International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1998
Management of a parturient with an uncorrected atrioventricular canal defect.
A 24-year-old woman at 37 weeks gestation, with an uncorrected atrioventricular canal defect and incipient congestive heart failure is presented. This rare defect is part of the larger group of endocardial cushion defects. ⋯ Her pregnancy was maintained until she developed symptoms of congestive heart failure. We discuss her peripartum management, monitoring and anesthetic choices.
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Int J Obstet Anesth · Jul 1998
Severe mitral stenosis in a parturient with congestive cardiac failure and hypoglycaemia.
We report a case of maternal mortality in a 34-year-old multipara who presented at the 35th week of gestation with severe hypoglycaemia. She had no history of diabetes mellitus. This episode was a prelude to catastrophic and refractory congestive cardiac failure due to previously undiagnosed severe mitral stenosis. ⋯ She also developed deranged liver function with disseminated intravascular coagulation, which mimicked acute fatty liver of pregnancy. The problems of diagnosis and management are discussed. Unfortunately the patient died before mitral valvular commissurotomy could be effected.
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We report a case of meningitis developing a number of days after a subarachnoid block for caesarean section. No organisms were grown but the clinical picture was suggestive of bacterial meningitis, the clinical course of which had been modified by the administration of antibiotics for presumed wound infection. The possible aetiology is discussed.
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Int J Obstet Anesth · Jul 1998
Anaesthetic management of vaginal delivery in a woman with Friedreich's ataxia complicated by cardiomyopathy and scoliosis.
We report the anaesthetic management of vaginal delivery in a woman with Friedreich's ataxia, who had hypertrophic cardiomyopathy and had previously undergone thoracic spinal fusion with Harrington rod fixation. Combined spinal-epidural analgesia was used. Options for the anaesthetic management of labour and delivery are discussed.
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Int J Obstet Anesth · Jul 1998
Epidural analgesia for term vaginal delivery after balloon valvotomy for mitral stenosis at 24 weeks gestation.
A woman presented at 24 weeks gestation with previously undiagnosed mitral stenosis. She did not respond to conservative management and underwent successful percutaneous balloon mitral valvotomy for refractory congestive cardiac failure, with complete resolution of her symptoms. The remainder of her pregnancy was uncomplicated and she delivered a healthy infant at 39 weeks gestation. An epidural block provided analgesia/anesthesia for vaginal delivery and repair of the perineal tear.