FHR monitering

[napman]

19 weeks pregnant for rt ankle manipulation under anesthesia for a syndesmatic injury. would you do fetal heart monitoring or consult OB. No other medical problems

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[IlDestriero]

OB consult to show +FHT pre op.
Tight Bp control, etc.
OB cons at end to show FHT still present after emergence.
I wouldn't try to monitor during the procedure.

 

[RedAnesthesia]

OB consult to show +FHT pre op.
Tight Bp control, etc.
OB cons at end to show FHT still present after emergence.
I wouldn't try to monitor during the procedure.

Agree with this. Just make sure to document FHT pre and post. Avoid the benzodiazepines and you should be good. Don't forget to do a hip bump once they are over 20 weeks.

Red

 

[Twiggidy]

Bump and agree.

As a matter of fact, this is from ACOG website

http://www.acog.org/Resources-And-P...ractice/Nonobstetric-Surgery-During-Pregnancy

 

[Noyac]

Agree with this. Just make sure to document FHT pre and post. Avoid the benzodiazepines and you should be good. Don't forget to do a hip bump once they are over 20 weeks.

Red

So you opened the box and now I will have to ask the question, why avoid benzos?

 

[Noyac]

As far as the case goes there are a few things to consider. 1) is the fetus viable if delivered at this point 2) is access easy or will it be in the surgical field.

I don't think anyone would balk at just documenting FHT before and after surgery.

However, you might want to consider doing it intraop as well if the abdomen is out of the surgical field as in this case. This way if the tones start to drop then you could react by doing a few things like, increasing BP or O2.

 

[Twiggidy]

However, you might want to consider doing it intraop as well if the abdomen is out of the surgical field as in this case. This way if the tones start to drop then you could react by doing a few things like, increasing BP or O2.

Excellent point

 

[RedAnesthesia]

So you opened the box and now I will have to ask the question, why avoid benzos?

I avoid it given on the old dogma of diazepam possibly causing oral cleft malformations. I realize literature is outdated and not pertaining to midazolam but I would say it is a little cya medicine. Additionally, pt is in 2nd trimester so she past organogenesis so makes it little clinical consequence. What is your practice with BNZ in pregnant pts out of curiosity?

Red

 

[Noyac]

I avoid it given on the old dogma of diazepam possibly causing oral cleft malformations. I realize literature is outdated and not pertaining to midazolam but I would say it is a little cya medicine. Additionally, pt is in 2nd trimester so she past organogenesis so makes it little clinical consequence. What is your practice with BNZ in pregnant pts out of curiosity?

Red

Exactly! Little to no clinical significance at this stage of labor. The reason I asked is that it may seem of little importance to you or even nit picky but it does matter. We need to be precise with our practice. If you feel it is risky or legally a risk then say so but to just say you would avoid it without any reason to back it up is lending yourself to scrutiny and doubt.
I avoid it during organogenesis only. Otherwise, if the pt needs it I will use it. But this is extremely rare. I very rarely give benzos for cases going to the OR that are not MAC.