International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2021
Observational StudyAccuracy of cricothyroid membrane identification using ultrasound and palpation techniques in obese obstetric patients: an observational study.
During performance of emergency front of neck access, the final step in management algorithms for the 'can't intubate, can't oxygenate' scenario, accurate identification of the cricothyroid membrane is crucial. Accurate identification using palpation techniques is low, with highest failure rates occurring in obese females. ⋯ Ultrasound-guided cricothyroid membrane localisation was significantly more accurate but slower than the landmark technique in obese obstetric patients. As such, we recommend the use of pre-procedural identification of the cricothyroid membrane in this patient population and formal training of anaesthetists in airway ultrasound.
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Int J Obstet Anesth · Nov 2021
Observational StudyFetal heart rate monitoring during fetoscopic repair of open spinal neural tube defects: a single-centre observational cohort study.
During fetal surgery, the haemodynamic stability of the fetus depends on the haemodynamic stability of the mother. The primary objective of this study was to assess changes in fetal heart rate (FHR) throughout the different stages of surgery. The secondary objective was to assess potential changes in maternal physiological parameters and their association with FHR. ⋯ The FHR remained stable during intra-uterine fetoscopic repair of open spina bifida. Maternal carbon dioxide tension and heart rate may have a mild influence on FHR.
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Int J Obstet Anesth · Nov 2021
Observational StudyProficiency-based progression training: implementing a novel approach to training for epidural analgesia in labour.
Epidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital. ⋯ In our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.
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Int J Obstet Anesth · Nov 2021
Case ReportsTwo cases of severe COVID-19 in gestational week 27 and 28 respectively, after which both pregnancies proceeded to term.
COVID-19 in pregnancy increases the risk of caesarean section. We present two cases of late gestation pregnant women with severe COVID-19. ⋯ These two cases demonstrate the possibility of treating pregnant women with severe COVID-19 with mechanical ventilation in the late second and early third trimesters without them having a pre-term delivery. With a multidisciplinary approach, such management could avoid the maternal risks of surgery during a severe infection and, at the same time, enable term birth with a lower risk of neonatal complications.
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Int J Obstet Anesth · Nov 2021
An audit of the effect of case selection on compliance with a 30-minute audit standard for decision-to-delivery interval at category 1 caesarean section.
Our hospital has an audit standard that ≥90% of women having category 1 (emergency) caesarean section should have a decision-to-delivery interval (DDI) ≤30 min. This audit aimed to identify potential influences of case selection on compliance. ⋯ Compliance with an audit standard for (DDI) at category 1 caesarean section is markedly influenced by the inclusion criteria. For comparability with other publications, it is suggested urgency should be reported as that applied at the point of decision for caesarean section, however, category 1 caesarean section cases following failed operative vaginal delivery in the operating theatre should be identified and reported separately.