Managing Complications in Pregnancy and Childbirth: - IAWG

P-12 Spinal anaesthesia• If the needle hits bone, it may not be in the midline. Withdraw theneedle and reinsert it, directing it slightly upwards while aiming forthe woman’s umbilicus.• Advance the spinal needle towards the subarachnoid space. Adistinct loss of resistance will be felt as the needle pierces theligamentum flavum.• Once the needle is through the ligamentum flavum, push the needleslowly through the dura. You will feel another slight loss ofresistance as the dura is pierced.• Remove the stylet. Cerebrospinal fluid should flow out the needle.• If cerebrospinal fluid does not come out, reinsert the stylet androtate the needle gently. Remove the stylet to see if the fluid isflowing out. If you fail two times, try another space.• Inject 1–1.25 mL of the local anaesthetic solution. For pregnantwomen who have not delivered, a smaller dose of the drug isneeded since the available subarachnoid space is reduced due toengorged epidural veins.• Help the woman to lie on her back. Have the operating table tiltedto the left or place a pillow or folded linen under her right lowerback to decrease supine hypotension syndrome.• Recheck the woman’s blood pressure. A fall in blood pressure islikely. If there is significant hypotension, give the woman more IVfluids (500 mL quickly):- If this does not raise her blood pressure, give ephedrine 0.2mg/kg body weight IV in 3 mg increments;- If blood pressure continues to fall after giving IV ephedrineboluses four times, give ephedrine 30 mg IM.• Give oxygen at 6–8 L per minute by mask or nasal cannulae.• After injecting the local anaesthetic solution, wait 2 minutes andthen pinch the incision site with forceps. If the woman can feel thepinch, wait 2 minutes and then retest.Anaesthetize early to provide sufficient time for effect.