International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2022
The time is now: addressing the need for training in maternal critical care medicine.
Amongst many high-income countries, indirect medical conditions (e.g. cardiovascular disease, sepsis) now account for the majority of maternal deaths. In response to this concerning rise in indirect causes of maternal deaths, professional societies have developed guidelines that regionalize high-risk obstetric care and prioritize critical care expertise as a requirement for designated 'top' maternity hospitals. ⋯ Despite these requirements, no formal obstetric critical care educational curricula or fellowship pathways, combining critical care medicine and obstetric anesthesiology, currently exist. Dual subspecialty training in both obstetric anesthesiology and critical care medicine represents one strategy to improve the care of critically-ill obstetric patients and reduce maternal mortality and morbidity, which is one of the pressing healthcare issues of our time.
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Int J Obstet Anesth · May 2022
Incidence of persistent postpartum opioid use by mode of delivery: a 2016 cohort study of Danish women.
The use of oral opioids as standard treatment after cesarean delivery has been linked to persistent use in opioid-naïve women in the USA. In Denmark, the use of opioids after cesarean delivery is typically restricted to in-hospital use. The aim of this study was to estimate the incidence of persistent postpartum opioid use in Denmark and compare the incidence by mode of delivery. ⋯ Women giving birth in Denmark, where use of post-discharge opioid treatment is generally restricted, have a low risk of developing persistent use of opioids, with very few women seeking additional analgesic treatment from their general practitioner.
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Int J Obstet Anesth · May 2022
Observational StudyAccuracy of visual estimation of blood loss in obstetrics using clinical reconstructions: an observational simulation cohort study.
Postpartum hemorrhage is the leading cause of maternal mortality worldwide, and optimal management requires accurate blood loss estimations. The aim of this study was to assess whether differences exist between visually estimated blood loss vs. actual blood loss based on delivery mode, blood volume or distribution/location and knowledge of patient's current cardiovascular status. ⋯ Most providers significantly overestimated blood loss volumes (by nearly 700 mL). Provider and scenario factors that impact inaccuracies in visual estimated blood loss identified in this study can be used to guide education and training.
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Int J Obstet Anesth · May 2022
Maternal serum C-reactive protein and white blood cell count at hospital admission as predictors of intrapartum maternal fever: a retrospective case-control study in women having epidural labor analgesia.
Non-infectious inflammation has been proposed as a major contributor to epidural-related maternal fever. We hypothesized that maternal serum C-reactive protein (CRP) and white blood cell (WBC) count at hospital admission predict intrapartum maternal fever. ⋯ Maternal serum CRP and WBC at hospital admission do not predict intrapartum fever in women having epidural labor analgesia at term.
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Int J Obstet Anesth · May 2022
Comparison of neonatal outcomes of cesarean sections performed under primary or secondary general anesthesia: a retrospective study.
The conversion of neuraxial anesthesia (NA) to general anesthesia (GA) during a cesarean section (CS) may be associated with a higher risk of neonatal morbidity by adding the undesirable effects of both these anesthesia techniques. We aimed to compare the neonatal morbidity of non-elective CS performed after conversion from NA to GA (secondary GA) vs. that after GA from the outset (primary GA). ⋯ Our study found insufficient evidence to identify a difference in neonatal outcomes between secondary compared with primary GA for CS, regardless of the level of emergency. However, our study is underpowered and additional studies are needed to confirm these data.