International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2004
Case ReportsAcute subdural haematoma after accidental dural puncture during epidural anaesthesia.
A case is reported of acute intracranial subdural haematoma following accidental dural puncture during epidural anaesthesia. A 36-year-old primigravida with a gestation of 37 weeks and 3 days underwent caesarean section for which epidural anaesthesia was initially planned. An 18-gauge Tuohy needle was inserted into the L3-4 interspace but accidental dural puncture occurred. ⋯ The persisting headache decreased on day 12 and disappeared on day 14. The patient was discharged from hospital on day 15. The presence of post dural puncture headache complicated by atypical neurological deterioration following epidural anaesthesia should prompt the anaesthetist to consider the existence of intracranial complications and to seek immediate clinical and radiological diagnosis.
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Int J Obstet Anesth · Jan 2004
Breast-feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast-feeding practices.
Various clinical practices have been found to be associated with breast-feeding problems. However, little is known about the effect of pain, obstetrical procedures and analgesia on breast-feeding behaviour. We designed a retrospective study with a questionnaire concerning pain, obstetrical procedures and breast-feeding practices mailed to 164 primiparae in Lapland. ⋯ In the sub-sample, 67% of the mothers who had laboured with epidural analgesia and 29% of the mothers who laboured without epidural analgesia reported partial breast feeding or formula feeding (P = 0.003). The problem of "not having enough milk" was more often reported by those who had had epidural analgesia. Further studies conducted prospectively are needed to establish whether a causal relationship exists between epidural analgesia and breast-feeding problems.
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Int J Obstet Anesth · Jan 2004
Case ReportsContinuous spinal anesthesia for cesarean section in a parturient with severe recurrent peripartum cardiomyopathy.
The anesthetic management of labor and delivery in patients with peripartum cardiomyopathy is not well defined. Using continuous spinal anesthesia in such a rare clinical situation has not been previously reported. ⋯ In addition, it also markedly reduced the patient's symptoms. Continuous spinal anesthesia is a reliable, rapidly titratable technique, which provides excellent analgesia with minimal undesirable hemodynamic changes for patients with peripartum cardiomyopathy undergoing cesarean delivery.