International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2012
Case ReportsPerioperative management of a parturient with hyponatraemia due to carbamazepine therapy.
We describe the perioperative management of an epileptic parturient who developed hyponatraemia due to carbamazepine therapy. Caesarean delivery was performed under combined spinal-epidural anaesthesia with a good outcome for both mother and neonate. The diagnostic and therapeutic approach, anaesthetic implications and maternal and neonatal risks for a patient with hyponatraemia complicating carbamazepine therapy are discussed.
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Int J Obstet Anesth · Jan 2012
Case ReportsPeripartum management of two parturients with ornithine transcarbamylase deficiency.
Ornithine transcarbamylase deficiency is a rare X-linked disorder in which female carriers are usually heterozygous for the ornithine transcarbamylase deficiency gene. In pregnancy it has been associated with altered mental status, seizures, coma and death, especially in the postpartum period. ⋯ Neuraxial techniques were used for pain relief in labor and anesthesia for operative delivery. A dextrose infusion provided caloric intake during labor and perioperatively.
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Int J Obstet Anesth · Jan 2012
Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission.
Previous studies on severe maternal sepsis during pregnancy or the postpartum period are rare and have focused on septic abortion. Voluntary abortion was legalized in France in 1975. This study was conducted to reassess the characteristics of maternal sepsis that have been managed in a French intensive care unit. ⋯ Over time, our intensive care unit has seen fewer cases of septic abortion. However, maternal sepsis remained a cause of intensive care admission and both maternal and fetal death. The percentages of antepartum and non-bacterial infections have increased over time. A prospective multicentre study is required to confirm these results and to investigate questions such as the effect of maternal sepsis on long-term fetal outcome.
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Int J Obstet Anesth · Jan 2012
Case ReportsMultidisciplinary management of an obstetric patient with glycogen storage disease type 3.
A 22-year-old primiparous woman with known glycogen storage disease type 3a presented to our hospital during her 12th week of pregnancy. Glycogen storage disease type 3 is a rare inherited disorder resulting from a deficiency of the glycogen debranching enzyme, causing the accumulation of abnormal short-chain glycogen in liver, blood cells, myocardium and striated muscle. Symptoms improve after puberty but the increased metabolism of pregnancy predisposes to hypoglycaemia, ketosis and lactic acidosis. ⋯ Intravenous dextrose infusion and regular blood glucose monitoring were used during the perinatal period to prevent hypoglycaemia. An arterial line was inserted in the operating room for frequent blood sampling and to avoid muscle cramps which could be induced by the intermittent inflation of the automated blood pressure cuff. Obstetric, anaesthetic and neonatal outcomes were uneventful.