Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

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Suction evacuation for miscarriage

Suction & evacuation is a technique of emptying the uterus of a pregnancy. It can be used to terminate a pregnancy or to remove a fetus that has died. It involves the removal of a fetus and accompanying tissue of the pregnancy from the uterus with instrumental evacuation through the vagina and is usually performed in the first trimester of pregnancy.

Reasons for procedure

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Vaccination and Pregnancy

It is important to ensure that you are adequately protected against certain infectious diseases during your pregnancy. In the community, people are protected against infectious disease because they have had the infections before and developed immunity to it. Some are protected against chickenpox, for example, because they had it when they were kids, causing their immune systems to make antibodies to the chickenpox virus. However, over time the antibody level may decline to a very low levels and the person may lose the protection against that particular infectious agent.

Alternatively, many in the community have been vaccinated and developed antibodies to that specific infectious agent contained in the vaccine. Many countries now have an immunization schedule that tries to cover as many infectious disease as possible, hoping to reduce the disease burden to the community and the health care system.

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Caesarean Section

WHAT IS IT?
Delivery of a baby through an incision in the mother’s lower abdominal and uterine walls and is performed when a vaginal delivery is not possible or is unsafe. This procedure is also called a C-section or Lower Segment Caesarean Section (LSCS).

 

 

 

REASONS FOR PROCEDURE

Danger to the mother or baby from one or more of many causes, including:

  • Baby’s head too large to pass through the birth canal.
  • Baby in the wrong orientation – head up (breech) or transverse.
  • Failure of cervix to dilate (failed induction of labour).
  • Abnormal placenta location obstructing the birth canal (placenta praevia).
  • Failure of normal labour progress.
  • Situation where urgent delivery is indicated such as fetal distress or severe illness in the mother (such as severe hypertension or sudden fits).
  • Infection such as HIV or acute herpes genitalis infection in the mother.

Special situations: pregnancy resulting from assisted reproductive technology (ART), maternal request

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Post-Natal Care – what to expect

Most women stay in the hospital for 24 to 48 hours after giving birth (or 3 to 4 nights after a caesarean section). This will depend on the condition of the mother and baby.
The physical changes that occur with pregnancy usually resolve by the end of 6 weeks, although some may resolve much earlier than this. It is important to know all these changes, as it will help you cope better and lessen your worries. Emotional sup¬port and much needed help from your spouse and family members is equally important to assist you in facing these changes and coping with the arrival of a new member into the family. You will also get lots of advice from friends and relatives who visit you – some may be conflicting and may be harmful. There are many ways of doing things with no particular hard and fast rules on what is best for you. It is best to avoid traditional or Chinese herbs during this period. In the end, it is all boils down to common sense and you have to decide what is best for you and your baby. Do some reading and ask your doctor or midwife about your recovery during the postnatal period

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Ectopic pregnancy

Ectopic pregnancy is one that develops outside the uterus. The egg (oocyte) and the sperm meet in the fallopian tube and fertilization occurs. The embryo is supposed to move back to the uterine cavity for implantation. However, in ectopic pregnancy this does not occur, and the embryo gets implanted elsewhere. The most common location is in one of the narrow tubes that connect each ovary to the uterus (fallopian tube). As the fertilized egg enlarges, the fallopian tube stretches and ruptures, causing life-threatening internal bleeding. Other locations include the ovary, cervix, space beside the uterus (broad ligament space) or in the abdominal cavity. About 1 in 100 pregnancies is an ectopic.

CAUSES AND RISK FACTORS

The occurrence of ectopic pregnancy is usually associated with an abnormal function of the fallopian tubes. Hence, tubal pregnancy is the most common type. Hormonal imbalances or abnormal development of the fertilized egg might also play a role. Certain condition may predispose to a higher chance of ectopic pregnancy such as:

  • Previous abdominal or pelvic infection
  • Pelvic inflammatory disease (PID), involving the fallopian tubes
  • Pregnancy after tubal ligation
  • Assisted reproduction techniques such as in vitro fertilization.
  • Adhesions (bands of scar tissue) from previous pelvic surgery.
  • Previous tubal pregnancy.
  • History of endometritis (infection of the inner uterine lining)
  • Malformed (abnormal) uterus or fallopian tubes
  • Pregnant with an intrauterine device (IUD) in place (failure of IUD)

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COVID-19 and Pregnancy

We are now faced with an unprecedented pandemic due to the coronavirus. The COVID-19 is a new strain that has not been previously identified in humans. Those infected may take up to 14 days to develop symptoms. The main mode of transmission is mainly through respiratory droplets and close contacts. It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Routes of transmissions such as fecal-oral, in-utero from mother to baby and others are not confirmed yet. Some infected persons may be asymptomatic and they potentially can pass along the infection to others. However, this is less common. For more information about coronavirus, click here and here

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