Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewCardiopulmonary resuscitation and the parturient.
Cardiopulmonary arrest occurs in 1: 30 000 pregnancies. Although rare, optimal outcomes are dependent on the cause of the arrest, the rapid response team's understanding of the physiological effects of pregnancy on the resuscitative efforts and application of the latest principles of advanced cardiac life support (ACLS). Anaesthesia-related complications, secondary to difficult or failed intubation, and inability to oxygenate and ventilate can result in adverse outcomes for mother and baby. ⋯ Delivery of the baby helps in the maternal resuscitation efforts and recovery of circulation. Finally, the 2003 International Liaison Committee on Resuscitation (ILCOR) and the 2005 American Heart Association (AHA) advocate the provision of mild therapeutic hypothermia to the survivors of cardiac arrest. This will improve the neurological outcomes by decreasing cerebral oxygen consumption, suppression of the radical reactions and reduction of intracellular acidosis and inhibition of excitatory neurotransmitters.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewObstetric anaesthesia in low-resource settings.
Close co-operation between obstetricians and obstetric anaesthesia providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. Maternal and foetal mortality is unacceptably high, and the practice of obstetric anaesthesia has an important influence on outcome. Well-conducted national audits have identified the contributing factors to anaesthesia-related deaths. ⋯ The importance of current outreach initiatives is emphasised, and educational resources and the available financial sources discussed. The difficulties of efficient procurement of equipment and drugs are outlined. Guiding principles for the practice of analgesia for labour, anaesthesia for caesarean section and the management of obstetric emergencies, where the anaesthetist also has a central role, are suggested.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewThe ongoing challenges of regional and general anaesthesia in obstetrics.
The increasing trend of caesarean section in the setting of increasing maternal age, obesity and other concomitant diseases will continue to challenge the obstetric anaesthetist in his/her task of providing regional and general anaesthesia. The challenges of providing anaesthesia for an emergency caesarean section, particularly the risks of general anaesthesia, will be debated. The need for involvement of a multidisciplinary team, good communication and challenges surrounding the provision of anaesthesia to such patients are discussed.
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Best Pract Res Clin Obstet Gynaecol · Jun 2010
ReviewObstetric audit and its implications for obstetric anaesthesia.
After briefly expounding the principles of an audit, this article focusses on the role of obstetric audit and how it can influence, and even shape, obstetric anaesthetic practice. The impact may be on service delivery, anaesthetic practice or the generation of new information. ⋯ Further examples include how different types of audit of pregnancy outcome, obstetric practice or areas of cross-interest to both obstetricians and anaesthetists are used by anaesthetists to evaluate health-care delivery, their own practices and to generate new audit and research agendas. Audits drive change and, hopefully, improvements that continue to make pregnancy a safer and more satisfying event for the mother and child.
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Every minute of every day, a woman dies in pregnancy or childbirth. The biggest killer is obstetric haemorrhage, the successful treatment of which is a challenge for both the developed and developing worlds. The presence of an attendant at every birth and access to emergency obstetric care are key to reducing maternal morbidity and mortality in the developing world while resource-rich countries have a rising caesarean section rate with its consequential effect on the incidence of abnormal placentation and its link with peripartum hysterectomy. ⋯ Various methods are available to try to stop the bleeding - from pharmacological methods to aid uterine contraction (e.g., oxytocinon, ergometrine and prostaglandins) to surgical methods to stem the bleeding (e.g., balloon tamponade, compression sutures or arterial ligation). Interventional radiology can be used if placenta accreta is suspected. Cell salvage has been introduced into obstetrics relatively recently in an attempt to reduce allogeneic transfusion.