Obsgynaecritcare

(*Hypothetical case) You are the anaesthetist on for obstetrics and a young woman is rushed from labour ward into your theatre for an emergency caesarean for fetal distress. Your registrar is talking with the patient and so you help with the team time out discussion. The obstetrician leading this asks “can you please give 2g of Cefazolin?”. No worries – you grab the 20ml syringe...

(*Hypothetical Case) A 26 yr old woman with a suspected ruptured ectopic pregnancy is rushed to theatre in haemorrhagic shock. The patient has a history of IVDU with a naltrexone implant. The team in the emergency department have been unable to get vascular access. She has a heart rate of 150/min and a BP of 75/45. She is now very distressed and unco-operative from both the abdominal pain but also...

You are in a peripheral hospital without onsite laboratory support after hours and you are involved in the care of a young parturient with uterine atony who has now bled over 2litres. Although you have called in someone to do some laboratory testing – you know that these results will be at least 45-90minutes away. How likely is it that this woman has become  coagulopathic? What approach shou...

This week Graeme and I take on a big topic! (excuse the pun), You are the anaesthetic consultant on call and you are woken by your registrar at 2am who asks you to come and give them a hand with a difficult patient. They have been asked to come down to labour ward to place an epidural in a supermorbidly obese patient who has arrived and appears to be in established labour. She weighs about 190kg,...

Hi Everyone, Congratulations & kudos Jeremy Hickey who correctly identified that this blood gas was a sample from a unit of stored allogeneic blood, sorry we don’t have any actual prize except for getting a mention on the podcast and the glory of seeing your name in print on the website! (If we have any more quizzes we may have to look into this.) Ryan Juniper also deserves a mention for...

Hi everyone, Join Graeme and I this week where we discuss podcasts for medical education (& recreation). Find out who Alexander Hamilton was and what our favourite medical podcasts are and our personal take on this topic. Want to get into some medical podcasts? Get yourself a good set of earphones, go onto your iphone and into the purple podcast icon (sorry Samsung and Android users Graeme and...

Hi everyone, This week on the podcast I have a fascinating interview with Dr Wynand Breytenbach a GP anaesthetist and obstetrician working in Narrogin WA. Join us on the podcast – we have a great conversation where Wynand recounts for us a case he had as a junior doctor working for the South African govt when he was stationed in Namibia on the border with Angola many years ago……....

Hi Everyone, After last weeks fascinating case discussion, Nolan and I continue with our discussion on amniotic fluid embolism. In this discussion we drill down into some of the current theories and understanding of the pathophysiology, prevalence, risk factors and AMOSS, the Australasian Maternities Outcomes Surveillance System, which has focussed on AFE in Australasia. The exact biological mecha...

Hi Everyone, This week we have a friend and colleague on the podcast, Assoc Prof Nolan McDonnell where he discusses a challenging case of amniotic fluid embolism which he was personally involved with earlier in his career. Join us and listen to the case where Nolan describes what it was like on a personal level – the uncertainty at first as to what is happening when there is a maternal colla...

(*Hypothetical Case) You are an obstetrician (or anaesthetist) and you work in a peripheral hospital in a metropolitan city. You are not on call but despite this you get woken by a phone call at 2am one night. It is a junior obstetric registrar who is very keen for you to come and give them some help. They tell you the on call obstetric consultant is already busy in theatre with an urgent caesarea...

Hi everyone, Thanks for joining us again, this week I am joined by my colleague Prof Yee Leung, Head of Gynaecological Oncology in Western Australia, to discuss the obstetric and surgical aspects of managing the patient with an abnormally invasive placenta (accreta / increta / percreta). Please join us, listen to our conversation on the podcast and let us know if you have any comments or questions...

(*Fictitious case) You are called to the postnatal ward by the midwife to review a woman who unfortunately had an accidental dural puncture the day before during her labour. When you see her today she has a classic postural headache – and has been unable to mobilise for more than 10-15 min and has basically confined to bed in a dark room. You take a detailed history and perform a neurologica...

(*Fictitious case) You are contacted by the ultrasound department – they have just completed a formal scan on an urgent referral and want to discuss their findings with you urgently. A 34yr old woman was admitted overnight with some PV bleeding at 32 weeks. She has had 2 previous caesareans and on the scan they have found a low lying anterior placenta which overlies the previous scar and con...

