This most recent contribution to the FAAM sequence presents a finished and recent dialogue of anaesthetic administration in being pregnant, in the course of supply, and in sufferers present process gynaecological surgical procedure. With authoritative contributions from foreign specialists it's a useful reference for all anaesthetists and professional clinicians.
Chapter 1 Maternal alterations in being pregnant (pages 1–29): James Eldrtdge
Chapter 2 the consequences of Anaesthesia and Analgesia at the child (pages 30–78): Jackie Porter
Chapter three ache reduction in Labour: Non?Regional (pages 79–108): Mark Scrutton
Chapter four nearby Analgesia and Anaesthesia (pages 109–177): Michael Paech
Chapter five normal Anaesthesia for Obstetrics (pages 178–200): Richard Vanner
Chapter 6 The Parturient with Co?Existing ailment (pages 201–238): Philippa Groves and Michael Avidan
Chapter 7 clinical Emergencies in being pregnant (pages 239–280): Caroline Grange
Chapter eight Postnatal evaluation (pages 281–302): Robin Russell
Chapter nine Anaesthesia for Gynaecological surgical procedure (pages 303–345): Kym Osborn and Scott Simmons
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Extra resources for Anaesthesia for Obstetrics and Gynaecology
T h e most commonly used method is intermittent blood sampling from the fetal scalp in labour, performed through the cervix. A low p H provides an indirect measure of hypoxia. Continuous readings have been obtained using a p H electrode applied to the subcutaneous tissues of the fetal scalp. Whilst this provides trend data and perhaps an earlier warning of fetal hypoxia than intermittent sampling, the correlation between p H Values following intermittent sampling and the p H electrode remains in question.
Deliberate hypotension should only be employed if absolutely necessary as a sustained fall in blood pressure causes fetal hypoxia and acidaemia. T h e incidence of cardiac surgery during pregnancy is probably rising. Pregnancy does not seem to increase the maternal mortality associated with the surgery, but fetal loss as high as 25% is to be expected with such operations. If cardiopulmonary bypass is required, the fetus appears to tolerate 25 ANAESTHESIA FOR OBSTETRICS AND GYNAECOLOGY mild hypothermia well, although fetal heart rate patterns may become very abnormal.
However, the concentration in fetal tissues, represented by umbilical arterial uv uv uv Fig 2 . 3 Pethidine transfer across the placenta. UA: umbilical artery; UV: umbilical vein; MA: maternal arterial blood; unbound pethidine molecule. Filled arrows represent direction of net pethidine transfer. Unfilled arrows represent direction of blood flow. " T h e ratio between total pethidine concentration in UA and in maternal blood increases with time. T h e longer the dose-to-delivery interval, the higher the ratio and often unity is reached after 2-4 hours (Fig.
Anaesthesia for Obstetrics and Gynaecology