ANAESTHETIC MANAGEMENT OF FETAL HEAD ENTRAPMENT
INTRAVENOUS NITROGLYCERIN (GTN)
* GTN must be immediately availablefor all vaginal breech deliveries.
* Inject GTN 250-500mcg intravenously (IV) in divided doses.
* Monitor maternal blood pressure and heart rate.
* 40-60 seconds after the dose, maternal tachycardia (which signals the onset of uterine relaxation) ensues.
* When maternal tachycardia occurs, advise the obstetrician of the onset of uterine relaxation.
* Give an additional GTN 250mcg IV, if necessary.
* Continue to monitor blood pressure, and heart rate. (Rarely, phenylehrine 20 to 40 mcg IV, may be necessary to restore blood pressure but should not be administered before delivery).
TERBUTALINE
* Inject terbutaline 250mcg subcutaneously.
* Monitor maternal blood pressure and heart rate.
* Avoid fluid overload (risk of pulmonary oedema).
GENERAL ANAESTHESIA (LEAST PREFERABLE OPTION)
* Rapid sequence induction.
* Tracheal intubation.
* Administer > 2 MAC volatileagent (preferably halothane).
* Monitor maternal vital signs appropriately.