International journal of obstetric anesthesia
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We report a case of a parturient with documented chronic Chagas' disease with cardiac manifestations presenting for labor management and complicated by the need for emergent hysterectomy after delivery. Chagas' disease is a common human hematogenous trypanosomiasis in Central and South America which is now, because of population migration, appearing in the USA. This disease predominantly affects the heart and the gastrointestinal system. This report discusses the parasite, the acute and chronic phases of Chagas' disease and highlights its medical implications, including maternal-fetal transfer of Trypanosoma cruzi.
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Int J Obstet Anesth · Apr 1996
An investigation of the changes in aortic diameter and an evaluation of their effect on Doppler measurement of cardiac output in pregnancy.
Measurement of cardiac output by means of Doppler ultrasound is based on the velocity of aortic blood flow and therefore requires that aortic diameter should not change between measurements. Work has been published which suggests that, in pregnancy, aortic diameter varies significantly with systemic blood pressure. ⋯ This study investigated the changes in aortic diameter with blood pressure in patients having spinal anaesthesia for caesarean section. Aortic diameter did appear to vary with blood pressure but this variation was within the error of the measurement and did not significantly affect the accuracy of the technique.
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Int J Obstet Anesth · Apr 1996
An audit cycle of blood ordering practice in a district maternity unit reduces unnecessary crossmatching.
We audited the appropriateness of blood ordering in our obstetric unit, by analysing the ratio of number of units of blood cross-matched to number transfused (C:T ratio), both overall and for specific indications. Based on this information, we devised a new blood ordering policy, and repeated the audit once this was in operation. The new policy resulted in a substantial increase in the efficiency of blood ordering. The overall C:T ratio fell from 10.9 to 3.0, and there were particularly large falls for caesarean section (from 34.3 to 6.2), high risk labours (from 67.8 to 9.1) and post-partum haemorrhage/retained placenta (from 4.3 to 1.9).
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A multigravid patient was admitted at 34 weeks with abdominal pain, signs of hypovolaemia and an intrauterine death. Ultrasonography and paracentesis revealed bleeding into the peritoneal cavity. The diagnosis of splenic artery aneurysm rupture was considered. Energetic resuscitation and a multidisciplinary approach to surgery allowed a sacular splenic artery aneurysm to be tied off with preservation of both the spleen and the mother's life.