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https://www.readbyqxmd.com/read/29044422/the-response-of-the-innate-immune-and-cardiovascular-systems-to-lps-in-pregnant-and-nonpregnant-mice
#1
Julia Zöllner, Laura G Howe, Lydia F Edey, Kieran P O'Dea, Masao Takata, Fabiana Gordon, James Leiper, Mark R Johnson
Sepsis is the leading cause of direct maternal mortality, but there are no data directly comparing the response to sepsis in pregnant and nonpregnant (NP) individuals. This study uses a mouse model of sepsis to test the hypothesis that the cardiovascular response to sepsis is more marked during pregnancy. Female CD1 mice had radiotelemetry probes implanted and were time mated. NP and day 16 pregnant CD-1 mice received intraperitoneal lipopolysaccharide (LPS; 10 μg, serotype 0111: B4). In a separate study, tissue and serum (for RNA, protein and flow cytometry studies), aorta and uterine vessels (for wire myography) were collected after LPS or vehicle control administration...
August 1, 2017: Biology of Reproduction
https://www.readbyqxmd.com/read/29034983/pleth-variability-index-can-predict-spinal-anaesthesia-induced-hypotension-in-patients-undergoing-caesarean-delivery
#2
S Kuwata, K Suehiro, T Juri, S Tsujimoto, A Mukai, K Tanaka, T Yamada, T Mori, K Nishikawa
BACKGROUND: Spinal anaesthesia carries a risk of hypotension. We hypothesized that pleth variability index and perfusion index would assess maternal volume status, and thus, allow identification of patients at higher risk of developing hypotension after spinal anaesthesia for caesarean delivery. METHODS: Fifty patients undergoing elective caesarean delivery were enrolled. All patients received spinal anaesthesia with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (10 mcg)...
October 16, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29034064/personalized-therapy-against-preeclampsia-by-replenishing-placental-protein-13-pp13-targeted-to-patients-with-impaired-pp13-molecule-or-function
#3
REVIEW
Hamutal Meiri, George Osol, Irene Cetin, Sveinbjörn Gizurarson, Berthold Huppertz
Hypertensive disorders affect about one third of all people aged 20 and above, and are treated with anti-hypertensive drugs. Preeclampsia (PE) is one form of such disorders that only develops during pregnancy. It affects ten million pregnant women globally and additionally causes fetal loss and major newborn disabilities. The syndrome's origin is multifactorial, and anti-hypertensive drugs are ineffective in treating it. Biomarkers are helpful for predict its development. Generic drugs, such as low dose aspirin, were proven effective in preventing preterm PE...
2017: Computational and Structural Biotechnology Journal
https://www.readbyqxmd.com/read/29033720/reducing-by-50-the-incidence-of-maternal-hypotension-during-elective-caesarean-delivery-under-spinal-anesthesia-effect-of-prophylactic-ondansetron-and-or-continuous-infusion-of-phenylephrine-a-double-blind-randomized-placebo-controlled-trial
#4
Jose Ramon Ortiz-Gómez, Francisco Javier Palacio-Abizanda, Francisco Morillas-Ramirez, Inocencia Fornet-Ruiz, Ana Lorenzo-Jiménez, Maria Lourdes Bermejo-Albares
BACKGROUND: Prophylactic administrations of ondansetron or phenylephrine have been reported to provide a protective effect against hypotension in women undergoing cesarean delivery under spinal anesthesia (SA). The main hypothesis is that ondansetron improves the hemodynamic response, especially combined with phenylephrine infusion. METHODS: This prospective, double-blind, randomized, placebo-controlled study included 265 healthy pregnant women scheduled for elective cesarean delivery under SA...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28986931/can-point-of-care-ultrasound-predict-spinal-hypotension-during-caesarean-section-a-prospective-observational-study
#5
L Zieleskiewicz, A Noel, G Duclos, M Haddam, A Delmas, C Bechis, A Loundou, J Blanc, A Mignon, L Bouvet, S Einav, A Bourgoin, M Leone
Spinal anaesthesia for elective caesarean section is associated with maternal hypotension, secondary to alteration of sympathetic tone and hypovolemia, in up to 70% of cases. Measurement of the subaortic variation in the velocity time integral (VTI) after passive leg raising allows prediction of fluid responsiveness. Our objective, in this prospective single-centre observational study, was to assess the ability of change in VTI after 45° passive leg raising to predict hypotension after spinal anaesthesia. Ultrasound measurements were performed just before elective caesarean section...
