International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Randomized Controlled Trial Comparative StudyA randomized controlled study of whether the partner's presence in the operating room during neuraxial anesthesia for cesarean delivery reduces patient anxiety.
This study compared anxiety in two groups of women undergoing elective cesarean delivery to ascertain if their partner's presence during neuraxial anesthesia placement affected patients' overall anxiety levels. ⋯ Although patients whose partners were present in the operating room at the time of neuraxial anesthesia placement reported less anxiety over the time of the study than did patients whose partners were not present, these differences were small and are not considered to be clinically important. Increased anxiety among partners who were not present at neuraxial placements warrants further study.
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Int J Obstet Anesth · Oct 2009
Randomized Controlled TrialA randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentation.
Improving the success of external cephalic version (ECV) for breech presentation may help avoid some cesarean deliveries. The results of randomized trials comparing the success of ECV with neuraxial analgesia compared to control are inconsistent. We hypothesized that combined spinal-epidural (CSE) analgesia would increase the success of ECV when compared with systemic opioid analgesia. ⋯ There was no difference in the rate of successful ECV or vaginal delivery with CSE compared to intravenous fentanyl analgesia. Pain scores were lower and satisfaction higher with CSE analgesia, and median time to fetal heart rate reactivity was shorter in the CSE group.
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Int J Obstet Anesth · Oct 2009
Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France.
In France obstetric haemorrhage is the leading cause of maternal death. The aim of this study was to evaluate if the management of postpartum haemorrhage at individual maternity units followed guidelines established by the Aurore Network. ⋯ The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage.
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Int J Obstet Anesth · Oct 2009
Perioperative anaesthetic management of high-order repeat caesarean section: audit of practice in a university-affiliated medical centre.
High-order (five or more) repeat caesarean sections (HORCS) are associated with increased rates of placenta praevia, placenta accreta and peripartum hysterectomy and prolonged surgical time secondary to intra-abdominal adhesions. This study summarizes our experience in the anaesthetic management of HORCS. ⋯ HORCS is not necessarily an indication for general anaesthesia provided uterine and placental abnormalities are sought preoperatively. In our practice single-shot spinal anaesthesia sufficed for uncomplicated HORCS.