International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2011
Letter Case ReportsEpidural anaesthesia for a parturient with Henoch-Schonlein purpura.
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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
ReviewMinimally- and non-invasive assessment of maternal cardiac output: go with the flow!
The measurement of cardiac output may be crucial in the management of the parturient with haemodynamic instability due to critical illness or cardiac disease. Invasive haemodynamic monitoring may not be desirable due to the potential risk of complications and issues with patient compliance. Minimally- and non-invasive techniques of cardiac output measurement include those based on ultrasonic technology and pulse contour waveform analysis. This review article provides a synopsis of the literature examining currently available minimally- and non-invasive techniques for maternal cardiac output monitoring and looks at their advantages and disadvantages with respect to the parturient.
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Int J Obstet Anesth · Oct 2011
Case ReportsAlagille syndrome and pregnancy: anesthetic management for cesarean section.
A 34-year-old multiparous woman with a breech presentation, intrauterine growth restriction and premature rupture of membranes was transferred to our referral unit at 33 weeks of gestation. She was diagnosed with Alagille syndrome soon after birth because of cholestasis and pruritus. Her condition was later complicated by esophageal varices, treated with propranolol, thrombocytopenia, and insulin-dependent diabetes. ⋯ Due to the early onset of spontaneous labor, emergency cesarean section under general anesthesia was performed 48 h after admission. This is the first case describing anesthetic care during delivery in a patient with Alagille syndrome. We discuss the anesthetic implications of the syndrome, emphasizing problems associated with portal hypertension and cholestasis, thrombocytopenia and cardiac abnormalities such as pulmonary artery stenosis.