Journal of perinatal medicine
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Neuraxial labor analgesia can be initiated via combined spinal-epidural (CSE) or stand-alone epidural. Pros and cons of these techniques are outlined in this review. In recent years computer-integrated patient-controlled epidural analgesia (CI-PCEA) and programed intermittent epidural boluses (PIEB) have been developed, adding to continuous infusion and PCEA for the maintenance of neuraxial analgesia. ⋯ Due to the increase in obesity the specific considerations for this patient group are discussed. New data have been presented for remifentanil, an ultra-shortly acting opioid, that is used in obstetric analgesia. Without breaking new data, the use of nitrous oxide especially by midwives has a kind of renaissance, and this will be discussed, too.
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We investigated the accuracy of left-to-right shunt detection using transpulmonary ultrasound dilution (TPUD) and compared the agreement between pulmonary over systemic blood flow (Qp/Qs) ratio measured by TPUD [Qp/Qs(tpud)] and ultrasonic flow probes [Qp/Qs(ufp)]. ⋯ The qualitative diagnostic accuracy of TPUD for shunt detection is high. Modification of the algorithm seems required as shunt quantification by TPUD is accurate, but not yet very precise.
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Randomized Controlled Trial
Extra-abdominal removal of placenta during cesarean section: a prospective randomized controlled trial of a novel technique.
To evaluate intraoperative and early postoperative outcomes of a novel placenta delivery technique; extra-abdominal removal vs. intra-abdominal removal of the placenta during cesarean section (CS). ⋯ By extra-abdominal removal of the placenta, the accumulation of bloody fluid in the abdominal cavity is significantly less compared to the intra-abdominal removal method, which, in turn, provides avoidance of excessive mounted-gauze use, intra-abdominal manipulations, or iatrogenic trauma.
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To compare the frequency of histologic chorioamnionitis and funisitis among women experiencing preterm labor, preterm premature rupture of membranes (PROM) and cervical insufficiency. ⋯ The highest frequency of funisitis was observed in cervical insufficiency among cases with spontaneous preterm birth.
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Randomized Controlled Trial Comparative Study
The effect of the use of oxytocin on blood loss during different postpartum periods.
Postpartum hemorrhage is the most important reason for maternal mortality. In developed countries, the reason of 13% of maternal deaths is postpartum hemorrhage while this percentage reaches more than 30% in other countries. In this study, the effect of oxytocin use in different times at the 3rd stage of delivery on changes in the postpartum hemoglobin levels was compared. ⋯ It was determined that the use of oxytocin after shoulder delivery has more effects on decreasing the amount of postpartum hemorrhage.