Obstetrics

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“Obstetric anaesthesia and analgesia is the only area of anaesthetic practice where two patients are cared for simultaneously. Pregnancy is a physiological rather than a pathological state. Patient expectations are high and the mother expects full involvement in her choices of care. The majority of the workload is the provision of analgesia in labour and anaesthesia for delivery. Multidisciplinary care for the sick mother is increasingly important and highlighted”.

Obstetrics

1. Basic knowledge of obstetrics
2. Management of twin pregnancy
3. Management of premature delivery
4. Assessment of fetal well being in utero
5. Maternal morbidity and mortality
6. Legal aspects related to fetus
7. Physiology of “abnormal pregnancy”
8. Optimisation for the ‘at risk’ baby
9. Hypertension in pregnancy
10. Feeding / starvation policies
11. Thromboprophylaxis

Obstetric analgesia

1. Pain pathways relevant to labour
2. Methods of analgesia during labour : indications and contraindications
3. Epidural / subarachnoid analgesia for labour
   1. Management of complications of regional block and of failure to achieve adequate block
   2. Epidural and subarachnoid anaesthesia for Caesarean Section, and other operative deliveries
   3. Conversion of analgesia for labour to that for operative delivery
   4. Management of accidental dural puncture and post-dural puncture headache

Obstetric anaesthesia

1. Principles of anaesthesia for incidental surgery during pregnancy
   1. Anaesthetic drugs and pregnancy
2. Preoperative assessment of pregnant patient
3. Effect of pregnancy on the technique of general and regional anaesthesia
4. Influence of common concurrent medical diseases
5. Acid aspiration prophylaxis
6. Intubation problems in the full-term mother
7. Anaesthesia for retained products of conception
8. Anaesthesia/analgesia for instrumental delivery
9. Anaesthesia for retained placenta
10. Anaesthesia for caesarean section
11. Management of dilutional coagulopathy
12. High dependency care of obstetric patients
13. Emergencies in obstetric anaesthesia:
    1. Pre-eclampsia, eclampsia
    2. Failed intubation
    3. Major haemorrhage, APH and PPH
    4. Maternal resuscitation
    5. Amniotic fluid embolus
    6. Total spinal

CEACCP 2005: DECEMBER
Amelia Banks and Andrew Norris
Massive haemorrhage in pregnancy