Geburtsh Frauenheilk
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Geburtsh Frauenheilk · Sep 1986
[HELLP syndrome: a rare, threatening complication in pre-eclampsia].
A very rare, but severe complication, occurring together with preeclampsia, is the so-called HELLP syndrome (H for haemolysis, EL for elevated liver enzymes and LP for low platelet counts). Perinatal mortality for this syndrome is estimated at 9.5% up to 60%, maternal mortality at 3.5%. We examined retrospectively 11 patients of the last 5 years, presenting not only hypertension, proteinuria and oedema, but also pathologically elevated data concerning transaminases, indirect bilirubin and thrombocytopenia; the mean value for GI in this group was 7.7 (3-11). ⋯ Time interval between onset of therapy and delivery was 3 days on the average, the mean gestational age at time of delivery was 34 weeks (27-39), average infant weight amounted to 1,960 g (580-3,700 g). 7 of the 11 women delivered by Caesarian section (64%); perinatal, respectively neonatal 3 babies died (27%). In two cases one Caesarian section did not produce maternal complications; 3 women had to undergo a hysterectomy. This syndrome is associated with a very problematic obstetrical situation in respect of differential diagnosis, foetal outcome and the high frequency of postoperative maternal complications.
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Geburtsh Frauenheilk · Jun 1986
[Effect of subpartal tocolysis on maternal cardiovascular parameters with subsequent cesarean section in general anesthesia].
The influence of subpartal beta-sympathicomimetic tocolysis on a subsequent Caesarean section with halothane as inhalational anaesthetic was examined in 42 pregnant women. Alterations in the heart rate, blood pressure and heart action during the operation were measured. 23 patients (group "bolus") received fenoterol monotherapy. In 19 patients (group "iv-tocolysis") fenoterol was combined with the cardioselective beta-1-blocking agent metoprolol. ⋯ Arrhythmias of ectopic origin and sinus bradycardias, however, were found seldom. The incidence of arrhythmias in the three groups during Caesarean section did not differ significantly. There was no evidence for an increased occurrence of arrhythmias following beta-sympathicomimetic tocolysis.
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A study on actual trends in obstetric analgesia and anaesthesia was conducted on data received from 385 German departments of obstetrics with a total of 267441 deliveries. On the basis of these extensive data quantitative results could be obtained about analgesic procedures for spontaneous deliveries, operative-vaginal deliveries, Caesarean sections and in cases of foetal or maternal risks. The type of analgesics and local anaesthetics used, their side effects and complications were recorded. In addition the cooperation and interaction between obstetricians and anesthesiologists in practising and monitoring obstetrical analgesia and anaesthesia are described.
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Geburtsh Frauenheilk · Mar 1984
[Effect and adverse effects of epidural anesthesia during labor. With special reference to changes in the cardiotocogram].
In an Obstetric Department with approximately 2,000 deliveries yearly, offry third mother is delivered under epidural anesthesia. In a group of 600 maternity patients, the effectiveness, the side effects and the changes in the fetal cardiotocogram were examined during labour and delivery under epidural anesthesia. Evaluated were questionnaire to the mothers with mainly subjective impressions, the anesthetic protocol, and the protocol of labour and delivery including the internal cardiotocogram. 85% of the mothers would have a future delivery under an epidural anesthesia. ⋯ The incidence of cesarian sections, fetal morbidity and changes in the cardiotocogram are discussed in detail. The incidence of transilent silent decelerations and alarm dips in the cardiotocogram are mentioned. This study shows that epidural anesthesia is free of risks and a highly effective method for the conduct of obstetric analgesia.
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A study of the side effects of epidural anesthesia for painless delivery in 100 patients showed that 90% of the post partum patients were very satisfied with the analgesia and did not consider symptoms post partum to be very debilitating and did not blame the epidural anesthesia for the symptoms. Severe pain in the occiput and the cervical spine occurred in only two cases. In one case, the cerebro-spinal fluid was punctured. ⋯ No correlation was found with puncture of the dura which is suspected in the literature. Retention of urine was not found to be correlated to the epidural anesthesia. Uniformity of the responses by the maternity patients were striking especially if one considered that the social condition and the psychic condition of the individual woman such as attitude to delivery, presence of the husband at delivery, and other factors were not evaluated.