International journal of obstetric anesthesia
-
Int J Obstet Anesth · Feb 2015
Case ReportsSpontaneous coronary artery dissection in a parturient with Nail-Patella syndrome.
Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome, occurring predominantly in women during and immediately after pregnancy; it carries a mortality rate of greater than 50%. While the exact etiology is unknown, possible contributing factors include pregnancy-related hormonal, connective tissue and hemodynamic changes. ⋯ Regardless of etiology, a delay in diagnosis of myocardial ischemia can lead to significant morbidity and mortality. In light of the increasing burden of cardiac disease in the obstetric population, clinicians should remain vigilant for signs of myocardial infarction and prepare for definitive diagnosis and treatment.
-
Int J Obstet Anesth · Feb 2015
Observational StudyMeasurement of blood loss during postpartum haemorrhage.
We set out to validate the accuracy of gravimetric quantification of blood loss during simulated major postpartum haemorrhage and to evaluate the technique in a consecutive cohort of women experiencing major postpartum haemorrhage. The study took part in a large UK delivery suite over a one-year period. All women who experienced major postpartum haemorrhage were eligible for inclusion. ⋯ The accuracy of the gravimetric method was confirmed in simulated postpartum haemorrhage. The clinical study shows that gravimetric measurement of blood loss is correlated with the fall in haemoglobin in postpartum haemorrhage where blood loss exceeds 1500mL. The method is simple to perform, requires only basic equipment, and can be taught and used by all maternity services during major postpartum haemorrhage.
-
Int J Obstet Anesth · Feb 2015
Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series.
With improvements in management and rehabilitation, more women with spinal cord injury are conceiving children. Physiologic manifestations of spinal cord injury can complicate anesthetic management during labor and delivery. Patients who delivered at Mayo Clinic, Rochester, Minnesota between January 1, 2001 and May 31, 2012 with a history of traumatic spinal cord injury were identified via electronic record search of all parturients. ⋯ These symptoms were not reported by any patient without a history of autonomic hyperreflexia. Neuraxial labor analgesia may have a higher failure rate in patients with spinal cord injury, possibly related to the presence of Harrington rods. Postpartum exacerbations of autonomic hyperreflexia are common in patients with a history of the disorder.
-
Int J Obstet Anesth · Feb 2015
Observational StudyThe effect of intra-abdominal pressure on sensory block level of single-shot spinal anesthesia for cesarean section: an observational study.
Increased intra-abdominal pressure in pregnancy is thought to affect intrathecal drug spread. However this assumption remains largely untested. The aim of this prospective study was to evaluate the association between intra-abdominal pressure and maximum sensory block level in parturients receiving spinal anesthesia for cesarean section. ⋯ In parturients, intra-abdominal pressure was not associated with spinal block spread, block onset time, recovery or side effects.
-
Int J Obstet Anesth · Feb 2015
Letter Randomized Controlled TrialRoutine cell salvage during elective caesarean section: a pilot randomised trial.