A parturient with a history of extremely difficult intravenous access recently presented
to our unit. She had previously required two category-3 caesarean sections, at 29
and 32 weeks of gestation, respectively, for severe early-onset preeclampsia. On both
occasions, despite multiple attempts at siting both peripheral and central access
by different consultant anaesthetists, surgical cut-down procedures were required
to provide venous access before surgery. She was therefore referred to our High Risk
Obstetric Anaesthetic Clinic for assessment at 16 weeks of gestation in her third
pregnancy. At that stage she had one palpable vein in her right antecubital fossa
and visible scarring on her other limbs from previous cut-downs. Although venous access
was considered possible in an elective situation, potentially with radiological guidance
or further cut-downs, the patient was obviously at risk if presenting as an emergency.
Central access had previously not been possible and with only an obstetric ultrasound
scanner available on the delivery suite in an acute situation, we were not confident
that this would be a reliable option.
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Lewis G, editor. The Confidential Enquiry into Maternal and Child Health (CEMACH); Saving Mothers, Lives: Reviewing maternal deaths to make motherhood safer 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. London; CEMACH: 2007.
Article info
Publication history
Published online: June 06, 2011
Accepted:
January 31,
2011
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
