International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2013
Peak plasma anti-Xa levels after first and third doses of enoxaparin in women receiving weight-based thromboprophylaxis following caesarean section: a prospective cohort study.
Women undergoing caesarean section are at higher risk for thromboembolic complications following delivery than other parturients. The aim of this study was to determine whether higher doses of enoxaparin based on body weight are safe and more likely to achieve plasma anti-Xa levels within the accepted thromboprophylactic range. ⋯ The majority of women receiving weight-based enoxaparin thromboprophylaxis following caesarean section achieved plasma anti-Xa levels within the putative thromboprophylactic range. No woman achieved levels associated with an increased risk of bleeding (>0.8 IU/mL). These findings provide a safety basis for a large prospective study using this regimen.
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Int J Obstet Anesth · Nov 2013
Case ReportsAirway obstruction, caesarean section and thyroidectomy.
Airway obstruction in pregnancy is rare. We report the case of a 39-year-old nulliparous woman with a body mass index of 47 kg/m(2) and a large multinodular goitre causing tracheal compression with airway symptoms who declined thyroid surgery until after delivery. However, worsening hypertension precipitated an urgent caesarean section and thyroidectomy at 32 weeks of gestation. ⋯ Caesarean section was performed and a healthy baby delivered followed by a total thyroidectomy. She was extubated, monitored closely for tracheomalacia and cared for postoperatively in the surgical high-dependency unit. This case highlighted a number of challenges managed successfully with a multidisciplinary team.
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Int J Obstet Anesth · Nov 2013
Outcomes of prospectively-collected consecutive cases of antenatal-suspected placenta accreta.
Accurate diagnosis of placenta accreta is tentative before surgery. This study developed a predictive score for antenatal diagnosis of placenta accreta through mathematical modeling using clinical signs. ⋯ Combining diagnostic features associated with placenta accreta through mathematical modeling has better positive predictive value than ultrasound alone.