Blood pressure monitoring using the superficial temporal artery and a Doppler ultrasonic flow detector

Managing a Pregnancy With Maternal Amelia

INTRODUCTION

Amelia, the complete absence of a limb, presents various management issues in pregnancy and delivery.

CASE

A woman with amelia of both lower limbs and flipper-like upper limb buds (phocomelia) presented in her first pregnancy at 19 weeks of gestation. Challenging issues encountered in the care of the patient included venous access, reliable blood pressure measurement, recommendations regarding mode of delivery, and preparation for caring for the child. The patient had abnormalities of the pelvis but an adequate midpelvis, so she was able to deliver vaginally without complication.

CONCLUSION

Careful planning to allow necessary modification of intrapartum management can allow for normal vaginal birth for a patient with severe limb reduction abnormalities such as amelia and phocomelia.

Dental anaesthesia for a child with complete amelia

A four year-old boy born without limbs (amelia) presented for dental restorations under general anaesthesia as an outpatient. Following intramuscular atropine administration anaesthesia was induced using halothane, oxygen and nitrous oxide inhaled by mask. Next, intravenous access was secured by external jugular vein catheterization. Because of his small mouth, hypognathic mandible, arched palate and anterior-superiorly located larynx, oral intubation under deep anaesthesia during spontaneous ventilation was difficult. The epiglottis was noted to be inverted on subsequent laryngoscopic inspection after intubation but was reduced mechanically to anatomic position. Despite being unable to accurately monitor the blood pressure the intraoperative period was uneventful. Postoperatively the patient was extubated and was able to return home the same day.