International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2013
Case ReportsManagement of a parturient with an anterior sacral meningocele.
Anterior sacral meningoceles are rare disorders featuring anterior herniation of the meninges through a sacral defect or foramen. They are frequently misdiagnosed as ovarian or abdominal cysts and surgical exploration has resulted in meningitis. In pregnancy it represents an obstacle to delivery of the fetus and rupture of the meningocele during vaginal delivery is a significant risk. The successful multidisciplinary management of a primiparous patient with an anterior sacral meningocele and previous abdominal surgery is presented.
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Int J Obstet Anesth · Jan 2013
Case ReportsHyperfibrinolysis diagnosed by rotational thromboelastometry in a case of suspected amniotic fluid embolism.
Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. ⋯ Rotational thromboelastometry showed hyperfibrinolysis and hypofibrinogenaemia, which allowed targeted coagulation factor replacement therapy and the use of tranexamic acid. Hyperfibrinolysis may be a contributor to the coagulopathy associated with amniotic fluid embolism but has been infrequently reported, perhaps due to limited diagnosis with traditional coagulation tests. Treatment of the coagulopathy associated with a suspected amniotic fluid embolism with antifibrinolytic agents may deserve greater consideration.
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Int J Obstet Anesth · Jan 2013
Case ReportsElectrical impedance tomography may optimize ventilation in a postpartum woman with respiratory failure.
Amniotic fluid embolism is a rare peripartum complication with the sudden onset of haemodynamic instability, respiratory failure and coagulopathy during labour or soon after delivery. A 31-year-old woman with amniotic fluid embolism was treated with vasopressors, inotropes, intravenous fluid, tranexamic acid and ventilatory support. Assessment of respiratory impairment was made using conventional chest X-ray, computed tomography and electrical impedance tomography. The potential for electrical impedance tomography to improve monitoring and guide respiratory therapy is explored.
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Int J Obstet Anesth · Jan 2013
Efficacy and safety of intraoperative intravenous methadone during general anaesthesia for caesarean delivery: a retrospective case-control study.
Most patients undergoing caesarean delivery with general anaesthesia require systemic opioid administration. Due to its rapid onset and long duration of action, intravenous methadone may make it suitable for analgesia after caesarean delivery. Intraoperative methadone combined with postoperative intravenous patient-controlled analgesia with fentanyl or morphine has recently been introduced in our unit. ⋯ A single intraoperative bolus of intravenous methadone appeared to provide effective analgesia with an acceptable side-effect profile.