International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2009
Incidence and management of postpartum haemorrhage following the dissemination of guidelines in a network of 16 maternity units in France.
In France obstetric haemorrhage is the leading cause of maternal death. The aim of this study was to evaluate if the management of postpartum haemorrhage at individual maternity units followed guidelines established by the Aurore Network. ⋯ The regional guidelines issued by the Aurore network were only partially followed. More effective guideline dissemination and implementation is required to improve the prevention and management of confirmed haemorrhage.
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Int J Obstet Anesth · Oct 2009
Perioperative anaesthetic management of high-order repeat caesarean section: audit of practice in a university-affiliated medical centre.
High-order (five or more) repeat caesarean sections (HORCS) are associated with increased rates of placenta praevia, placenta accreta and peripartum hysterectomy and prolonged surgical time secondary to intra-abdominal adhesions. This study summarizes our experience in the anaesthetic management of HORCS. ⋯ HORCS is not necessarily an indication for general anaesthesia provided uterine and placental abnormalities are sought preoperatively. In our practice single-shot spinal anaesthesia sufficed for uncomplicated HORCS.
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Int J Obstet Anesth · Oct 2009
Case ReportsDifficult intubation during rapid sequence induction in a parturient with Ehlers-Danlos syndrome, hypermobility type.
There have been several reports of resistance to local anaesthetic agents in women with Ehlers-Danlos syndrome, hypermobility type, also known as Ehlers-Danlos syndrome Type III. General anaesthesia with rapid sequence induction was performed for caesarean section due to prolonged second stage of labour, but intubation proved to be difficult. ⋯ There are reports of cervical spine instability and temporomandibular joint dysfunction in patients with this syndrome suggesting a potential for difficult airway management. Additional anaesthetic problems associated with Ehlers-Danlos syndrome involve patient positioning and vascular access.
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Int J Obstet Anesth · Oct 2009
Comparative StudyAn observational study of anaesthesia and surgical time in elective caesarean section: spinal compared with general anaesthesia.
Neuraxial techniques are increasingly used in obstetric anaesthesia. In our hospital, time constraints are the main problem when planning anaesthesia for elective caesarean section. Neuraxial anaesthesia is believed to take longer than general anaesthesia. The objective of this prospective, observational study was to compare time to surgical readiness and total operating room time with spinal with general anaesthesia for elective caesarean section at a Pakistani university hospital for a period of six months. ⋯ In our hospital, the use of spinal anaesthesia was not associated with decreased intra-operative time efficiency compared to general anaesthesia for elective caesarean section.