International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
A retrospective one-year single-centre survey of obstetric red cell transfusions.
Fears about safety and availability of blood in the United Kingdom have prompted efforts to encourage evidence-based blood transfusion in all areas of medicine, with increasing interest in the obstetric population. A retrospective one-year single-centre audit of obstetric red cell transfusions was conducted. ⋯ Overall there appeared to be a low threshold for red cell transfusion, with 31% of transfusions occurring despite a haemoglobin >7 g/dL and in the absence of ongoing bleeding or symptoms of anaemia. Such transfusions are deemed inappropriate according to the Royal College of Obstetricians and Gynaecologists guidelines. The main recommendations are to implement an educational programme and guidelines in all obstetric units, reduce blood use and encourage documentation of appropriate consent.
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Int J Obstet Anesth · Oct 2009
Case ReportsDexmedetomidine for awake fiberoptic intubation in a parturient with spinal muscular atrophy type III for cesarean delivery.
Spinal muscular atrophy in pregnancy is rare and poses multiple problems for the anesthesiologist. The effects of dexmedetomidine on a parturient with spinal muscular atrophy have not previously been reported. There are also no in vivo data on placental transfer of dexmedetomidine and its effects on a human neonate. ⋯ Apgar scores at 1 and 5 min were 6 and 8. The fetal concentration of dexmedetomidine (540 pg/mL) indicates significant placental transfer, but significant adverse neonatal effects were not observed. Dexmedetomidine alone provided adequate sedation for awake intubation without respiratory compromise in this patient.
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Int J Obstet Anesth · Oct 2009
Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric center.
The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center. ⋯ More formal assessment and documentation of the etiologic factors associated with transfusion management in pregnant patients is advised. In addition, the identification and management of undetected postpartum anemia is underappreciated.