International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2021
Observational StudyAn observational pilot study of a novel loss of resistance syringe for locating the epidural space.
The EpiFaith® syringe is a novel loss-of-resistance syringe that utilizes a spring-loaded plunger that automatically moves forward within the syringe when there is a loss of resistance. We evaluated the syringe in a clinical setting among a cohort of pregnant women receiving neuraxial labor analgesia. ⋯ This feasibility study found that three of the four anesthesiologists scored the EpiFaith® syringe as better or the same as using their regular loss-of-resistance syringe. More extensive studies are required to determine if the EpiFaith® syringe reduces adverse outcomes such as unintentional dural punctures.
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Int J Obstet Anesth · Aug 2021
Patient race and racial composition of delivery unit associated with disparities in severe maternal morbidity: a multistate analysis 2007-2014.
High Black-serving delivery units and high hospital safety-net burden have been associated with poorer patient outcomes. We examine these hospital-level factors and their association with severe maternal morbidity (SMM), independently and as effect modifiers of patient-level factors. ⋯ The patient racial/ethnic composition of the delivery unit is associated with adjusted-odds of SMM, both independently and interactively with individual patient race.
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Int J Obstet Anesth · Aug 2021
Observational StudyUtility of viscoelastography with TEG 6s to direct management of haemostasis during obstetric haemorrhage: a prospective observational study.
The TEG 6s is an automated cartridge-based device with limited description of use in obstetric haemorrhage. The aim of this analysis was to describe the utility of TEG 6s in identifying abnormal laboratory results of coagulation and platelet count, and inform an interventional treatment algorithm for postpartum haemorrhage. ⋯ The TEG 6s CFF can be used to identify low fibrinogen during obstetric haemorrhage. A value to identify transfusion thresholds for PT/aPTT and platelets was not established, and laboratory results should continue to be used.
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Int J Obstet Anesth · Aug 2021
Factor XIII activity at onset of labour and association with postpartum haemorrhage: an exploratory post-hoc study.
Platelets, fibrinogen and factor XIII (FXIII) are required to form a stable clot in case of haemorrhage. The aims of this study were to evaluate a possible association between FXIII activity at the onset of labour and postpartum haemorrhage (PPH), and to ascertain whether FXIII activity at labour onset differs from after delivery. ⋯ At the onset of labour women with a subsequent PPH had significantly lower mean FXIII activity than that of women without PPH. This difference was small and within normal limits. FXIII activity did not change during normal delivery. The importance of FXIII during PPH requires study.
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Int J Obstet Anesth · Aug 2021
Case ReportsFetal heart rate mirrors maternal temperature during posterior fossa craniotomy: a case report.
While it is well known that maternal temperature affects fetal heart rate, the exact relationship is not well described. The circumstances accompanying most cases of maternal hypothermia and rewarming (e.g. a drowning event) have precluded a precise quantitative description of this relationship. ⋯ Continuous electronic fetal heart rate and core temperature monitoring demonstrated a near linear relationship during the development of hypothermia and rewarming. Recognition of the close relationship between maternal temperature and fetal heart rate can help safeguard maternal and fetal health, and prevent unnecessary delivery during non-obstetric surgery in pregnancy.