International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jan 2011
ReviewImaging evaluation of the pregnant patient with suspected pulmonary embolism.
Pulmonary embolism is the leading cause of maternal death in the developed world. The clinical diagnosis of pulmonary embolism is particularly challenging in pregnant patients as physiologic changes of pregnancy can mimic symptoms of pulmonary embolism or deep venous thrombosis. Clinical decision and imaging algorithms for venous thromboembolic disease have been proposed in the literature for the general population, but have not undergone wide-scale validation in pregnant patients. ⋯ Additional factors beyond test performance must be weighed during pregnancy: radiation exposure to the fetus and maternal breast tissue, the safety of intravenous contrast administration and the diagnostic accuracy of the various testing options so that diagnosis and proper management are not delayed. The epidemiology of pregnancy-related venous thromboembolic disease and the different diagnostic methods are reviewed, with emphasis on the pregnant patient. Finally, a diagnostic imaging algorithm is proposed for the evaluation of the pregnant patient when a clinical suspicion of pulmonary embolism exists.
-
Int J Obstet Anesth · Jan 2011
The effect of labor on sevoflurane requirements during cesarean delivery.
Labor results in the release of sensitizing substances such as progesterone, prostaglandins, cytokines and cortisol, some of which have been observed to participate in sleep regulation. We hypothesized that these substances could affect sleep regulation and therefore the amount of volatile agent required to provide general anesthesia for cesarean delivery. ⋯ Anesthetic requirements for sevoflurane, as measured by Bispectral Index, decrease in laboring versus non-laboring parturients undergoing cesarean delivery. Prolactin, progesterone and cortisol do not appear to be responsible for this observation.
-
When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. ⋯ The effect on breast feeding has yet to be established, though it is certainly no worse than that of systemic opioid analgesia. Variations in neuraxial technique have little impact on the newborn. Widespread ignorance of the benefit to the newborn of neuraxial labour analgesia in the UK among non-anaesthetists needs to be combated.
-
Int J Obstet Anesth · Jan 2011
Case ReportsMaternal myasthenia gravis complicated by fetal arthrogryposis multiplex congenita.
We report the management of a 24-year-old primigravid woman who was diagnosed with myasthenia gravis at 20weeks of gestation. Maternal symptoms improved with therapeutic plasma exchange, steroids, immunoglobulin therapy and pyridostigmine. ⋯ The mother underwent thymectomy within five weeks of delivery. The implications of myasthenia gravis for both the mother and baby are discussed.