(*Fictitious case) A 32 yr old pregnant woman with insulin dependent diabetes presents to a regional hospital in WA at 27 weeks gestation, with probable premature rupture of her membranes, threatened preterm labour and a low grade fever. She is given a dose of celestone (betamethasone) intramuscularly, some nifedipine for tocoloysis and has an urgent areomedical transfer organised. During the flig...

Hi everyone, This weeks post is part 2 of the 5th in my mini series on patient blood management in obstetrics and gynaecology. We discuss some of the strategies we can use to avoid or treat excessive bleeding which can occur during gynaecological surgery or obstetric haemorrhage – this week focussing on anaesthetic / pharmacological and coagulation management strategies. I am told by some tr...

You phone goes off – you roll over it is 2am – when you pick up it is a theatre nurse calling to ask if you can urgently come to the hospital immediately – the team are too busy to talk to you. The nurse tells you a woman has just arrived via ambulance from another small peripheral hospital. She had an emergency caesarean about 6 hours ago and hasn’t stopped bleeding since....

Merry Xmas! This weeks post was inspired by a recent unexpected case of severe hyperkalaemia in a severe pre-eclamptic – I have put together a fictitious case which is a little more severe in order to illustrate the principles of managing hyperkalaemia – I hope you enjoy & take it easy over Xmas! CASE HISTORY (*A fictitious patient history ) Your pager goes off – code blue me...

Hi everyone, This weeks post is the 5th in my mini series on patient blood management in obstetrics and gynaecology. We discuss some of the strategies we can use to avoid or treat excessive bleeding which can occur during gynaecological surgery or obstetric haemorrhage. After sitting down to put this section together I soon realised that there is actually a lot more to discuss than I anticipated &...

You get called down to labour ward to place an urgent epidural in a labouring nulliparous woman. When you get there the team inform you that “she is going crazy with the pain”, they can’t get her to hold still, they are having trouble monitoring the fetus and they are really worried she might be having an abruption. They plead “can you please do an epidural so we can get co...

Hi Guys, Number 4 in the patient blood management in obstetrics and gynaecology mini tute series. Intravenous iron – a relatively safe and effective treatment that can rapidly correct iron deficiency and anaemia, increasingly used in many of our patients. But how much do you really know on this topic? What are all these different preparations available? What are the risks / cautions / contra...

Hi Guys, Number 3 in the patient blood management in obstetrics and gynaecology mini tute series. Nice and short this time! Oral iron the treatment of choice for the vast majority of our patients – seems relatively simple yeah? Maybe but there’s more than to it meets the eye! –  do it wrong and you’ll fail miserably – if they take the wrong tablets, don’t take t...

Hi again! This is episode two in my mini tutorial series on patient blood management (PBM) in obstetrics and gynaecology. This one is on the basics of iron physiology – I can hear you all yawning already! However if you really want to know how to effectively treat anaemia with iron (oral, intravenous) and understand how to recognise and diagnose iron deficiency and iron deficiency anaemia (I...

Gidday, Bonjour, Hi! This is the first episode in my mini series on patient blood management in O&G. Menorrhagia, haemorrhage, PV bleeding, iron deficiency, anaemia – any of this seem familiar? It should do! These issues affect a huge number of obstetric and gyaecologic patients, and as such this is an issue we should all be interested in learning more about – so I hope you find th...

(*This is a fictional case) Your patient has just had a very difficult instrumental delivery in theatre after a prolonged obstructed labour. Unfortunately now her uterus won’t contract despite oxytocin and ergometrine and she is bleeding pretty briskly. You clean her deltoid with an alco-chlorhex wipe, inject 250mcg (1 ampoule) of carboprost i.m. and cross your fingers that this will do the...

      Can the type of anaesthetic you get when you have your cancer surgery effect how long you live afterwards? Well the answer is……………… maybe. Listen to my 6min discussion here: https://www.obsgynaecritcare.org/wp-content/uploads/2017/09/Doestheanaestheticeffectcanceroutcomes.m4a I wouldn’t be surprised that if you aren’t an anaesthe...