International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2011
Assessment of coagulation in the obstetric population using ROTEM® thromboelastometry.
Assessment of maternal coagulation to determine suitability for neuraxial anaesthesia and management of obstetric haemorrhage remains a challenge. Thromboelastography provides point of care patient assessment of the viscoelastic properties of whole blood clotting and can assist the clinician in haemostatic decision-making. The study aim was to determine the ROTEM® thromboelastometer 95% reference limits for third trimester parturients and to compare these with non-pregnant female controls. ⋯ ROTEM® thromboelastometry clearly demonstrates the hypercoagulability of pregnancy. Formal reference ranges for ROTEM® that may be potentially useful in the haemostatic management of the parturient are presented.
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Int J Obstet Anesth · Oct 2011
Randomized Controlled TrialThe effect on maternal temperature of delaying initiation of the epidural component of combined spinal-epidural analgesia for labor: a pilot study.
Labor epidural analgesia is associated with maternal hyperthermia. This pilot study compared the effects on maternal temperature during labor of different timing of initiation of the epidural component of combined spinal-epidural analgesia. ⋯ Delaying the epidural component of combined spinal-epidural analgesia did not significantly affect maternal temperature in the study population of whom 83.3% had a labor of <5 h. However, this study was underpowered to detect a difference in the incidence of fever and a larger prospective study is required.
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Int J Obstet Anesth · Oct 2011
Case ReportsAnaesthetic management of caesarean delivery in a parturient with malaria.
Malaria is a life-threatening illness with significant maternal and infant morbidity and mortality worldwide. Due to the rarity of its diagnosis in the UK population, there is little information about the number of pregnant women affected by malaria. ⋯ A brief overview of malaria in pregnancy as relevant to this case and its outcome is presented. The report highlights the need for vigilance of all healthcare providers to allow timely recognition and management of rare but treatable disorders.
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When diagnosed antenatally placenta accreta has often been managed by cesarean hysterectomy, but recently techniques involving uterine preservation have been developed. Uterine artery embolization has become an adjuvant treatment, although the potential for obstetric hemorrhage still exists. A multidisciplinary approach has permitted the development of anesthetic strategies for these patients. ⋯ In this case series, the expectation of major blood loss at cesarean delivery in the presence of placenta accreta and attempts at uterine conservation surgery initially prompted a conservative approach using general anesthesia. Greater experience has permitted modification of this approach and neuraxial anesthesia is now employed more frequently. When managed appropriately, most patients are able to tolerate both prolonged surgery and significant blood loss under epidural anesthesia.
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Int J Obstet Anesth · Oct 2011
Letter Case ReportsBronchospasm and cardiac arrest during cesarean section.