Obsgynaecritcare

This week Dr Esther Godfrey, an intensivist and anaesthetist from Wales, joins us on the podcast. Esther is visiting WA on a family holiday, and yet she kindly offered to come and speak with us this morning. In this episode Esther shares a very moving personal experience and then we discuss all the amazing work she and her colleagues have been doing in this space in Wales and now across the UK / Ireland – The SuPPORT Project (see the links below). Thank you Esther – and thank you to your family for letting us borrow you for the morning! Links The SuPPORT Project website

You have attempted to top up an epidural for a category one caesar for fetal distress. The block seems adequate but once the surgeons enter the abdomen your patient complains of significant pain and you decide to convert to general anaesthesia. You perform an RSI with propofol and rocuronium. After intubation she has a heart rate of 130 and an NIBP of 155 / 90. Your registrar asks “why didn’t we give her any opioid?” and you patiently explain that we avoid opioids until after delivery because we don’t want them to cross the placenta and to cause respiratory depression in the neonate……………but is this always true??? Hi everyone, Join Jacob and I as we discuss the recent literature surrounding this topic. What is the evidence? What about the short acting opioids such as alfentanil & remifentanil? What are the advantages / disadvantages of using an opioid and what are the downsides of not using opioids? References Best practice in obstetric general anaesthesia: an umbrella review of pharmacological strategies for induction of general anaesthesia. Anaesthesia, 81: 1269-1280. 2026. https://doi.org/10.1111/anae.70214 Induction opioids for caesarean section under general anaesthesia: a systematic review and meta-analysis of randomised controlled trials International Journal of Obstetric Anesthesia, 2019; 40, 4-13

Join Sarah & Declan as we continue our series covering the ANZCA final exam curriculum for obstetrics across four episodes. This second episode covers complications in labour and delivery including management of postpartum haemorrhage. We hope this resource will be helpful for everyone, but especially those of our trainees preparing for the final exam. To get the most out of it, we suggest regularly pausing the podcast to answer each question yourself, before listening to our answers. Of course there is much more detail expected in the exam, but if you can answer all these questions confidently, we think you’ll have a great chance. If you find this podcast helpful, or have suggestions for future episodes in this series, please send us an email to let us know. Resources mentioned in this episode: Question 1: AFE, haemorrhage management BJA Education — Haemostatic agents in the management of obstetric haemorrhage (2024) https://www.bjaed.org/article/S2058-5349(24)00089-1/fulltext RANZCOG — Management of Postpartum Haemorrhage (2021) https://www.ranzcog.edu.au/wp-content/uploads/Management-Postpartum-Haemorrhage.pdf BJA Education — Amniotic fluid embolism (2018) https://www.bjaed.org/action/showPdf?pii=S2058-5349%2818%2930060-X BJA Education — Point-of-care viscoelastic testing (2022) https://www.bjaed.org/article/S2058-5349(22)00094-4/fulltext Deranged Physiology — Interpretation of abnormal ROTEM data https://derangedphysiology.com/main/required-reading/haematology-and-oncology/Chapter-108/intepretation-abnormal-rotem-data Question 2: GA unstable bleeding pt, uterine inversion management RANZCOG — Management of Postpartum Haemorrhage (2021) https://www.ranzcog.edu.au/wp-content/uploads/Management-Postpartum-Haemorrhage.pdf BJA Education — Uterine inversion (2024) https://www.bjaed.org/article/S2058-5349(24)00009-X/fulltext Question 3: Placenta accreta planning and management RANZCOG — Placenta Accreta Spectrum (PAS) (C-Obs 20) (2023) https://ranzcog.edu.au/wp-content/uploads/Placenta-Accreta-Spectrum.pdf BJA Education — Management of patients with suspected placenta accreta spectrum (2022) https://www.bjaed.org/article/S2058-5349(21)00131-1/fulltext Question 4: Foetal demise SOAP — Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients with Thrombocytopenia (2021) https://www.soap.org/assets/docs/Consensus/SOAP%20Consensus%20Statement%20Thrombocytopenia%202021.pdf

Hi everyone Dexmedetomidine, is both a difficult word to pronounce correctly in casual conversation but also a useful pharmacological tool in many different situations. This week I am joined by one of our fellows Dr Han Lu to discuss dexmedetomidine, it’s history, it’s basic pharmacology and then more specifically it’s use in different clinical situations where it may be useful in obstetrics and gynaecology. Thanks Han for a great Tuesday talk and a very informative podcast! References Han’s powerpoint talk Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis. BJA September 2024 Crowe. G, et al Perioperative Applications of Dexmedetomidine. ATOTW 469 — Perioperative Applications of Dexmedetomidine April 2022 Douglas MS, Soloniuk LJ, Jones J, Derderian R, Baker C, Stier G. Intravenous dexmedetomidine use in obstetric anesthesia: a focused review. Int J Obstet Anesth. 2025 May;62:104345. doi: 10.1016/j.ijoa.2025.104345. Epub 2025 Feb 13. PMID: 40090158 Atipamezole – alpha 2 agonist reversal agent used in veterinary practice

Hypothetical Case: You finish injecting the spinal anaesthetic for your patient who has come for an urgent caesarean section. She has pre-eclampsia and her blood pressure just before you started was 180/100. Just after lying down she starts vomiting and unfortunately the non invasive blood pressure cuff is going up and down but not giving you a number – she is shaking and can’t stop moving around. Is she vomiting because of hypotension, should you give her a bolus of phenylephrine? What if she is actually still hypertensive – you don’t want to push her BP over 200. Wouldn’t it be great if you had a beat to beat continuous display of her BP – maybe you should have placed an arterial line before starting. Are there any other options that might have been helpful??? Hi everyone, This week I am joined by John to discuss continuous non-invasive blood pressure monitoring. Many of these technologies have actually been around for a number of years now, but despite this don’t seem to be in commonplace usage. There does seem to be a recent renewed interest in re-evaluating these technologies. How do these technologies work? How accurate are they? Have there been any improvements? What are the economics and costs? Thanks John for all your hard work researching this topic! Methods Arterial Applanation Tonometry Volume Clamp Method Photoplethysmography (PPG): Origins to Modern Applications in Wearable Technology References Enhancing Patient Safety with Continuous Blood Pressure Monitoring – APSF (Anesthesia Patient Safety Foundation Newsletter 2026)