American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Nov 1989
Case ReportsAntagonism of antihypertensive drug therapy in pregnancy by indomethacin?
Two women with preeclampsia treated with pindolol and propranolol became profoundly hypertensive when indomethacin was added because of premature contractions. The interaction of nonsteroidal antiinflammatory agents and beta-blockers and their role in the control of blood pressure in obstetrics are discussed. Indomethacin should not be given to pregnant patients with hypertension treated with beta-blockers.
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Am. J. Obstet. Gynecol. · Oct 1989
Case ReportsAnesthetic management of labor in a patient with dextrocardia, congenitally corrected transposition, Wolff-Parkinson-White syndrome, and congestive heart failure.
Labor and delivery greatly stress the cardiovascular system. In this patient with underlying congenital heart disease and congestive heart failure, hemodynamic stability was maintained with a combination of lumbar epidural and caudal epidural anesthesia.
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Am. J. Obstet. Gynecol. · Sep 1989
The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women.
Epidural analgesia in labor is generally accepted as safe and effective and therefore has become increasingly popular. However, little is known regarding the effect of epidural analgesia on the incidence of cesarean section for dystocia in nulliparous women. During the first 6 months of 1987 we studied 711 consecutive nulliparous women at term, with cephalic fetal presentations and spontaneous onset of labor. ⋯ The incidence of cesarean section for fetal distress was similar (p greater than 0.20) in both groups. There were no clinically significant differences in frequency of low Apgar scores at 5 minutes or cord arterial and venous blood gas parameters between the two groups. This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women.
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Am. J. Obstet. Gynecol. · Sep 1989
Comparative StudyMeasurement of cardiac output in pregnancy by thoracic electrical bioimpedance and thermodilution. A preliminary report.
Thoracic electrical bioimpedance is a noninvasive, continuous method of obtaining cardiac output that requires no operator skill. However, the most recent thoracic electrical bioimpedance technology has not been validated in pregnancy. We therefore compared two methods of measuring cardiac output in pregnancy, thoracic electrical bioimpedance and thermodilution. ⋯ Bivariate linear regression with these nine cases showed excellent correlation (r = 0.91, p less than 0.001) with a slope of 1.04, which indicated a one-to-one relationship between thoracic electrical bioimpedance and thermodilution. The remaining two cases were removed from analysis because of septic shock in one case (which invalidates thoracic electrical bioimpedance) and 4+ tricuspid regurgitation in another case (which invalidates thermodilution). These data support that thoracic electrical bioimpedance measurement of cardiac output may be valid in most peripartum patients.