You have attempted to top up an epidural for a category one caesar for fetal distress. The block seems adequate but once the surgeons enter the abdomen your patient complains of significant pain and you decide to convert to general anaesthesia. You perform an RSI with propofol and rocuronium. After intubation she has a heart rate of 130 and an NIBP of 155 / 90. Your registrar asks “why didn’t we give her any opioid?” and you patiently explain that we avoid opioids unitl after delivery because we don’t want them to cross the placenta and to cause respiratory depression in the neonate……………but is this always true???
Hi everyone,
Join Jacob and I as we discuss the recent literature surrounding this topic. What is the evidence? What about the short acting opioids such as alfentanil & remifentanil? What are the advantages / disadvantages of using an opioid and what are the downsides of not using opioids?
References
Best practice in obstetric general anaesthesia: an umbrella review of pharmacological strategies for induction of general anaesthesia. Anaesthesia, 81: 1269-1280. 2026. https://doi.org/10.1111/anae.70214 (https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.70214)
9 Sept 2026
154 Obstetrics in the ANZCA final exam — Part 2
Join Sarah & Declan as we continue our series covering the ANZCA final exam curriculum for obstetrics across four episodes. This second episode covers complications in labour and delivery including management of postpartum haemorrhage.
We hope this resource will be helpful for everyone, but especially those of our trainees preparing for the final exam. To get the most out of it, we suggest regularly pausing the podcast to answer each question yourself, before listening to our answers. Of course there is much more detail expected in the exam, but if you can answer all these questions confidently, we think you’ll have a great chance.
If you find this podcast helpful, or have suggestions for future episodes in this series, please send us an email to let us know.
Resources mentioned in this episode:
Question 1: AFE, haemorrhage management
BJA Education — Haemostatic agents in the management of obstetric haemorrhage (2024)
https://www.bjaed.org/article/S2058-5349(24)00089-1/fulltext (https://www.bjaed.org/article/S2058-5349(24)00089-1/fulltext)
RANZCOG — Management of Postpartum Haemorrhage (2021)
https://www.ranzcog.edu.au/wp-content/uploads/Management-Postpartum-Haemorrhage.pdf (https://www.ranzcog.edu.au/wp-content/uploads/Management-Postpartum-Haemorrhage.pdf)
BJA Education — Amniotic fluid embolism (2018)
https://www.bjaed.org/action/showPdf?pii=S2058-5349%2818%2930060-X (https://www.bjaed.org/action/showPdf?pii=S2058-5349%2818%2930060-X)
BJA Education — Point-of-care viscoelastic testing (2022)
https://www.bjaed.org/article/S2058-5349(22)00094-4/fulltext (https://www.bjaed.org/article/S2058-5349(22)00094-4/fulltext)
Deranged Physiology — Interpretation of abnormal ROTEM data
https://derangedphysiology.com/main/required-reading/haematology-and-oncology/Chapter-108/intepretation-abnormal-rotem-data (https://derangedphysiology.com/main/required-reading/haematology-and-oncology/Chapter-108/intepretation-abnormal-rotem-data)
Question 2: GA unstable bleeding pt, uterine inversion management
RANZCOG — Management of Postpartum Haemorrhage (2021)
https://www.ranzcog.edu.au/wp-content/uploads/Management-Postpartum-Haemorrhage.pdf (https://www.ranzcog.edu.au/wp-content/uploads/Management-Postpartum-Haemorrhage.pdf)
BJA Education — Uterine inversion (2024)
https://www.bjaed.org/article/S2058-5349(24)00009-X/fulltext (https://www.bjaed.org/article/S2058-5349(24)00009-X/fulltext)
Question 3: Placenta accreta planning and management
RANZCOG — Placenta Accreta Spectrum (PAS) (C-Obs 20) (2023)
https://ranzcog.edu.au/wp-content/uploads/Placenta-Accreta-Spectrum.pdf (https://ranzcog.edu.au/wp-content/uploads/Placenta-Accreta-Spectrum.pdf)
BJA Education — Management of patients with suspected placenta accreta spectrum (2022)
https://www.bjaed.org/article/S2058-5349(21)00131-1/fulltext (https://www.bjaed.org/article/S2058-5349(21)00131-1/fulltext)
Question 4: Foetal demise
SOAP — Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients with Thrombocytopenia (2021)
https://www.soap.org/assets/docs/Consensus/SOAP%20Consensus%20Statement%20Thrombocytopenia%202021.pdf (https://www.soap.org/assets/docs/Consensus/SOAP%20Consensus%20Statement%20Thrombocytopenia%202021.pdf)
18 Aug 2026
153 Dexmedetomidine in O&G
Hi everyone
Dexmedetomidine, is both a difficult word to pronounce correctly in casual conversation but also a useful pharmacological tool in many different situations.
This week I am joined by one of our fellows Dr Han Lu to discuss dexmedetomidine, it’s history, it’s basic pharmacology and then more specifically it’s use in different clinical situations where it may be useful in obstetrics and gynaecology.
Thanks Han for a great Tuesday talk and a very informative podcast!
References
Han’s powerpoint talk (https://www.obsgynaecritcare.org/wp-content/uploads/2026/08/Dexmed.pdf)
Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis. BJA September 2024 (https://www.bjanaesthesia.org/article/S0007-0912(24)00346-5/fulltext)
Crowe. G, et al Perioperative Applications of Dexmedetomidine. ATOTW 469 — Perioperative Applications of Dexmedetomidine April 2022 (https://resources.wfsahq.org/atotw/perioperative-applications-of-dexmedetomidine-atotw-469/)
Douglas MS, Soloniuk LJ, Jones J, Derderian R, Baker C, Stier G. Intravenous dexmedetomidine use in obstetric anesthesia: a focused review. Int J Obstet Anesth. 2025 May;62:104345. doi: 10.1016/j.ijoa.2025.104345. Epub 2025 Feb 13. PMID: 40090158 (https://www.obstetanesthesia.com/article/S0959-289X(25)00017-2/abstract)
Atipamezole – alpha 2 agonist reversal agent used in veterinary practice (https://en.wikipedia.org/wiki/Atipamezole)
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