International journal of obstetric anesthesia
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A 35-week pregnant patient with ankylosing spondylitis and a known previous failed intubation required an elective caesarean section for intrauterine growth retardation. Regional anaesthesia was prevented by extensive spinal fusion. The anaesthetic management involved an awake oral fibreoptic intubation followed by induction and maintenance of general anaesthesia allowing delivery of a live infant without harm to the mother.
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It is essential for an obstetric anesthesiologist to be aware of the fetal status before undertaking care of the laboring mother. In the last 20 years electronic fetal monitoring has been the most widely used technique of evaluating the fetus in labor. ⋯ This review presents a summary of the current technology and interpretation of intrapartum electronic fetal monitoring, as well as a discussion of its limitations and some of the developments in this field which may help improve the accuracy of fetal assessment. The new developments in fetal monitoring discussed in this article are computerized assessment of fetal heart tracings, heart rate variability analysis, fetal electrocardiogram waveform analysis, abdominal detection of fetal ECG, fetal scalp oxygen saturation, fetal pH sampling and transcutaneous oxygen and carbon dioxide measurement.
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Int J Obstet Anesth · Jul 1995
Epidural clonidine-fentanyl combination for labour analgesia: a comparison with bupivacaine-fentanyl.
This open study of 20 women compared epidural clonidine (300 microg)/fentanyl (100 microg) with bupivacaine (25 mg)/fentanyl (100 microg) in the provision of pain relief in labour. Sensory tests in the clonidine group revealed slight alterations in the appreciation of pin prick and temperature but motor power was unchanged. ⋯ Midwives also commented favourably on the normal mobility of these labouring mothers. There was no difference between the two groups in the duration of labour or the condition of the infants.
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Int J Obstet Anesth · Jul 1995
Acute tocolysis for suspected intrapartum fetal distress: maternal effects of terbutaline versus magnesium sulfate.
This study was undertaken to determine the maternal hemodynamic impact of terbutaline versus magnesium sulfate in the acute treatment of fetal distress prior to cesarean delivery. Forty-six women were prospectively randomized to receive 0.25 mg subcutaneous terbutaline or 4.0 g intravenous magnesium sulfate for in utero fetal resuscitation before cesarean delivery. ⋯ However, mean urine output was significantly greater in the terbutaline group (88 +/- 42 ml/h) than in those treated with magnesium sulfate (61 +/- 26 ml/h; P < 0.03). Terbutaline, the superior agent for acute tocolysis, is not associated with an increase in maternal cardiovascular side effects during anesthesia.