Journal of perinatal medicine
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We report on an exceptional therapy with epidural anesthesia and tunnelling of the peridural catheter over a time period of 2-14 days in patients with threatening early preterm labor, intact membranes and vaginal engagement of the infants (4 singleton, 8 twin and 2 triplet pregnancies). A combination of bupivacaine (0.125%) and fentanyl (2 microg/mL) was used up to a maximum of 20 mL/h during the treatment period. Long-term follow-up of the infants was normal in 19/20 infants. ⋯ The online version of the Journal (see http://dx.doi.org/10.1515/jpm.2008.081_supp-1) allows video illustrations of a triplet pregnancy, in which the first triplet was born after one week of epidural anesthesia and the pregnancy continued under epidural anesthesia for the remaining two triplets staying with intact membranes in the vagina (delayed interval delivery) for six more days. The results of this pilot series suggest that prolongation of these pregnancies under epidural anesthesia might be an option in exceptional cases when viability is questionable or when corticosteroid therapy is desired before final delivery. Further evaluation of this strategy is needed but only in tertiary centers with 24-h presence of qualified obstetric and neonatal care and intensive surveillance.
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Letter Case Reports
Non-cardiogenic lung edema in a woman treated with atosiban for preterm labor.
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Randomized Controlled Trial Comparative Study
A randomized trial of tight vs. less tight control of mild essential and gestational hypertension in pregnancy.
To assess the effects of applying a tight vs. a less tight control of mild chronic essential or gestational non-proteinuric hypertension in pregnancy. ⋯ Tight control of blood pressure reduces the rate of antenatal hospitalization and does not adversely affect perinatal outcomes in women with mild essential or gestational hypertension.
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Severe peripartum hemorrhage (PPH) contributes to maternal morbidity and mortality and is one of the most frequent emergencies in obstetrics, occurring at a prevalence of 0.5-5.0%. Detection of antepartum risk factors is essential in order to implement preventive measures. ⋯ An up-to-date presentation of the importance of embolization and of the diagnosis of coagulopathy in PPH is provided. Furthermore, the committee recommends changes in the management of PPH including new surgical options and the off-label use of recombinant factor VIIa.
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Regional anesthesia for pain at delivery in the presence of maternal thrombocytopenia is a clinical dilemma. We reviewed 10,369 obstetric cases (12 months) from our tertiary center. Generally, hemodilution of pregnancy does not result in thrombocyte counts of <150,000/mm(3) at delivery. ⋯ There were no statistically significant differences in mean birth weights. Women with thrombocytes <150,000/mm(3) at birth but within the normal range at week 36 were more likely multiparas (P=0.001). We conclude that a difference in maternal and neonatal outcomes exists between mothers who were thrombocytopenic only at delivery compared to those with trimester-long thrombocytopenia, with the latter mothers and babies having more adverse events.