International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1999
A patient who was found to be pregnant unexpectedly during hysteromyomectomy.
We present a case of an unexpected pregnancy and an ultimately successful obstetric outcome. The patient underwent abdominal myomectomy under spinal anaesthesia for a uterine leiomyoma with menorrhagia and infertility. ⋯ The blastocyst survived the surgical manipulation and anaesthesia, resulting in a successful pregnancy. The literature on the endocrinological stress response during anaesthesia and surgery suggests that spinal anaesthesia administered in this case was potentially helpful in maintaining progesterone levels and avoiding increased prolactin levels; increased prolactin levels might be deleterious to implantation of the blastocyst.
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Int J Obstet Anesth · Jul 1999
The development of a maternal satisfaction scale for caesarean section.
Satisfaction has become an important outcome measure. The purpose of this study was to develop a valid, reliable maternal satisfaction scale for women undergoing caesarean section. After Research Ethics Board approval, each patient gave verbal consent. ⋯ Maternal sense of control was the item most related to satisfaction. This scale provides more detailed information than a simple VAS. In the population studied, this tool was found to be a valid and reliable method for assessing maternal satisfaction in women undergoing non-emergent caesarean section.
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Int J Obstet Anesth · Jul 1999
What height of block is needed for manual removal of placenta under spinal anaesthesia?
The technique of spinal anaesthesia for manual removal of placenta was examined prospectively in 101 women. Factors associated with maternal discomfort during surgery were the height of the block (P = 0.007) and the force applied by the surgeon in removing the placenta (P = 0.04). A sensory block to cold to T9 or T10 resulted in discomfort for six out of 27 women (22%). ⋯ A block to cold to T6 or above is therefore recommended for manual removal of placenta under subarachnoid block. Factors not affecting maternal comfort were grade of the obstetrician, (P = 0.61), grade of the anaesthetist (P = 0.88), position of the mother during spinal injection (P = 0.32), volume of hyperbaric bupivacaine injected (P = 0.75), time from spinal injection to the start of surgery (P = 1.0), and duration of surgery (P = 0.77). Intraoperative hypotension was more common in those women with greater blood loss, (P = 0.002), but not with higher sensory levels (P = 0.31).
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Int J Obstet Anesth · Jul 1999
Visual disturbances and seizures associated with pregnancy: a diagnostic dilemma and the role of radiological techniques as an aid to diagnosis.
We present two cases of visual disturbances associated with tonic-clonic seizures during pregnancy and the associated radiological findings. We review the use of neuroimaging techniques as an aid to diagnosis and their role in elucidating the pathophysiology of cortical blindness.