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Re: Anaesthesia for emergency C-SectionFrom: Braun, R. Daniel (rbraun@iupui.edu)Fri May 7 13:41:54 1999
IV nitroglycerine or Terbutaline will give uterine relaxation. I never rupture the membranes on the second twin until after I have hold of at least one and preferably two feet. At that point rupture of the membranes occurs after the baby is in a longitudinal lie. Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN -----Original Message----- From: Dr Suresh Deshpande [SMTP:sureshdeshpande@hotmail.com] Sent: Friday, May 07, 1999 12:50 PM To: Multiple recipients of list OB-GYN-L Subject: Anaesthesia for emergency C-Section Dear Ob-Gyn netters, The subject of anaesthesia for emergency Caessarean Operation was discussed a few weeks ago. I had an unfortunate experience that I would like to share with fellow posters. A primae was admitted in premature labour, with twins. Both babies were in transverse presentation, with predicted weight around 2 kg. The case was in small hospital, where anaesthesia coverage is inadequate - skill and equipmentwise, and and I have to operate as charity. The anaesthetist said, under the circumstances, he has to go for spinal anaesthesia. I was expecting difficult extraction, but general anaesthesia was not possible. The first baby was having the convexity of spine as presenting part. It took me three minute to vatch the ankle. Completion of delivery took mearly two more minutes. I could rupture the membranes of second baby, immediately. And this one was also presenting by its spine. I hoped that the increase of available space will make this delivery easier, but no. It became virtually ipossible to insinuate my fingers upto the foot. There was no part of this baby that could be grasped with a forceps. At the end of about 12 minutes, I managed to deliver this baby. The Apgars were 6 & 9 for the first and 0 & 5 for the second. The weights were 2.1 and 1.9 kg. The second baby was required to be kept in intensive care, and died due to Respiratory Distress Syndrome after 5 days. The spinal anaesthesia is known to cause intense contraction of uterus. This effect is observed after about 8 to 12 minutes of administration. If you think that you may not be able to deliver baby/babies by this time, it is better to plan for general anaesthesia. I was forced to operate under the specified circumstances, and lost a baby. All comments are welcome. Dr Suresh Deshpande, M.D., F.I.C.O.G., Consultant Obstetrician & Gynaecologist, Deshpande Hospital & Laparascopy Clinic 33/15,B, Karve Road, PUNE 411 004, INDIA Phone +9120 331961 Fax +9120 364669. sureshdeshpande@hotmail.com
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