{"title":"Physiology of pregnancy","authors":"Nancy Ghosh, Kirsty MacLennan","doi":"10.1016/j.mpaic.2025.02.014","DOIUrl":"10.1016/j.mpaic.2025.02.014","url":null,"abstract":"<div><div>During pregnancy, maternal physiology undergoes continual adaptation. These often-interlinked changes occur in all body systems and are affected by the hormonal influences of the placenta and the mechanical adaptations required to accommodate the developing fetus. These important physiological changes can potentially lead to decompensation in parturients with pre-existing comorbidities. They may also unmask asymptomatic pre-pregnancy disease. A sound knowledge of the expected maternal changes is essential to enable accurate interpretation of physiological and laboratory parameters. This allows for the implementation of robust care planning with the aim of reducing potential complications.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 220-226"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pre-eclampsia – anaesthetic considerations","authors":"Caroline Thompson, W Ross Macnab","doi":"10.1016/j.mpaic.2025.01.015","DOIUrl":"10.1016/j.mpaic.2025.01.015","url":null,"abstract":"<div><div>Pre-eclampsia is a multisystem disorder associated with end-organ damage that forms part of the spectrum of hypertensive disorders of pregnancy. It occurs after 20 weeks’ gestation and contributes to significant maternal and fetal morbidity. In the UK, it was responsible for nearly 2.5% of maternal deaths in the recent maternal confidential death report. Placental growth factor-based testing and estimation of soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PIGF) ratio can improve diagnostic accuracy and predict the risk of maternal complications. Aspirin in the dose of 75–150 mg for antenatal prophylaxis, targeted blood pressure control using anti-hypertensive medications, fluid restriction, magnesium sulphate for seizure prophylaxis and timely delivery remain the key strategies to decrease maternal morbidity. Anaesthetists may be involved as part of multidisciplinary team in managing hypertensive and obstetric emergencies in severe pre-eclampsia, facilitate resuscitation, monitoring and stabilization, and provision of appropriate labour analgesia and anaesthesia. Neuraxial anaesthesia provided the coagulation status is normal is preferred for operative interventions. If a general anaesthesia is administered, anaesthetists should be cognisant of the precipitant nature of pre-eclampsia. This should include preparation for a potential difficult intubation, plans to obtund the pressor response to laryngoscopy and avoidance of hypertension on emergence from anaesthesia. Critical care input may be useful in women with cardio-respiratory, neurological, and hepato-renal morbidity.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 201-207"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Antenatal anaesthetic assessment of obstetric patients","authors":"Nosakhare A. Uwubamwen, Dipali Verma, Ben Jones","doi":"10.1016/j.mpaic.2025.01.018","DOIUrl":"10.1016/j.mpaic.2025.01.018","url":null,"abstract":"<div><div>Early identification and anaesthetic assessment of high-risk patients in pregnancy is important and best delivered through a formal assessment clinic. It provides the opportunity to provide information, agree management plans, and carry out necessary investigations and referrals to other specialists prior to labour and delivery. Clear referral criteria and lines of communication are necessary for an effective service.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 183-186"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Spinal-induced hypotension at caesarean section","authors":"Sara Harrop, Catherine E Armstrong","doi":"10.1016/j.mpaic.2025.01.012","DOIUrl":"10.1016/j.mpaic.2025.01.012","url":null,"abstract":"<div><div>Spinal-induced hypotension (SIH) is a common but potentially serious side effect of spinal anaesthetics during caesarean section, with potential maternal and fetal consequences. A number of non-pharmacological methods can be employed to reduce the incidence of SIH, including maternal positioning and fluids. However, these should be used in conjunction with pharmacological methods, which have been shown to be superior in reducing SIH. For many years phenylephrine has been the standard vasopressor in obstetrics, but emerging evidence indicates that there may be more appropriate pharmacological options, with a promising/recent focus on investigating noradrenaline.