Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
Review Comparative StudyThe effects of maternal labour analgesia on the fetus.
Maternal labour pain and stress are associated with progressive fetal metabolic acidosis. Systemic opioid analgesia does little to mitigate this stress, but opioids readily cross the placenta and cause fetal-neonatal depression and impair breast feeding. Pethidine remains the most widely used, but alternatives, with the possible exception of remifentanil, have little more to offer. ⋯ Actual neonatal outcome, however, suggests that benefits outweigh detrimental influences. Meta-analysis demonstrates that Apgar score is better after epidural than systemic opioid analgesia, while neonatal acid-base balance is improved by epidural compared to systemic analgesia and even compared to no analgesia. Successful breast feeding is dependent on many factors, therefore randomized trials are required to elucidate the effect of labour analgesia.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewNerve injuries after neuraxial anaesthesia and their medicolegal implications.
Serious and permanent neurologic complications in the obstetric population are rare. Most neurologic complications following childbirth are intrinsic obstetric palsies. The most common intrinsic obstetric palsy is lateral femoral neuropathy. ⋯ Postpartum complaints should be addressed promptly. For infection and space-occupying lesions of the neuraxial canal, prompt diagnosis and treatment are essential to prevent permanent injury or death. Survey studies have demonstrated that women want to be told of the risks of neuraxial procedures, even when the incidence is rare.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewThe preoperative assessment of obstetric patients.
The importance of early identification and management of the high-risk obstetric patient is emphasised in the Confidential Enquiry into Maternal and Child Health (CEMACH) report. High-risk patients who need anaesthetic input include those with airway problems, cardiorespiratory disease and rare genetic conditions, such as malignant hyperthermia and suxamethonium apnoea. ⋯ Input from other medical teams, such as cardiologists or haematologists, are often needed. Ultimately, these measures should reduce maternal morbidity and mortality.
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The coagulation system undergoes significant change during pregnancy. The clinician caring for the parturient must understand these changes, particularly when the parturient has a pre-existing haematological condition. Because many haematological conditions are rare, there often is limited information to guide the obstetric and anaesthetic management of these parturients.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewPharmacogenetic influences in obstetric anaesthesia.
Genomic discoveries in the field of perioperative medicine and anaesthesia have generated multiple publications and some hope that pharmacogenetic testing may guide clinicians to provide safe and effective medicine in a 'tailored' manner. Within the field of anaesthesia, many consider that 'titration of drugs to the desired effect works just fine' and wonder if pharmacogenomics will ever impact on their daily practice. This review will cite practical examples of relevant candidates genes and common polymorphisms that have shown to alter the response to medication prescribed in the peripartum period by obstetricians and anaesthesiologists.