Obstetric patient

Magnesium plays an important role in the transmission of nerve impulses. It is also important in the activity of many enzyme reactions, for example carbohydrate metabolism. Magnesium sulfate is used as replacement therapy in hypomagnesemia Magnesium sulfate (MgS04) is used in die prevention and control of seizures in obstetric patients with pregnancy-induced hypertension (PIH, also referred to as eclampsia and preeclampsia). It may also be added to TPN mixtures. 

Bronchospasm has been reported in two obstetric patients, possibly due to thoracic sympathetic blockade in one and hjrpersensitivity in the other (SEDA-21,132). 

Wong CA, Slavenas P. The incidence of transient radicular irritation after spinal anesthesia in obstetric patients. Reg Anesth Pain Med 1999 24(l) 55-8. 

Philip J, Sharma SK, Gottumukkala VN, Perez BJ, Slaymaker EA, Wiley J. Transient neurologic symptoms after spinal anesthesia with lidocaine in obstetric patients. Anesth Analg 2001 92(2) 405-9. 

Subhypnotic doses of propofol (20 mg) given to 120 women receiving intrathecal morphine after cesarean section had no significant effect on pruritus (55). Higher success rates have been reported for propofol with non-obstetric patients, suggesting that labor-related factors may perpetuate this adverse effect. 

The matemofetal transfer or rocuronium, as indicated by a fetaFmatemal plasma concentration ratio of 0.16, is between that of vecuronium and pancuronium (32). When rocuronium was used for cesarean section, no adverse effects on the fetus were observed (32). With regard to the duration of rocuronium-induced paralysis and the relatively high incidence of failed intubations in obstetric patients, however, it was agreed that rocuronium should be considered for rapid-sequence intubation for cesarean section only if suxamethonium is contraindicated (33-35). 

This report is the first of respiratory depression after intrathecal sufentanil in a non-obstetric patient. Previous obstetric cases had occurred earlier and with larger doses of sufentanil. The site of action of sufentanil in this case is likely to have been supraspinal, by either direct cephalad migration in the CSF or through a systemic effect after vascular absorption. 

In obstetric patients there have been experiences of home care giving support to the woman before or after childbirth. 

Duff P. Antibiotic selection in obstetric patients. Infect Dis Clin North Am 1997 11 1-12. 

A study reported rapid and prolonged analgesia in all of 14 obstetric patients who received a dose of only 1 mg synthetic human P-endorphin intrathecally at time of delivery. Since this peptide does not cross the BBB (or placenta), no fetal respiratory depression accompanied the procedure, nor were CNS or cardiovascular effects observed. 

The use of alcohol to treat patients in alcohol withdrawal or obstetrical patients with premature contractions is no longer recommended. Some medical centers continue to use alcohol to prevent or reduce the risk of alcohol withdrawal in postoperative patients, but administering a combination of a benzodiazepine with haloperidol or clonidine may be more appropriate. 

The interaction between metoclopramide and suxamethonium is an established but not extensively documented interaction of only moderate or minor clinical importance. However anaesthetists should be aware that some enhancement of blockade can occur. The interaction between metoelopra-mide and mivacurium has only more recently been demonstrated. Metoclopramide appears to allow a reduction in the infusion rate of mivaeurium and it causes a significant delay in recovery from neuromuscular block. Care is recommended during combined use. The authors of the suxamethonium reports also point out that plasma cholinesterase activity is reduced in pregnancy and so suxamethonium sensitivity is more likely in obstetric patients. Ester-type local anaesthetics also depend on plasma... 

The compound atropine has been shown to rapidly cross the placenta (Kanto et al. 1981 Kivalo and Saarikoski 1977 Onnen et al. 1979) and has been used to test placental function in high-risk obstetric patients (Heilman and Fillisti 1965). Atropine has also been used to reduce gastric secretions before cesarean section with no fetal or neonatal effects observed (Diaz et al. 1980 Roper and Salem 1981). 

Diaz, D.M., S.R Diaz, and G.F. Marx. 1980. Cardiovascular effects of glycopyrrolate and belladonna derivatives in obstetric patients. Bull. N.Y. Acad. Med. 56(2) 245. 

Sherman SJ, Greenspoon JS, Nelson JM, Paul RH (1992) Identifying the obstetric patient at high risk of multiple-unit blood transfusions. J Reprod Med 37 649-652... 

Obstetric discharge, principal diagnosis of deep vein thrombosis, and obstetric patients are not included in this safety indicator. 

This short film, a dramatized case study of a system breakdown dnring the treatment of an obstetrics patient, is based on actual cases and is an effective tool for stimulating discussion about systems issues in ensuring patient safety. 

Remifentanil (40 micrograms/bolus, lockout of 2 minutes, limit 1200 micrograms/hour, n=52), pethidine (49.5 mg- -5 mg bolus, lockout 10 minutes, limit 200 mg, =53), and fentanyl (50 micrograms - - 20 microgram boluses, lockout 5 minutes, limit 200 micrograms/hour, =54) have been compared for obstetric patient-controlled analgesia [172 "]. Remifentanil was associated with more periods of desaturation and more sedation and pruritus. 

Ramos-Aparici R, Segura-Pastor D, Edo-Cebollada L, Vila-Sanchez M. Acute subdural hematoma after spinal anesthesia in an obstetric patient J Clin Anesth 2008 20(5) 376-8. 

Mrs. R. was admitted to labor and delivery and a normal spontaneous vaginal delivery was anticipated. Her first stage of labor was uneventful. She refused epidural anesthesia and reached full dilatation 4 hours after admission. During this phase of labor, her muscular back pain was treated with gentle myofascial stretching techniques. In general, obstetric patients in active labor tolerate these types of soft tissue techniques. However, as labor pain intensifies, patients may be unable to bear any manipulative treatment. This patient expressed relief of her muscular back pain but was unable to endure treatment of the sacrum and iliopsoas because of labor pain. 

Tahir, A. H., Adriani, J. and Naraglii, M. (1975) Acute systemic toxicity from bupivacaine during epidural anesthesia in obstetric patients. Sth. med. J. (Bgham, Ala./, 68, 1377. 

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