International journal of obstetric anesthesia
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Int J Obstet Anesth · Dec 2016
Anaesthetic management of parturients with univentricular congenital heart disease and the Fontan operation.
Women with a single ventricle circulation palliated with the Fontan operation require specialist multidisciplinary management. We report 14 such cases with successful pregnancies and detail the pathophysiology encountered. A combined obstetric and cardiac service between Chelsea and Westminster Hospital and Royal Brompton Hospital provides care for women with heart disease, and maintains a prospective database of referred women. ⋯ Women with a Fontan circulation are increasingly encountered in obstetric practice. A good understanding of the underlying anatomy and its impact on physiology, coupled with meticulous care are essential to allow safe delivery for mother and baby. Multidisciplinary input into peripartum care is required, with anticipation of increased risk of complications such as haemorrhage and arrhythmias.
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Int J Obstet Anesth · Dec 2016
The effect of dalteparin on thromboelastography in pregnancy: an in vitro study.
Dalteparin is often used for prophylaxis or treatment of venous thromboembolism during pregnancy, yet there is no laboratory test to accurately reflect its clinical activity. Thromboelastography is a point-of-care monitor of whole blood coagulation. The aim of this study was to determine if serial doses of dalteparin added in vitro to whole blood samples from term, pregnant women are detectable as changes in thromboelastography parameters. ⋯ This pilot study provides proof-of-concept that thromboelastography can discriminate differences in blood anticoagulated with varying doses of dalteparin in a dose-dependent manner. This suggests that thromboelastography may be a feasible monitor of anticoagulation in the presence of dalteparin in maternal whole blood and may potentially translate to a point-of-care test that can be used to determine real-time coagulation status in patients.
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Int J Obstet Anesth · Dec 2016
Meta AnalysisClinical effectiveness of transversus abdominis plane (TAP) blocks for pain relief after caesarean section: a meta-analysis.
The effectiveness of transversus abdominis plane (TAP) blocks for acute pain relief after caesarean section, in comparison to normal practice, remains uncertain. ⋯ TAP blocks provide effective analgesia after caesarean section; however, additional benefits are more difficult to demonstrate when long-acting intrathecal opioids are administered.
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Int J Obstet Anesth · Dec 2016
Observational StudySevere maternal morbidity in a general intensive care unit in Nigeria: clinical profiles and outcomes.
Data on outcomes of obstetric admissions to intensive care units can serve as useful markers for assessing the quality of maternal care. We evaluated the intensive care unit utilization rate, diagnoses, case-fatality rate, mortality rate and associated factors among obstetric patients. ⋯ Direct obstetric morbidities constituted the leading reasons for obstetric admissions to the intensive care unit, with sepsis accounting for the highest case-fatality rate. Abdominal delivery and/or peripartum hysterectomy increased risk of death among obstetric admissions.