Describe the Pre-anaesthetic assessment of a pregnant woman

AAGBI, e-safe-anaesthesia.org

The pre-anaesthetic assessment of a pregnant woman is important because

• Allows for ID of mothers at HIGHER RISK of complications during preg and delivery

• MINIMISE RISK for patients by planning their care (assistance may be needed)

• Improve patients experience by RELIEVING ANXIETY and answering questions

When should the pre-anaesthetic assessment happen?

• As early as poss

• High risk pts shoudl be seen 30-34 weeks so that issues are ID and management plans are made for delivery

What is involved in pre-assessment?

• HX

  • Gravida

  • Para

  • Gest

  • Intra partum problems

  • Past Obs Hx

  • PMHx

  • Meds and allergies

  • PAnaes Hx

  • GORD

  • ?Fasting

• EXAM

  • Vitals

  • BMI

  • CVS and resp

  • Airway assesment

  • Examination of the spine

  • Fluid status

  • Signs of haemorrhage

  • Signs of PET/Eclampsia

• IX

  • FBC, G+H, Obs USS, Urine protein creatinine ratio

• CONSENT

  • See next card

Go through consent for anaesthetic options

• Spinal risks =

  • low BP, (1 in 5)

  • PDPH (1 in 500)

  • failure (1 in 100)

  • nerve damage (1 in 1000, permanent 1 in 13,000),

• Epidural risks =

  • low BP (1 in 50)

  • PDPH (1 in 200)

  • failure (1 in 100)

  • nerve damage 1 in 1000, permanent 1 in 13,000)

• GA risks =

  • sore throat (1 in 5)

  • PONV (1 in 10)

  • chest infection (1 in 5)

  • failed intubation (1 in 250)

  • awareness (1 in 500)

  • damage to teeth (1 in 4500)

  • anaphylaxis (1 in 10,000)

Also remember

• IV access

• Blood products