International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2016
Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series.
The management of patients with morbidly adherent placenta has been described using vascular balloon catheters placed in the iliac arteries, but rarely in the aorta. This case series presents our experience with prophylactic lower abdominal aorta balloon occlusion in 45 women. ⋯ Prophylactic lower abdominal aorta balloon occlusion has the potential to reduce intraoperative blood loss, transfusion and hysterectomy rate in patients with morbidly adherent placenta undergoing caesarean section. Careful patient selection is critical as the technique may be associated with potentially serious complications.
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Int J Obstet Anesth · Aug 2016
Randomized Controlled Trial Comparative StudyRandomized double-blind comparison of ephedrine and phenylephrine for management of post-spinal hypotension in potential fetal compromise.
Most studies comparing phenylephrine and ephedrine have been conducted during elective caesarean sections in healthy mothers with no fetal compromise. The effect of vasopressors on fetal outcome may differ between healthy and compromised fetuses. There has been little research into the effect of phenylephrine and ephedrine, when used for management of post-spinal hypotension in the presence of potential fetal compromise. ⋯ Both phenylephrine 100μg and ephedrine 8mg boluses are equally efficacious when treating post-spinal hypotension in the presence of potential fetal compromise. However, phenylephrine may be a better choice in the presence of maternal tachycardia.
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Int J Obstet Anesth · Aug 2016
Case ReportsUse of Doppler ultrasound in the management of uteroplacental perfusion during cardiopulmonary bypass in pregnancy.
Cardiopulmonary bypass, the extreme of non-obstetric surgery during pregnancy, presents unique challenges to minimize maternal and fetal risk. We present our experience with a woman who was diagnosed with a left atrial myxoma following an ischemic cerebrovascular accident. ⋯ We recommend using intermittent Doppler ultrasound as a non-invasive real-time assessment of uteroplacental perfusion during non-obstetric surgery in pregnancy. Monitoring of perfusion facilitates active feedback for appropriate in utero resuscitation in these cases.