Non Obstetric Surgery in Pregnancy
Considerations
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Pregnancy considerations (difficult intubation, aspiration, ↓ time to desaturation, aortocaval compression, 2 patients)
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Maintenance of uteroplacental perfusion:
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FHR monitoring when possible
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Avoid hypoxemia, hypotension, acidosis
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Risk of preterm labour:
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Obstetrical consult with consideration of steroids for lung maturity & magnesium for brain protection
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Surgical considerations of a gravid uterus
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Anesthetic drug effects on fetus (FHR changes, teratogenicity)
Goals & Conflicts
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Delay nonelective surgery to the second trimester if possible
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Optimize & maintain normal maternal physiologic function
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Optimize & maintain uteroplacental blood flow & oxygen delivery (guided by FHR monitoring)
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Preparations for preterm labour:
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Fetal lung maturity
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Availability of NICU
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Avoid teratogens
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Avoid stimulating the myometrium (oxytocic effects) to prevent preterm labour
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Use regional anesthesia if possible