International journal of obstetric anesthesia
-
Int J Obstet Anesth · Jul 2008
Case ReportsCerebral venous sinus thrombosis following accidental dural puncture and epidural blood patch.
We report the case of a woman who developed cerebral venous sinus thrombosis after an attempted epidural. The epidural was complicated by an accidental dural puncture and the ensuing headache was initially treated with an epidural blood patch. Cerebral venous sinus thrombosis is an uncommon condition with varying aetiology and risk factors. We discuss the importance of the differential diagnosis for postpartum headache and explore the relationship between cerebral venous sinus thrombosis and the triad of pregnancy, dural puncture and epidural blood patch.
-
Int J Obstet Anesth · Jul 2008
Case ReportsHemorrhagic stroke following elective cesarean delivery.
We present a case of hemorrhagic stroke after cesarean delivery under combined spinal-epidural anesthesia in an 35-year-old Hispanic patient treated with anticoagulants for protein C deficiency. She required vasopressor therapy for intraoperative hypotension and developed severe headache immediately after administration. ⋯ Although the exact cause of her hemorrhagic stroke is uncertain, the hypertensive response that may have led to the hemorrhagic stroke occurred following administration of commonly used doses of vasopressor agents. We discuss the possible causes of stroke.
-
Int J Obstet Anesth · Jul 2008
Case ReportsInterventional radiology in women with suspected placenta accreta undergoing caesarean section.
Placenta praevia in the presence of a previous uterine scar is associated with increased risk of placenta accreta, which could lead to major haemorrhage at delivery. Major haemorrhage is one of the leading causes of maternal mortality in the UK. Interventional radiology with trans-catheter balloon occlusion or arterial embolisation is a recognised technique for the management of intractable obstetric haemorrhage. ⋯ The obstetricians and anaesthetists in our institution are of the impression that the use of peri-operative, preferably pre-operative, internal iliac artery catheterization with or without balloon occlusion or embolisation, in women with placenta accreta or percreta, improves the operative field and potentially reduces blood loss and transfusion requirements. We were unable to find evidence that this technique reduces the need for caesarean hysterectomy. Through our experience, we have developed a unit protocol for the management of women with suspected placenta accreta undergoing caesarean section.