The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
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J. Matern. Fetal. Neonatal. Med. · Apr 2020
Randomized Controlled Trial Multicenter StudyMaternal car driving capacity after birth: a pilot prospective study randomizing postnatal women to early verses late driving in a driving simulator.
Background: Women are commonly advised to avoid driving following cesarean section (CS), however, this advice is based upon little evidence. Aims: We aimed to assess a woman's capacity to drive a car postbirth using a driving simulator to objectively examine driving behavior and competencies. Materials and methods: We conducted a pilot, prospective, randomized study from a tertiary referral hospital in Sydney, Australia. ⋯ At 7-8 weeks, all women were driving, without an accident. Conclusions: Although the study is limited by small sample size, there was no difference in driving capability by early versus late driving time since birth, nor by mode of birth. Further research is needed, but we cannot provide evidence to discourage well women from driving from 2-3 weeks post birth.
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J. Matern. Fetal. Neonatal. Med. · Apr 2020
Case ReportsCardiac arrest in the delivery room after spinal anesthesia for cesarean section: a case report and review of literature.
Cardiac arrest in pregnancy is a rare event due to different cause. When it occurs after spinal anesthesia a cause that can explain this event is the Bezold-Jarish Reflex (BJR). ⋯ During this event perimortem caesarean delivery (PMCD) is the rapid surgical way that can improve maternal and fetal outcomes. In this situation, it is very important to have a multidisciplinary team of midwives, obstetricians, anesthetists, neonatologists, intensivists that is able to perform perimortem caesarean delivery according to the guidelines.
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J. Matern. Fetal. Neonatal. Med. · Mar 2020
Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study.
Objective: To determine the effectiveness of extending epidural analgesia following epidural labor analgesia for intrapartum cesarean section, and provide a reference for clinical practice. Methods: Data of 1254 singleton parturient who failed trial of epidural labor analgesia and underwent intrapartum cesarean section were retrospectively included. After entering the operating room, parturient were given 3 ml of 1.5% lidocaine with 1:200,000 epinephrine 15 µg as a test dose, followed by a dose of 10 ml 0.75% ropivacaine plus 5 ml of 2% lidocaine mixed solution was administered via the epidural catheter. ⋯ Adverse reactions of extending epidural anesthesia: 6.7% (72 of 1067) parturient experienced hypotension and 12.1% (129 of 1067) of nausea and vomiting occurred. For the neonatal Apgar scores at 1 min, eleven of 1254 (0.9%) newborns were between 0 and 3 points, 107 (8.5%) newborns between 4 and 7 points, and 1136 (90.6%) newborns Apgar scores between 8 and 10 point. 24 (1.9%) newborns with Apgar scores between 4 to 7 points at 5 min transferred to the department of neonatology, and the rest 1230 (98.1%) newborns with Apgar scores 8-10 points. Conclusion: Extending epidural analgesia using the well-functioning epidural catheter for epidural labor analgesia might be a reliable and effective anesthetic method for intrapartum cesarean section.
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J. Matern. Fetal. Neonatal. Med. · Mar 2020
Scheduled versus as-needed postpartum analgesia and oxycodone utilization.
Background: An optimal approach for providing sufficient postpartum analgesia while minimizing the risk of opioid misuse or diversion has yet to be elucidated. Moreover, there is scant literature on the efficacy of around-the-clock (ATC) scheduled dosing of opioid analgesia compared to pro re nata (PRN; as-needed) dosing for postpartum pain management. Here we evaluate a quality improvement intervention that aimed to proactively provide pain relief with a multimodal analgesic regimen that includes oxycodone at scheduled time intervals. ⋯ Scheduled multimodal analgesia was associated with an improvement in HCAHPS scores for patient reported pain control after cesarean section (63 versus 71% reporting "Always" well controlled; p < .001) but had no effect after vaginal delivery. Conclusion: After cesarean delivery, scheduled multimodal analgesia that includes ATC dosing of acetaminophen, ibuprofen, and low-dose oxycodone, with the option to decline any of these medications, does not increase the percentage of women who receive oxycodone or mean oxycodone consumption per inpatient day compared to as-needed analgesia. After vaginal delivery, scheduled multimodal analgesia is associated with an increase in the percentage of women who receive oxycodone but no change in mean oxycodone consumption per inpatient day.
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J. Matern. Fetal. Neonatal. Med. · Feb 2020
Literature review on the distribution characteristics and antimicrobial resistance of bacterial pathogens in neonatal sepsis.
Purpose: Neonatal sepsis (NS) has no specific clinical manifestations and blood culture analysis requires a long period of time. Knowledge of prevalent bacterial isolates and their antibiotic susceptibility is crucial when choosing an empirical therapy to decrease morbidity and mortality. This literature review summarizes the distribution characteristics and antimicrobial resistance of bacterial pathogens associated with bloodstream infections in Chinese neonates, and thus serves as a reference for pediatricians. ⋯ For Gram-negative enteric bacteria, aminoglycoside and carbapenem were sufficient for treatment. Compared to the CARSS data on bacterial resistance, the data in this review on the resistance of pathogens causing NS were not favorable. The next goal in antibiotic management in NICUs must be to develop strategies to reduce the use of antibiotics.