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1、急診剖宮產(chǎn)的 麻醉選擇和術(shù)中處理費(fèi)敏2010-3-26DefinitionAbdominaldeliveryasurgicalprocedurethatpermitsdeliveryoftheinfantthroughincisionsintheabdominalanduterinewall.CesareanSectionCaedere–SecoPompiliusII730BCnotwidelyuseduntilthe1920sIndicationsforCesareanSectionRepeatScheduledFailedattemptatvaginaldeliveryD
2、ystociaAbnormalpresentationTransverselieBreechMultiplegestationFetalstress/distressDeterioratingmaternalmedicalillnessPreeclampsiaHeartdiseasePulmonarydiseaseHemorrhagePlacentapreviaPlacentalabruptionCesareanSection>60%unplannedMoreextensiveperipartummonitoringLowerthresholdforsurgicalinter
3、ventionWhatisan‘emergency’Caesareansection?-Category1&2GradeDefinition(attimeofdecisiontooperate)Category1ImmediatethreattolifeofwomanorfetusCategory2Maternalorfetalcompromise,notimmediatelylife-threateningCategory3NeedingearlydeliverybutnomaternalorfetalcompromiseCategory4Atatimetosuitthew
4、omanandmaternityteamCategory1IndicationPlacentalabruptionuterinerupturecordprolapseActivelybleedingplacentapraeviaIntrapartumhemorrhagePresumedfetalcompromisewithseverelyabnormalCTGand/orseverefetalacidosisThe30-minuteruleamaximumdecision-to-deliverytimeof30minforCategory1situationAssociati
5、onofAnaesthetistsofGreatBritainandIrelandandObstetricAnaesthesists’Association.Guidelinesforobstetricanaesthesiaservices;2005.HillemannsP,StraussA,HasbargenU,etal.Crashemergencycesareansection:decision-to-deliveryintervalunder30minanditseffectonApgarandumbilicalarterypH.ArchGynecolObstet200
6、5;273:161–165.anaesthetistinformed–deliveryPerianestheticEvaluationAdirectedhistoryandphysicalexaminationplateletcountAnintrapartumbloodtypeandscreenforallparturientsreducesmaternalcomplicationsPerianestheticrecordingofthefetalheartratereducesfetalandneonatalcomplicationsAdirectedhistoryand
7、physicalexaminationMaternalhealthandanesthetichistoryRelevantobstetrichistoryAirwayandheartandlungexaminationBaselinebloodpressureBackexaminationwhenneuraxialanesthesiaisplannedorplacedPlateletcountAroutineintrapartumplateletcountdoesnotreducematernalane
