Use of a Superficial Abdominal Wall Vein in a Gravida Patient for Emergency Vascular Access

Obtaining vascular access through a superficial vein of the abdominal wall of a gravida patient is an option in an emergency Cesarean surgery when other means fail. Such superficial veins may be mistaken for striae gravidarum on physical exam. A small intravenous (IV) cannula is not ideal but could save valuable time and avoid delaying induction of general anesthesia. Once the airway is secured, a larger bore IV can then be inserted while surgical exposure is undergoing. Analysis of the risks and benefits of inducing general anesthesia with a small gauge IV for a gravida patient should take into consideration risk factors for massive peripartum hemorrhage such as placental disorders (accreta, increta, precreta, abruption, or previa), presence of uterine fibroids, preeclampsia, hemolysis, elevated liver enzymes, low platelet count (HELP syndrome), severe polyhydramnios, history of grand multiparty, and bleeding disorders such as Von Willibrands and hemophilia.