International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2011
Case ReportsAnesthetic management of a parturient with type III Klippel-Feil syndrome.
Klippel-Feil syndrome is believed to occur from failure of normal segmentation of cervical somites during gestation. We present the case of a 38-year-old primiparous woman with type III Klippel-Feil syndrome for elective cesarean delivery. Our patient had a short webbed neck, short stature, limited neck flexion and extension, and thoraco-lumbar abnormalities. ⋯ We planned a combined spinal-epidural technique; however, only the epidural technique was obtained. Cesarean delivery was commenced with favorable maternal and fetal outcomes. Post-operative pain management was provided with intravenous morphine patient-controlled analgesia.
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Int J Obstet Anesth · Jan 2011
Case ReportsMultiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta.
The incidence of placenta praevia/accreta is increasing, placing women at significant risk of postpartum haemorrhage with associated morbidity and mortality. National guidelines recommend prophylactic placement of internal iliac artery balloon occlusion catheters for women with abnormal placentation. ⋯ She developed bilateral pseudoaneurysms, unilateral arterial rupture and compromised vascular supply to her right leg secondary to thrombus formation, and suffered massive haemorrhage, both despite and as a result of intervention. This is the first case report of multiple complications in an obstetric patient after temporary internal iliac balloon occlusion in an elective setting.
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Int J Obstet Anesth · Jan 2011
Case ReportsProphylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series.
Endovascular occlusion balloon catheters can be placed preoperatively in internal iliac vessels of patients perceived to be at risk of major obstetric haemorrhage during caesarean section. Their safety and efficacy remains undefined, and we report our experience of 14 patients over four years. ⋯ Internal iliac balloon catheters can be inserted electively or in an emergency in patients at risk of major obstetric haemorrhage. Although useful in some, they are not universally effective; patients are still at risk of significant blood loss and at high risk of requiring a hysterectomy. In our experience, catheters can be placed electively or in an emergency but have been associated with adverse outcomes. These lessons have been important learning points in perioperative management.
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Int J Obstet Anesth · Jan 2011
Case ReportsAnesthetic management of a pregnant woman with Gorham-Stout disease.
Gorham-Stout disease is a rare disorder of bone loss and proliferation of lymphatic and vascular tissue (lymphangiomatosis). A 30-year-old nulliparous woman with Gorham-Stout disease presented at 8weeks of gestation with a fused cervical spine. At 31weeks she developed basilar invagination and neurological symptoms that were managed with a neck brace. ⋯ A semi-urgent cesarean delivery under spinal anesthetic proceeded uneventfully, with an otolaryngologist present in case a surgical airway was required. Mother and baby were discharged home after three days. Maternal postpartum recovery was complicated by episodes of respiratory compromise and critical bone loss in the cervical spine, necessitating further surgical reinforcement.