International journal of obstetric anesthesia
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Care of pregnant migrants is a considerable challenge for all health care workers and health systems. Maternal mortality and serious morbidity are both greatly increased among migrants in western countries, particularly in Africans and asylum seekers. While in many instances, migrants are healthier than native populations and have better perinatal outcomes, this is inconsistent and poorer outcomes are described in many groups. ⋯ Accordingly, improvement in outcome requires a multifaceted approach with a focus on early access to antenatal services and enhanced medical screening and surveillance for detection and optimisation of comorbid conditions. Provision and/or acceptance of analgesia in labour have not been well researched but existing data are sufficient to suggest that some migrant groups do not receive equivalent pain relief during labour. Provision of information and translation services are important components in improvement of standards of care.
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Int J Obstet Anesth · Oct 2011
Letter Case ReportsBronchospasm and cardiac arrest during cesarean section.
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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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Int J Obstet Anesth · Oct 2011
Case ReportsUse of a 23-gauge continuous spinal catheter for labor analgesia: a case series.
Seven women received labor analgesia with 0.125% bupivacaine and fentanyl 2 μg/mL delivered through a new generation of over-the-needle 23-gauge spinal catheters. The first patient was managed with intermittent bolus injections but inadequate pain control prompted a conversion to a continuous infusion for subsequent patients. One patient developed a postdural puncture headache following catheterization for 5 h, but there were no headaches in those who had an indwelling catheter for 8h or longer. ⋯ One patient with labor lasting over 17 h developed pain and paresthesia that resolved in 24 h without treatment. Two patients had motor block that necessitated a temporary reduction in rate or discontinuation of the infusion. The continuous spinal catheter appeared to be acceptable to patients but the optimal choice of drugs, concentration, and mode of administration remains to be determined.