International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2021
Observational StudyProficiency-based progression training: implementing a novel approach to training for epidural analgesia in labour.
Epidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital. ⋯ In our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.
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Int J Obstet Anesth · Nov 2021
Case ReportsTwo cases of severe COVID-19 in gestational week 27 and 28 respectively, after which both pregnancies proceeded to term.
COVID-19 in pregnancy increases the risk of caesarean section. We present two cases of late gestation pregnant women with severe COVID-19. ⋯ These two cases demonstrate the possibility of treating pregnant women with severe COVID-19 with mechanical ventilation in the late second and early third trimesters without them having a pre-term delivery. With a multidisciplinary approach, such management could avoid the maternal risks of surgery during a severe infection and, at the same time, enable term birth with a lower risk of neonatal complications.
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Int J Obstet Anesth · Nov 2021
An audit of the effect of case selection on compliance with a 30-minute audit standard for decision-to-delivery interval at category 1 caesarean section.
Our hospital has an audit standard that ≥90% of women having category 1 (emergency) caesarean section should have a decision-to-delivery interval (DDI) ≤30 min. This audit aimed to identify potential influences of case selection on compliance. ⋯ Compliance with an audit standard for (DDI) at category 1 caesarean section is markedly influenced by the inclusion criteria. For comparability with other publications, it is suggested urgency should be reported as that applied at the point of decision for caesarean section, however, category 1 caesarean section cases following failed operative vaginal delivery in the operating theatre should be identified and reported separately.
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Int J Obstet Anesth · Nov 2021
Anesthetic management for the peripartum care of women with Fontan physiology.
As outcomes for surgical palliation have improved, women with single ventricle congenital heart disease are surviving into their reproductive years and may become pregnant. The cardiovascular changes of pregnancy may stress the Fontan circulation and pose significant risk to the mother and fetus. ⋯ Epidural anesthesia is safe and effective for both vaginal and cesarean deliveries. Judicious fluid management is critical in minimizing postpartum cardiovascular complications. Many patients do not require a higher level of care, invasive monitoring or central venous access during the peripartum period.