labor and maternal fever. Anesthesiology 90, 1271–5.CrossRefGoogle ScholarPubMed
Powner, D. J. and Bernstein, I. M. (2003) Extended somatic support for pregnant women after brain death. Crit. Care Med. 31, 1241–9.CrossRefGoogle ScholarPubMed
Rathmell, J., Viscomi, C. and Ashburn, M. (1997) Management of non obstetric pain during pregnancy and lactation. Anesth Analg. 85, 1074–87CrossRefGoogle Scholar
Reedy, M. B., Kallen, B. and Kuehl, T. J. (1997) Laparoscopy during pregnancy: a study of fetal outcome parameters with use of the Swedish Health Registry. Am. J. Obstet. Gynecol. 177, 673–9.CrossRefGoogle ScholarPubMed
Rosen, M. A. (1999) Management of anaesthesia for the pregnant surgical patient. Anesthesiology 91, 1159–63.CrossRefGoogle ScholarPubMed
Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. (2001) National Sentinel Caesarean Section Audit Report. London: RCOG.
Royal College of Obstetricians and Gynaecologists. (2002) Tocolytic Drugs for women in Preterm Labour clinical guideline. London: RCOG
Sato, K., Nishiwaki, K., Kuno, N.et al. (2000) Unexpected hyperkalaemia following succinylcholine administration in prolonged immobilised parturients treated with magnesium and ritodrine. Anesthesiology 93, 1539–41.CrossRefGoogle Scholar
Scott, J. R., Wagoner, L. E., Olsen, S. L., Taylor, D. O. and Renlund, D. G. (1993) Pregnancy in heart transplant recipients: management and outcome. Obstet. Gynecol. 82, 324–7.Google ScholarPubMed
Shnider, S. M., Wright, R. G., Levinson, G.et al. (1979) Uterine blood flow and plasma norepinephrine changes during maternal stress in the pregnant ewe. Anesthesiology 50, 524–7.CrossRefGoogle ScholarPubMed
Steinbrook, R. A. and Datta, S. (1997) Increase in the arterial-to-end-tidal gradient (intraabdominal carbon dioxide insufflation in the pregnant ewe). Anesthesiology 87, 1596.CrossRefGoogle Scholar
Tuffnell, D. J., Wilkinson, K. and Beresford, N. (2001) Interval between decision and delivery by Caesarean section- are current standards achievable? Observational case series. BMJ 322, 1330–3.CrossRefGoogle ScholarPubMed
Urmey, W. F. and Rowlingson, J. C. (1998) Do antiplatelet agents contribute to the development of perioperative spinal hematoma?Reg. Anesth. Pain Med. 23 Suppl, 146–51.CrossRefGoogle ScholarPubMed
Velde, M., Budts, W., Vandermeersch, E. and Spitz, B. (2003) Continuous spinal analgesia for labour pain in a parturient with aortic stenosis. Int. J. Obstet. Anesth. 12/151–4.CrossRefGoogle Scholar
Vinson, D. C., Thomas, R. and Kiser, T. (1993) Association between epidural analgesia during labour and fever. J. Fam. Pract. 36, 617–22Google ScholarPubMed
Whitty, J. E. (2002) Maternal cardiac arrest in pregnancy. Clin. Obstet. Gynecol. 45, 377–92.CrossRefGoogle ScholarPubMed
Yentis, S. M. (1990) Suxamethonium and hyperkalaemia. Anaesth. Intensive Care 18, 92–101.Google ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×