Nihon Sanka Fujinka Gakkai zasshi
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Nippon Sanka Fujinka Gakkai Zasshi · Mar 1987
[A study of intrapartum and postpartum bleeding based on changes in blood coagulation and fibrinolysis during pregnancy].
The relationship between changes in blood coagulation and fibrinolysis during pregnancy and intrapartum-postpartum bleeding was studied as a trial prediction of abnormal bleeding during vaginal delivery in 27 subjects without any complications. The following results were obtained: In the third trimester, shortening of prothrombin time and activated partial thromboplastin time, increases in fibrinogen, platelet epinephrine, collagen aggregation, and plasminogen, and a decrease in alpha 2-plasmin inhibitor were marked as compared with those in the first trimester. In the same subjects, the relationship between changes in blood coagulation and fibrinolysis in the first and third trimesters and intrapartum-postpartum bleeding was studied by the independent matched pair test. ⋯ In the subjects whose prothrombin time and activated partial thromboplastin time in the third trimester were shorter than those in the first trimester, intrapartum and postpartum bleeding increased. The subjects whose prothrombin time and activated partial thromboplastin time in the third trimester were less by more than 0.52 seconds and more than 3.98 seconds, respectively, than those in the first trimester experienced abnormal bleeding exceeding 500 ml during delivery. In the intrapartum and postpartum bleeding group, shortening of prothrombin time and activated partial thromboplastin time, decreases in fibrinogen and alpha 2-plasmin inhibitor and an increase in platelet aggregation were more significantly observed than in the intrapartum and postpartum normal bleeding groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nippon Sanka Fujinka Gakkai Zasshi · Feb 1987
[Ephedrine administration for cesarean section under spinal anesthesia].
Prophylactic ephedrine was administered to healthy parturients undergoing elective cesarean section under spinal anesthesia. The methods of ephedrine administration were as follows: intramuscular injection of 0.3 mg/kg, 15 minutes before the block (20 cases: group M), infusion of 0.02% solution immediately after the block (20 cases: group D), premedication with atropine 0.5 mg and infusion immediately after the block (20 cases: group AD). The mean ephedrine dosage was 18.8 +/- 2.2 gm (SD) in group M, 12.6 +/- 6.2 mg in group D and 5.2 +/- 0.7 mg in group AD, and there were significant differences among the three groups. ⋯ One- and 5-minute Apgar scores were 8 or more in all, and umbilical acid-base values were within normal limits in all of them, though the base deficit in group AD was significantly lower than that in group M. Atropine premedication makes it possible to retrench the ephedrine dosage without any harmful effect on either mother or fetus, and ephedrine infusion makes it easy to cope with changes in maternal blood pressure. Consequently, for healthy parturients receiving elective cesarean section under spinal block, we recommend atropine premedication and minimal infusion of ephedrine immediately following the block.
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Nippon Sanka Fujinka Gakkai Zasshi · Dec 1986
[Neonatal effects of the delivery interval during cesarean section under spinal anesthesia].
The relationships between I-DI (induction to delivery interval) or U-DI (uterine incision to delivery interval) and fetal acid-base status or neonatal clinical condition were studied in 60 healthy parturients undergoing elective cesarean section under spinal anesthesia. The patients were divided into groups, i.e. group A (U-DI less than 90 sec, I-DI greater than 14 min, 18 cases), group B (U-DI less than 90 sec, I-DI greater than 14 min, 12 cases), group C (U-DI greater than 90 sec, I-DI less than 14 min, 15 cases) and group D (U-DI greater than 90 sec, I-DI greater than 14 min, 15 cases). Acid-base values for maternal arterial (MA), umbilical venous (UV) and umbilical arterial blood (UA), and acid-base gradients for (MA-UV) and (UV-UA) in each group were all in the normal range and revealed no significant differences among 4 groups, though U-DI was correlated with UVPCO2, UAPCO2, and (UV-UA) base deficit (r = 0.322, 0.266, -0.256: p less than 0.05). ⋯ Both 1 and 5 minute Apgar scores were 8 or more in all neonates. There was no correlation between I-DI and fetal acid-base values or neonatal clinical conditions. It is conceivable that gentle and careful manipulations of the uterus and fetus rather than shortening of U-DI might be important in preventing against fetal or neonatal depression during cesarean section under spinal block.
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Nippon Sanka Fujinka Gakkai Zasshi · Dec 1985
[A study on spinal anesthesia for cesarean section--with special reference to left uterus displacement device (LUDD)].
In this study, 303 cases of cesarean section by spinal anesthesia with the application of LUDD were studied to find the relationships between induction to delivery time (I-D time) and Apgar score (Ap-S), level of anesthesia and changes in maternal circulation and also to observe changes in feto-maternal acid base status, feto-maternal CO2 metabolism monitored with an Anesthesia & Brain activity Monitor (ABM) and post anesthesia complications. ⋯ The use of LUDD as a prophylactic measure to prevent maternal hypotension was very effective. The elevation of anesthesia level always involved the risk of maternal hypotension even when the LUDD was used. A slight drop in blood pressure during the short period before the infant was delivered did not adversely affect the AP-S, but prolonged I-D time did affect the clinical condition of the infant and probably promoted acidosis. Administration of 100% O2 induced mild maternal acidosis but, for the short period before delivery, the fetal oxygenation and CO2 metabolism were smooth with reduced acidosis. Since there was a close correlation between maternal PECO2 and PaCO2 and PCO2 of the maternal blood (MA, MV) and umbilical blood (UA, UV) were also correlated, the continuous monitoring of PECO2 with an ABM was deemed to be very useful in anesthesia for cesarean section. In the 303 cases studied, a case of headache was the only post-anesthesia complication.
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Nippon Sanka Fujinka Gakkai Zasshi · Oct 1984
[The influence of maternal oxygen inhalation for 30 to 60 minutes on fetal oxygenation].
Healthy parturients with uterine displacement received oxygen inhalation before and during spinal anesthesia for elective cesarean section. Oxygen was administered through a mask (group OH2 : 20 cases) or via a nasal cannula (group OH1: 20 cases) for 33 to 69 minutes. All patients were in the right lateral position prior to spinal block and were in the left tilt after the anesthesia. ⋯ The Apgar scores and both the maternal and fetal acid-base values for all groups were excellent. The umbilical vein to artery PO2 and SO2 gradients of the OH2 group were significantly greater than those of the other groups. It is emphasized that maternal hyperoxia with uterine displacement improves fetal oxygenation without adversely affecting the fetal acid-base state, even if it is excessive and maintained for 60 minutes.