analgezia si anestezia in obstetrica. analgezia in travaliu - anestezie ...
analgezia si anestezia in obstetrica. analgezia in travaliu - anestezie ...
analgezia si anestezia in obstetrica. analgezia in travaliu - anestezie ...
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Nasterea pe cale naturala: <strong>in</strong> caz de praevia m<strong>in</strong>ora (placenta <strong>in</strong>serata la ><br />
2cm de orificiul cervical <strong>in</strong>tern):<br />
- <strong>analgezia</strong> epidurala - de preferat<br />
- monitorizare fetala cont<strong>in</strong>ua<br />
Operatia cezariana electiva:<br />
- <strong>anestezia</strong> sp<strong>in</strong>ala sau comb<strong>in</strong>ata sp<strong>in</strong>ala/epidurala are avantajul exten<strong>si</strong>ei<br />
blocului regional <strong>in</strong> cazul prelungirii <strong>in</strong>terventiei<br />
- AG daca exista risc de hemoragie necontrolabila<br />
- 2 aborduri venoase periferice largi 14G<br />
- monitorizare TA cont<strong>in</strong>ua <strong>in</strong> caz de placenta praevia majora<br />
- efectuarea compatibilitatii sangu<strong>in</strong>e<br />
- dispozitive de transfuzare rapida<br />
Operatia cezariana de urgenta:<br />
- <strong>in</strong> cazul<br />
- sangerarilor necontrolabile<br />
- <strong>in</strong>stabilitate cardio-vasculara<br />
- coagulopatie<br />
- sufer<strong>in</strong>ta fetala<br />
PLacEnta accrEta<br />
3 tipuri:<br />
- accreta vera (placenta creste d<strong>in</strong>spre endometru spre miometru)<br />
- <strong>in</strong>creta (placenta creste <strong>in</strong> gro<strong>si</strong>mea miometrului)<br />
- percreta (placenta depaseste gro<strong>si</strong>mea miometrului patrunzand <strong>in</strong><br />
seroasa uter<strong>in</strong>a sau structurile <strong>in</strong>vec<strong>in</strong>ate)<br />
Operatia cezariana - <strong>si</strong>ngura po<strong>si</strong>bilitate de nastere.<br />
Hemoragia poate fi catastrofala.<br />
Anestezia: AG<br />
- abord <strong>in</strong>travenos dublu 14G<br />
- profilaxia antiacida<br />
- sange >6 unitati<br />
- dispozitive de transfuzare rapida<br />
- monitorizare TA <strong>in</strong>vaziva<br />
- histerectomie<br />
EMBoLIa aMnIotIca<br />
Cl<strong>in</strong>ic:<br />
- dispnee<br />
- convul<strong>si</strong>i<br />
- colaps cardio-vascular<br />
- coagulopatie cu hemoragie ma<strong>si</strong>va.<br />
Diagnostic - pr<strong>in</strong> excludere + <strong>si</strong>mptome cl<strong>in</strong>ice<br />
Management:<br />
- nespecific<br />
- suportiv:<br />
A-airway<br />
B-breath<strong>in</strong>g<br />
C-circulation<br />
- resuscitare cardiorespiratorie daca este cazul<br />
- provocarea nasterii<br />
- tratarea <strong>in</strong>suficientei cardiace<br />
- tratarea hemoragiei <strong>si</strong> a tulburarilor de coagulare<br />
- transfer <strong>in</strong> sectia TI<br />
rEtEntIa PLacEntara<br />
- Acces iv larg 14-16 G<br />
- Evaluarea ratei/cantitatii hemoragiei <strong>si</strong> a stabilitatii cardio-vasculare<br />
- Anestezie regionala daca pierderea sangv<strong>in</strong>a < 1000 ml (sp<strong>in</strong>ala monodoza<br />
sau peridurala pe cateter preexistent)<br />
- Anestezie generala daca sunt semne de hipovolemie marcata<br />
259<br />
Obstetrică
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