# Obstetric OT Preparation

> Obstetric OT preparation for OT Technology: left uterine tilt, RSI for caesarean, neonatal resuscitation trolley, PPH tray and spinal anaesthesia setup.

- Canonical URL: https://prepelephant.com/topics/allied/operation-theatre-technology/obstetric-ot-preparation
- Exam / course: Allied Health · Subject: Operation Theatre Technology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Obstetric OT Preparation", PrepElephant, https://prepelephant.com/topics/allied/operation-theatre-technology/obstetric-ot-preparation

## Direct answer

Two patients share one operating table in every caesarean section, and the theatre prepares for both: for the mother, a rapid-sequence induction setup with working suction, 15–30 degree left uterine tilt against aortocaval compression, cross-matched blood traceable in minutes, and a PPH tray with oxytocin, ergometrine, carboprost and misoprostol; for the newborn, a checked radiant warmer with a resuscitation trolley — small self-inflating bag, appropriately sized masks, low-pressure suction, and warming linen. Elective lists run spinal anaesthesia with the same readiness behind them — an elective caesarean can become the haemorrhage or the depressed neonate of now. The technician's craft is that neither trolley ever needs assembling after the emergency begins.

## What you must remember

- **Aortocaval compression:** from about 20 weeks, supine position compresses the inferior vena cava — 15–30 degrees left tilt or manual uterine displacement is standard for every obstetric procedure.
- **Aspiration risk:** pregnancy delays gastric emptying and raises acidity — rapid sequence induction with cricoid pressure, and prophylaxis such as a non-particulate antacid or ranitidine per protocol for elective cases.
- **Spinal anaesthesia for caesarean:** pencil-point needle (25–27 G), hyperbaric bupivacaine 0.5% commonly 2–2.5 mL (about 10–12.5 mg) with opioid adjunct; block to about T4 for surgical anaesthesia; hypotension pre-empted with fluids and vasopressor ready.
- **Neonatal trolley:** functioning radiant warmer, self-inflating bag (paediatric size) with masks from neonatal down, T-piece device if used, suction regulated to low negative pressure (roughly 80–100 mmHg), stethoscope, timer, warm towels — checked before every case, not every day.
- **PPH tray:** oxytocin 5 IU slow IV at delivery with infusion prepared, ergometrine 0.25 mg IM (avoided in hypertension and pre-eclampsia), carboprost 250 μg IM every 15 minutes to a maximum of 8 doses (avoided in asthma), misoprostol 800 μg sublingual as a further line.
- **Blood readiness:** group and save minimum for low-risk cases, cross-matched units for expected difficulty — with the emergency release ("group O negative") pathway known.
- **Third stage and counting:** controlled cord traction, a staged placenta tray, and counts as rigorous as any laparotomy.
- **Uterotonic cross-check:** the tray's contraindications checked aloud — ergometrine with hypertension, carboprost with asthma — before the rush, not during it.

## Elective list to emergency add-on in one shift

The morning list is three elective caesareans under spinal. Before the first patient: the neonatal trolley checked item by item — warmer heated, bag assembled and valve tested, two mask sizes, suction set low, towels warmed. The spinal trolley carries pencil-point needles, fluids running, vasopressor drawn; the mother tilted as soon as she lies down; the PPH tray sealed, its contraindications flagged on the card.

Mid-list the call comes: fetal distress, category-one section, general anaesthesia. The calm converts on rehearsed rails — table tilting left, suction at the head tested at the catheter, RSI drugs drawn, cricoid pressure assigned by name. The surgeon preps while the anaesthetist induces; the scalpel waits only for the anaesthetist's "go". The neonate arrives depressed: warmed towels, drying, airway positioning, bag ventilation at the warmer, the timer running while the paediatric team called. Mother-side, the oxytocin runs, the placenta is inspected, counts complete, and both trays are restocked before the next patient — readiness is the treatment.

## Where students slip

The examination traps are the tilt's reason and the uterotonic contraindications. "Left tilt for comfort" scores nothing — it relieves aortocaval compression, preventing supine hypotension and placental underperfusion; the number (15–30 degrees) and manual uterine displacement belong in the answer. The drug pairs get swapped under pressure: ergometrine avoided in hypertension and pre-eclampsia, carboprost avoided in asthma — a viva favourite because both sit on the same tray card. Candidates also describe neonatal resuscitation equipment in adult terms: the self-inflating bag must be the paediatric size with a pressure-limiting valve, suction must be low-pressure, and the first intervention is drying and warmth. Finally, "counting can be skipped in a bleeding caesarean" is a failing answer — PPH is exactly the case where packs are lost and exactly why counts are never suspended.

## Frequently asked questions

### Why is left uterine tilt used in obstetric anaesthesia?

To relieve aortocaval compression by the gravid uterus beyond about 20 weeks — 15–30 degrees left lateral tilt or manual uterine displacement maintains venous return and placental perfusion.

### What spinal dose is typical for elective caesarean section?

Hyperbaric bupivacaine 0.5%, commonly about 2–2.5 mL (10–12.5 mg) through a 25–27 G pencil-point needle, targeting a block to around T4, with hypotension pre-empted.

### What must the neonatal resuscitation trolley carry?

A functioning radiant warmer, paediatric self-inflating bag with pressure-limiting valve, term and preterm masks, low-pressure suction, warm towels, stethoscope and timer — checked before every delivery.

### Which uterotonics make up the PPH tray?

Oxytocin (5 IU slow IV with infusion), ergometrine 0.25 mg IM, carboprost 250 μg IM (repeat to 8 doses) and misoprostol 800 μg sublingual — staged with their contraindications flagged.

### Why is ergometrine avoided in pre-eclamptic patients?

It causes intense vasoconstriction and can precipitate hypertensive crisis; carboprost is similarly avoided in asthma — hence the tray's cross-check card.