International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2011
An observational study of factors leading to difficulty in resident anaesthesiologists identifying the epidural space in obstetric patients.
Multiple attempts at needle placement for neuraxial block may cause patient discomfort, a higher incidence of spinal haematomas, postdural puncture headache and nerve trauma. The aim of this study was to evaluate the factors predicting difficult epidural analgesia for inexperienced residents. ⋯ For residents with no prior experience in obstetric anaesthesia, the most reliable factor in predicting difficult epidural cannulation was spinal abnormality.
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Postpartum haemorrhage is an important cause of maternal morbidity and mortality. It is associated with haemostatic impairment which may exacerbate bleeding. ⋯ Fibrinogen level was the parameter that best correlated with increasing volume of haemorrhage and was the most useful marker of developing haemostatic impairment. Guidelines for fresh frozen plasma use in major postpartum haemorrhage were rarely followed and should be reviewed.