International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2018
Myocardial tissue characterisation and detection of myocardial oedema by cardiovascular magnetic resonance in women with pre-eclampsia: a pilot study.
Pre-eclampsia is characterised by increased left ventricular wall thickness on transthoracic echocardiography (TTE). This is assumed to be myocardial hypertrophy, however TTE cannot determine myocardial structure which may be muscle, oedema or fibrosis. Given the high incidence of peripheral oedema in pre-eclampsia, we hypothesised that increased thickness could represent oedema. Cardiovascular magnetic resonance (CMR) characterises myocardial tissue, differentiating between hypertrophy, oedema and fibrosis. This pilot study was designed to characterise myocardial composition using CMR in pregnant women (healthy or with pre-eclampsia) and to compare cardiac output and left ventricular mass using TTE and CMR. ⋯ Cardiovascular magnetic resonance was used to characterise the myocardial tissue in women with pre-eclampsia. Data suggest that some women with pre-eclampsia have myocardial oedema rather than hypertrophy.
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Int J Obstet Anesth · Nov 2018
Case ReportsCombined spinal-epidural anesthesia with non-invasive ventilation during cesarean delivery of a woman with a recent diagnosis of amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis is the most common neurodegenerative upper and lower motor neuron disease in adults but is not common in women of child-bearing age. We present a case of a pregnant woman who was diagnosed with amyotrophic lateral sclerosis and developed respiratory distress at 32 weeks-of-gestation. She underwent a cesarean delivery under combined spinal-epidural anesthesia with non-invasive ventilation. This resulted in a successful outcome for both the mother and the baby.
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Int J Obstet Anesth · Nov 2018
Observational StudyOcular ultrasonography for diagnosing increased intracranial pressure in patients with severe preeclampsia.
Ultrasound measurements of optic nerve sheath diameter (ONSD) and optic disc height (ODH) measured outside pregnancy correlate with intracranial hypertension. Data on the usefulness of ocular ultrasonography in preeclampsia are limited. ⋯ Severe preeclampsia was associated with a significantly higher ONSD and increased ODH, which could be ultrasonographic evidence of papilledema.
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Int J Obstet Anesth · Nov 2018
Observational StudyClearsight™ use for haemodynamic monitoring during the third trimester of pregnancy - a validation study.
We assessed the validity of Clearsight™ as a non-invasive cardiac output and stroke volume monitoring device, comparing it with transthoracic echocardiography measurements during the third trimester of pregnancy. ⋯ The agreement between Clearsight™ and the echocardiography measurements of cardiac output and stroke volume were not within an acceptable range in the third trimester of pregnancy.
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Int J Obstet Anesth · Nov 2018
Case ReportsNew onset acute pulmonary edema after methylergonovine given during cesarean delivery of a patient with undiagnosed Raynaud's disease.
Raynaud's disease is a medical condition in which arterial spasm causes episodes of reduced blood flow, in the setting of certain triggers such as cold weather. Patients with this condition are at risk of adverse reactions if they receive medications with vasoactive properties. ⋯ However, pulmonary events have rarely been reported. We report our anesthetic management of a 36-year-old patient, with undiagnosed Raynaud's disease and undergoing cesarean delivery, who experienced new onset acute pulmonary edema after methylergonovine administration to manage postpartum hemorrhage.