International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2024
Randomized Controlled Trial Comparative StudyNon-inferiority randomized controlled trial comparing CricOid pressure and para-laryngeal pressure in parturients undergoing cesarean delivery: NiCOP trial.
Cricoid pressure has been surrounded with controversies regarding its effectiveness. Application of ultrasound-guided para-laryngeal (PL) force has been shown to occlude the esophagus effectively compared with cricoid pressure (CP) in awake patients. We hypothesized that there would be no meaningful difference in the change in antero-posterior esophageal diameter from with application of cricoid or para-laryngeal pressure in parturients undergoing cesarean delivery under general anesthesia. ⋯ Para-laryngeal pressure was non-inferior to CP in occluding the esophagus in parturients undergoing cesarean delivery under general anesthesia and furthermore, no significant deterioration in intubation parameters was seen.
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Int J Obstet Anesth · Aug 2024
Comparative Study Observational StudyEarly viscoelastometric guided fibrinogen replacement combined with escalation of clinical care reduces progression in postpartum haemorrhage: a comparison of outcomes from two prospective observational studies.
Viscoelastometric haemostatic assays (VHA) give rapid information on coagulation status, allowing individualised resuscitation. ⋯ These results suggest that use of VHA as part of an early bundle of PPH care targeting fibrinogen ≤2 g/L with fibrinogen concentrate reduces PPH progression. The greatest benefit was seen when fibrinogen levels were ≤2 g/L at first testing.
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Int J Obstet Anesth · Aug 2024
Case ReportsSevere back labor pain masks a scald caused by shower hydrotherapy: a case report.
Shower hydrotherapy is generally considered benign during labor. We report a case of extensive scalds in a primigravida who used shower hydrotherapy to treat severe back labor pain from fetal malposition. Interestingly, her back pain was so severe that she felt no pain as her scald developed, describing the hot water from the showerhead as the only measure which "soothed" her pain. ⋯ Severe pain from persistent fetal malposition may alter somatic pain perception during labor, increasing burn risks during shower hydrotherapy. These women are also at increased risk of operative delivery and infection risks from inadvertent neuraxial blockade after burns. Improved prevention strategies and vigilance for scalds are warranted in women with severe back labor undergoing shower hydrotherapy, including by anesthesiologists assessing them for neuraxial blockade.
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Int J Obstet Anesth · Aug 2024
Variability of fibrinolytic activity in pregnant patients exposed to tissue plasminogen activator: an in vitro study utilizing rotational thromboelastometry.
The investigation into the variability of fibrinolysis in obstetric patients is notably limited despite its relevance to postpartum hemorrhage. We investigate an in vitro model of fibrinolysis measured by rotational thromboelastrometry (ROTEM) in maternal blood samples with lysis stimulated by tissue plasminogen activator (tPA). ⋯ We demonstrate a wide range of fibrinolytic response in the obstetric population to exogeneous tPA. We found subgroups of patients that were very responsive to tPA and insensitive to tPA. This study represents a preliminary exploration into classifying the obstetric fibrinolytic phenotypes. Further research will integrate relevant coagulation factors to establish a predictive model for testing susceptibility to lysis that can be applied at the point of care.