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 197-200"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intrauterine fetal resuscitation","authors":"Ahmed Mahfouz, Suna Monaghan, Amanda Zacharzewski","doi":"10.1016/j.mpaic.2025.01.013","DOIUrl":"10.1016/j.mpaic.2025.01.013","url":null,"abstract":"<div><div>Oxygen transport from the atmosphere to the fetus is dependent on maternal, placental and fetal factors. If any of these are disturbed, progressive fetal hypoxia and acidosis occur. Electronic fetal heart rate (FHR) monitoring is considered the primary method to assess fetal condition. Fetal distress refers to the presence of a non-reassurance heart trace, irrespective of the presence or absence of fetal acidosis. Intrauterine fetal resuscitation (IUFR) is a practice designed to enhance oxygen delivery to the placenta and maintain umbilical blood flow to counteract fetal hypoxia and acidosis, enabling safe delivery. IUFR measures might include: (i) re-positioning of the parturient to left lateral or alternative to relieve aortocaval compression; (ii) reducing uterine contractions by stopping oxytocics and using tocolytics (iii) correcting maternal hypotension and maximizing uterine blood flow via rapid intravenous crystalloid infusion; and (iv) maternal oxygen administration to reduce fetal hypoxaemia. IUFR measurements are simple to implement, do not need extensive resources and can lead to considerable improvements in fetal health. Anaesthetists play a pivotal role in IUFR and should be familiar with the process as they will be actively involved in the management of parturient during labour and before emergency surgical interventions.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 208-212"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.02.015","DOIUrl":"10.1016/j.mpaic.2025.02.015","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 227-228"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neuraxial analgesia in labour – initiation and maintenance techniques","authors":"Umer E Javed, Kailash Bhatia","doi":"10.1016/j.mpaic.2025.01.011","DOIUrl":"10.1016/j.mpaic.2025.01.011","url":null,"abstract":"<div><div>Neuraxial analgesia is the gold standard for managing pain during labour. Techniques employed to facilitate labour neuraxial analgesia include the use of an epidural catheter, the combined spinal epidural, the dural puncture epidural, and an intrathecal catheter. The adoption of these techniques for labour analgesia varies across different maternity units. Over time, numerous regimens have been developed for enhancing labour neuraxial analgesia effectiveness while minimizing maternal side effects. Patient-controlled epidural analgesia and programmed intermitted bolus techniques are now the most commonly utilized regimens for maintenance of neuraxial analgesia in the UK. This article explores the commonly used techniques and regimens utilized to initiate and maintain neuraxial analgesia in labour.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 191-196"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non-neuraxial analgesia in labour","authors":"Kerry Burnett, Supriya Mhatre, Vinayak Vanjari","doi":"10.1016/j.mpaic.2025.01.014","DOIUrl":"10.1016/j.mpaic.2025.01.014","url":null,"abstract":"<div><div>Labour pain is one of the most painful experiences encountered in healthcare. Labour analgesia can be provided by neuraxial or non-neuraxial techniques. Non-neuraxial analgesia can be offered in women in whom neuraxial techniques are contraindicated or are unsuccessful. They may also be chosen as a first-line analgesia by some women. The use of patient-controlled analgesia using remifentanil is a useful alternative to an epidural and is being offered by increasing number of delivery units.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 187-190"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Functions of the placenta","authors":"W Ross Macnab","doi":"10.1016/j.mpaic.2025.01.017","DOIUrl":"10.1016/j.mpaic.2025.01.017","url":null,"abstract":"<div><div>The placenta is an organ that connects a developing fetus to the uterine wall for the exchange of nutrients, antibodies and hormones between mother and fetus. The development of the placenta is essential for the removal of waste products, for fetal growth, development and the maintenance of a healthy pregnancy and it is an important endocrine organ.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 216-219"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Uterine physiology","authors":"W Ross Macnab","doi":"10.1016/j.mpaic.2025.01.016","DOIUrl":"10.1016/j.mpaic.2025.01.016","url":null,"abstract":"<div><div>The uterus serves the essential function of supporting the fetus throughout the duration of pregnancy until childbirth. It is anatomically divided into three main sections: the fundus, the body, and the cervix. The functioning of the uterus is primarily regulated by hormones, which induce considerable transformations during pregnancy. At the time of delivery, alterations in hormonal levels trigger cervical remodelling and uterine contractions, resulting in the expulsion of the fetus. Various medications can influence uterine activity and may be utilized to either initiate or inhibit labour.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 4","pages":"Pages 213-215"},"PeriodicalIF":0.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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