In this podcast, Becky Taylor and Blake Kesby discuss spinals and epidurals, what they are, what the difference is, and how to manage patients going into labour requesting an epidural. Becky and Blake discuss when you might encourage spinals and epidurals, considerations to keep in mind, anaesthetic contraindications, and risks. They also cover an approach to postdural puncture headache (PDPH).
Summary Writers: Becky Taylor and Jane McDonnell
Script Writer: Jane McDonnell
Editor: Blake Kesby
Interviewer: Becky Taylor
Interviewee: Blake Kesby
Rebecca (Becky) Taylor is a 5th year O&G trainee. Originally hailing from the UK, she trained at the University of Edinburgh where she also completed her internship and residency, before moving to Australia. She undertook her basic O&G training at Royal Prince Alfred Hospital in Sydney and is currently undertaking a six-month fertility fellowship at Westmead Hospital. When Becky’s not knee-deep in amniotic fluid she is a keen swimmer and free diver, a terrible cook and married to an anaesthetist she met at a Cat One Caesarean.
Blake Kesby is a Consultant Anaesthetist at Royal North Shore Hospital in Sydney, Australia. He has a special interest in medical education, particularly simulation-based training. When he’s not putting people to sleep he’s a keen free diver, an excellent cook, and married to the O&G Reg who roped him into this podcast.
With Dr Becky Taylor, Obstetrics & Gynaecology Fellow based in Sydney and Dr Blake Kesby, Consultant Anaesthetist at Royal North Shore Hospital.
A 30-year-old primigravid woman, Annie, is in spontaneous labour at 39 weeks’ gestation. Her last vaginal examination was performed 3 hours ago and she was 4cm dilated. She has been using nitrous gas with good effect but now the pain is increasing and she is requesting an epidural. She has a pre-pregnancy BMI of 30 and no other medical issues.
Case: Annie’s epidural is working well. The obstetric registrar is asked to review her 4 hours later and she remains 4cm dilated. Her CTG demonstrates recurrent complicated variable decelerations and the decision is made to proceed to an emergency Caesarean section.
Case: Annie proceeds to an uncomplicated Caesarean section and delivers a healthy baby girl. She is reviewed the following day and complains of a headache which doesn’t resolve with paracetamol.
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