International journal of obstetric anesthesia
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Int J Obstet Anesth · Dec 2016
The effect of dalteparin on thromboelastography in pregnancy: an in vitro study.
Dalteparin is often used for prophylaxis or treatment of venous thromboembolism during pregnancy, yet there is no laboratory test to accurately reflect its clinical activity. Thromboelastography is a point-of-care monitor of whole blood coagulation. The aim of this study was to determine if serial doses of dalteparin added in vitro to whole blood samples from term, pregnant women are detectable as changes in thromboelastography parameters. ⋯ This pilot study provides proof-of-concept that thromboelastography can discriminate differences in blood anticoagulated with varying doses of dalteparin in a dose-dependent manner. This suggests that thromboelastography may be a feasible monitor of anticoagulation in the presence of dalteparin in maternal whole blood and may potentially translate to a point-of-care test that can be used to determine real-time coagulation status in patients.
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Int J Obstet Anesth · Dec 2016
Stimulation of contractions in pregnant human myometrium is associated with 5-HT3 receptors.
Serotonin (5-HT) is known to play an important role in regulating uterine contractions. However, the specific receptors involved have not been well characterized. We evaluated whether 5-HT3 receptors exist in human myometrium, and their effects on myometrial contractility when stimulated by a 5-HT3 agonist. ⋯ 5-HT3 receptors are expressed on non-pregnant and pregnant uteri. RS56812 enhanced myometrial contractions, but this was not affected by granisetron, the mechanism of which requires further investigation.
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Int J Obstet Anesth · Dec 2016
Anaesthetic management of parturients with univentricular congenital heart disease and the Fontan operation.
Women with a single ventricle circulation palliated with the Fontan operation require specialist multidisciplinary management. We report 14 such cases with successful pregnancies and detail the pathophysiology encountered. A combined obstetric and cardiac service between Chelsea and Westminster Hospital and Royal Brompton Hospital provides care for women with heart disease, and maintains a prospective database of referred women. ⋯ Women with a Fontan circulation are increasingly encountered in obstetric practice. A good understanding of the underlying anatomy and its impact on physiology, coupled with meticulous care are essential to allow safe delivery for mother and baby. Multidisciplinary input into peripartum care is required, with anticipation of increased risk of complications such as haemorrhage and arrhythmias.