International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2016
Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study.
The aim of this impact study was to compare the analgesic efficacy and side effect profile of programmed intermittent epidural boluses (PIEB)+patient-controlled epidural analgesia (PCEA) to continuous epidural infusion (CEI)+PCEA for maintenance labor analgesia after the introduction of PIEB at our institution. ⋯ Using PIEB compared to CEI as the background maintenance epidural analgesia method in conjunction with PCEA reduced the number of women requiring clinician rescue boluses while providing comparable labor analgesia. The findings of this clinical care impact study confirm the results of randomized controlled studies and suggest PIEB may be a preferable technique to CEI for the maintenance of labor analgesia.
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Int J Obstet Anesth · May 2016
ReviewThe 2016 Hughes Lecture: What's new in maternal morbidity and mortality?
Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. ⋯ This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world.
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A contemporary, robust immunologic explanation for common obstetric conditions remains elusive; why some pregnant women are more susceptible to developing preeclampsia or preterm labor is not completely understood. We explore the immunology behind four important and commonly encountered pregnancy-related conditions: preeclampsia, recurrent miscarriage, preterm labor and gestational diabetes. For each condition, we summarize the current understanding of cytokines implicated in the pathogenesis, discuss the impact of anesthesia and analgesia on selected cytokine profiles, and suggest potential opportunities for clinical and research interventions.
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Successful pregnancy requires a state of immune homeostasis. Maternal tolerance of the genetically distinct fetoplacental unit is in part mediated by maternal and fetal pro- and anti-inflammatory cytokines; these cytokines have also been implicated in different pregnancy-related pathologic states. ⋯ In part one, we review basic and pregnancy-related elements of the immune system, with an emphasis on the role of cytokines. From this foundation, we offer a perspective of a unique phenomenon witnessed within obstetric anesthesia - maternal temperature elevation associated with labor epidural analgesia.
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Int J Obstet Anesth · May 2016
Review Case ReportsHeparin-induced thrombocytopenia in pregnancy: an interdisciplinary challenge-a case report and literature review.
Heparin-induced thrombocytopenia is a serious adverse event of anticoagulation with a high risk of thromboembolic complications. As a consequence, anticoagulants other than heparins must be administered. ⋯ Impaired coagulation bears the risk of adverse events following neuraxial procedures and of peripartum hemorrhage. We describe the case of heparin-induced thrombocytopenia in a 29-year-old pregnant woman at 27weeks of gestation with severe valvular heart disease.