International journal of obstetric anesthesia
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Two cases of severe postpartum anaemia are presented in Jehovah's witnesses who refused blood transfusion. Despite haemoglobin concentrations of less than 3 g/dl both women survived. ⋯ In the other case, recombinant human erythropoietin was used to encourage red cell production. The recovery of haemoglobin concentration in the two cases is compared.
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Int J Obstet Anesth · Jul 1996
alpha1-acid glycoprotein and albumin in the spinal fluid of pregnant women.
Pregnant women at term need a smaller dose of local anaesthetic to produce the same spinal anaesthesia as non-pregnant women. The aim of the study was to see whether the concentrations of binding proteins were reduced in spinal fluid in pregnant women. The concentrations of the binding proteins [Formula: see text] glycoprotein (AAG) and albumin were measured in plasma and spinal fluid from 20 pregnant and 20 non-pregnant women, ASA 1. ⋯ The concentrations in plasma were also reduced in late pregnancy. All the changes were statistically significant. Since only a minor fraction of bupivacaine seems to be protein bound in spinal fluid these differences may have only a little influence on the free fraction and cannot be solely responsible for the increased sensitivity of pregnant women to spinal anaesthesia.
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Int J Obstet Anesth · Jul 1996
Analgesic efficacy of intravenous morphine in labour pain: a reappraisal.
The aim of the present study was to investigate the dose-related analgesic effect of intravenous (i.v.) morphine during spontaneous term first stage labour. This was an open study in 17 parturients who requested analgesia for severe labour pain. All women were given morphine i.v. in repeated doses of 0.05 mg/kg following every third contraction until a final dose of 0.20 mg/kg was reached. ⋯ No adverse reactions related to morphine were noted in the neonates. We conclude that i.v. morphine does not significantly reduce overall labour pain intensity. Thus, if a real analgesic effect is desired, systemically given morphine seems inappropriate and other techniques should be used.
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Int J Obstet Anesth · Jul 1996
A comparison of non-invasive methods of blood pressure measurement in normotensive and hypertensive pregnant women.
We compared two types of automatic non-invasive blood pressure measuring device with sphygmomanometey in 47 normotensive and 38 hypertensive women in the third trimester of pregnancy. An automatic oscillometric device (Accutor) and a volume-clamp device (Finapres) significantly underestimated the diastolic pressure as measured by the fourth Korotkoff sound using a Hawksley random zero sphygmomanometer. ⋯ The mean difference between the sphygmomanometer and Finapres measurement of diastolic blood pressure was +6.1 mmHg in the normotensive women and +11.5 mmHg in hypertensive women (P = 0.003). The increased use of continuous non-invasive devices to monitor blood pressure in women with hypertension should be accompanied by sound knowledge of their limitations in this group of patients.
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The report of the Expert Maternity Group 'Changing Childbirth' (The Cumberlege Report) advocates a greater role for midwives in the care of the low risk pregnant woman, and has promoted much discussion about the future development of maternity services in the UK. At Leicester Royal Infirmary NHS Trust the 'Home from Home' delivery scheme provides midwifery-led antenatal and intrapartum care of women with uncomplicated pregnancies. We have performed a retrospective review of the requirements for anaesthetic services in this unit. ⋯ One hundred and eighty one women subsequently received anaesthetic intervention. Of this group, 137 (77.0%) required an epidural, 17 (9.6%) a spinal, 18 (10.1%) a general anaesthetic, 5 (2.8%) an epidural and a general anaesthetic and 1 (0.6%) an epidural and a spinal. Our results demonstrate that low risk pregnant women in labour being cared for in a midwifery led unit have a considerable need for anaesthesia and analgesia.