Nihon Sanka Fujinka Gakkai zasshi
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Nippon Sanka Fujinka Gakkai Zasshi · Apr 1983
[The maternal and fetal acid-base status during general or spinal anesthesia for elective cesarean section in the left tilt position].
Thirty one healthy parturients received spinal or general anesthesia for elective cesarean section. Maternal blood pressures, maternal and fetal acid-base values, induction to delivery intervals (I-DI) and Apgar scores were determined. On spinal anesthesia, acute hydration by 6% hydroxyethyl starch solution and intramuscular injection of ephedrine were enforced prior to the block and in the left tilt position (17 degrees) oxygen inhalation immediately after the block was begun (group OII: 16 cases). ⋯ A positive correlation between umbilical venous pH values and 1 or 5 minutes Apgar scores was confirmed in group OII, and a negative correlation between 1 minute Apgar scores and I-DI was noticed in group G. Fetal acid-base values were not correlated with I-DI in either group, and it was postulated that placental or fetal circulation was sufficiently maintained. Biochemical status and clinical conditions in mothers and their infants are very favorable in well-conducted general or spinal anesthesia for elective cesarean section.
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Nippon Sanka Fujinka Gakkai Zasshi · Feb 1983
An autopsy study of 306 cases of maternal death in Japan.
Based on autopsy findings in 306 cases of maternal death from 1964 to 1980, recent trends in maternal death in Japan were discussed. Main topics dealt with were as follows: 1. Although rate of maternal death in Japan is decreasing markedly year by year, approximately 90 per cent of our autopsy cases were direct or indirect maternal deaths. 2. ⋯ Fifteen cases (4.9 per cent) of amniotic fluid embolism were confirmed by autopsy. However, only in 6 out of 15 cases, a clinical diagnosis of amniotic fluid embolism was given. In the remaining 9 cases, clinical diagnoses such as "shock of unknown etiology", "septic or endotoxin shock" and "postpartum collapse" were presumed.
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Nippon Sanka Fujinka Gakkai Zasshi · Dec 1982
[Studies on neurobehavioral response (Scanlon test) in newborns after epidural anesthesia with various anesthetic agents for cesarean section].
In order to examine the influence of larger doses of anesthetic drugs on newborns, 146 infants delivered by cesarean section with epidural anesthesia employing various anesthetic agents were assessed by Apgar score, blood gas analysis, drug concentration as well as Scanlon's examination. The following results were obtained: 1. ⋯ The groups whose mothers had received epidural block with either lidocaine or mepivacaine for cesarean section showed significantly lower scores in Scanlon test compared with the groups with bupivacaine or chloroprocaine and spinal anesthesia group. From these findings, it may be concluded that bupivacaine or chloroprocaine does offer some advantages over (three local anesthetic agents) lidocaine, mepivacaine or tetracaine to the obstetric patients who need cesarean section for delivery.
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Nippon Sanka Fujinka Gakkai Zasshi · Apr 1982
[Alterations in coagulation and fibrinolytic system in abruptio placentae (author's transl)].
Abruptio placentae tends to be accompanied by abnormal coagulation and fibrinolysis, and is known as high risk pregnancy allowing both mother and fetal lives to endanger. Blood coagulation and fibrinolytic system in abruptio placentae, in particular, sequential changes around its onset have been remained unclarified despite the progress in hematology. This permits an irregular therapeutical process for its acute clinical manifestation. ⋯ A moderate type demonstrating an increased serum FDP with retarded ESR and lowering in fibrinogen level were observed, but those abnormalities recovered to normal by 3 days after delivery. In serious case, observations also were made of marked decrease of fibrinogen, prolonged PT and PTT, high concentrations of serum and urinary FDP, lowering in levels of coagulation factors, attenuated platelet counts, retarded ESR, and inhibition of platelet aggregation along with thrombelastgram that showed thrombocytopenic type. All of those anomalies tended to be improved following delivery.
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Nippon Sanka Fujinka Gakkai Zasshi · Feb 1982
[Clinical studies on prevention of spinal hypotension and aortocaval compression during elective cesarean section (author's transl)].
Maternal blood pressures, maternal and fetal blood-gas values, induction delivery intervals (I-D intervals) and Apgar scores were determined in 60 cases of elective cesarean section under spinal anesthesia. The procedures were as follows: In the right lateral position on an operating table, the intravenous drip infusion of 6 per cent hydroxyethyl starch solution (12 ml/kg) for 30 minutes prior to spinal anesthesia and the intramuscular injection of ephedrine (0.5 mg/kg) 15 minutes before spinal anesthesia were performed. Immediately after the anesthesia, on the left semilateral position the operation was started (group S). ⋯ It is suggested that the uteroplacental circulation in group O and E was maintained more or less smoothly than that in group S. Oxygen inhalation led to a significant increase in fetal PO2 and the improvement of 5 minutes Apgar score. On performing elective cesarean section under spinal anesthesia, it may be advisable to take the procedures of group OII (Oxygen flow: 31/min., through a nasal cannula) and to make mother respire closing their mouths.