October 7, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28980306/effect-of-maternal-oxygen-inhalation-on-foetal-free-radical-activity-a-prospective-randomized-trial
#6
V Ahuja, S Gombar, S Jaswal, J Kaur, P Gupta, D Chawla, A Huria, S Singh
BACKGROUND: Maternal inhalation of 35-40% oxygen concentration has no significant effect on foetal partial pressure of oxygen, and 60-100% produced maternal and foetal hyperoxia with increased free radical activity. The benefit of 50% maternal oxygen inhalation on foetal oxygenation, oxidant stress and total antioxidant status (TAS) during Caesarean section (CS) has not been simultaneously evaluated. METHODS: In this prospective, randomized, controlled trial 120 ASA physical status I-II, term pregnant women were recruited to elective CS (n = 60) and emergency CS (n = 60) and received either 50% oxygen or air inhalation following subarachnoid block (SAB)...
October 5, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28976555/techniques-for-preventing-hypotension-during-spinal-anaesthesia-for-caesarean-section
#7
REVIEW
Cheryl Chooi, Julia J Cox, Richard S Lumb, Philippa Middleton, Mark Chemali, Richard S Emmett, Scott W Simmons, Allan M Cyna
BACKGROUND: Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. It can be associated with nausea or vomiting and may pose serious risks to the mother (unconsciousness, pulmonary aspiration) and baby (hypoxia, acidosis, neurological injury). OBJECTIVES: To assess the effects of prophylactic interventions for hypotension following spinal anaesthesia for caesarean section. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (9 August 2016) and reference lists of retrieved studies...
August 4, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28942689/fetal-inflammatory-response-syndrome-firs-and-outcome-of-preterm-neonates-%C3%A2-a-prospective-analytical-study
#8
Francis, Vishnu Bhat, Nivedita Mondal, Bethou Adhisivam, Sajini Jacob, Gowri Dorairajan, Bn Harish
OBJECTIVES: To estimate the incidence of fetal inflammatory response syndrome (FIRS) in preterm neonates and correlate it with immediate and 1-year neurodevelopmental outcome. MATERIAL AND METHODS: This prospective observational analytical study, in preterm neonates with gestational age between 26 and 34 weeks was conducted from May 2014 to December 2015 in a tertiary care hospital in South India. FIRS was defined as the presence of either elevated levels of interleukin-6 (IL-6) in cord blood ≥ 11 pg/ml and / or the placental histopathology showing evidence of fetal inflammatory response...
September 24, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28891082/thrombolysis-for-massive-pulmonary-embolism-in-pregnancy
#9
Mojdeh S Heavner, Min Zhang, Chelsea E Bast, Lindsey Parker, Rachel F Eyler
Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Non-pregnant patients who develop PE with hypotension or showing signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics and all data available in this population is published as case reports or case series...
September 11, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28872480/a-random-allocation-graded-dose-response-study-of-norepinephrine-and-phenylephrine-for-treating-hypotension-during-spinal-anesthesia-for-cesarean-delivery
#10
Warwick D Ngan Kee
BACKGROUND: Norepinephrine has been investigated as a potential alterative to phenylephrine for maintaining blood pressure during spinal anesthesia for cesarean delivery with the advantage of less depression of maternal heart rate and cardiac output. However, the relative potencies of these two vasopressors have not been fully determined in this context. METHODS: In a random-allocation, graded dose-response study, 180 healthy patients undergoing spinal anesthesia for elective cesarean delivery received a single bolus of norepinephrine in one of six different doses ranging from 4 to 12 µg or phenylephrine in one of six different doses ranging from 60 to 200 µg to treat the first episode of hypotension...
September 5, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28860857/preventing-nausea-and-vomiting-in-women-undergoing-regional-anesthesia-for-cesarean-section-challenges-and-solutions
#11
REVIEW
Yvonne Jelting, Christian Klein, Thomas Harlander, Leopold Eberhart, Norbert Roewer, Peter Kranke
BACKGROUND: Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28817493/dna-methylation-of-the-glucocorticoid-receptor-gene-promoter-in-the-placenta-is-associated-with-blood-pressure-regulation-in-human-pregnancy
#12
Sulistyo E Dwi Putra, Christoph Reichetzeder, Martin Meixner, Karsten Liere, Torsten Slowinski, Berthold Hocher
BACKGROUND: Blood pressure (BP) regulation during pregnancy is influenced by hormones of placental origin. It was shown that the glucocorticoid system is altered in hypertensive pregnancy disorders such as preeclampsia. Epigenetic mechanism might influence the activity of genes involved in placental hormone/hormone receptor synthesis/action during pregnancy. METHOD: In the current study, we analyzed the association of 5'-C-phosphate-G-3' (CpG) site methylation of different glucocorticoid receptor gene (NR3C1) promoter regions with BP during pregnancy...
November 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28795968/differential-roles-of-the-right-and-left-toe-perfusion-index-in-predicting-the-incidence-of-postspinal-hypotension-during-cesarean-delivery
#13
Zifeng Xu, Tao Xu, Puwen Zhao, Rui Ma, Mazhong Zhang, Jijian Zheng
BACKGROUND: Aortocaval compression by the gravid uterus, low baseline vasomotor tone, and spinal anesthesia-related sympathetic blockade contribute to spinal anesthesia-induced hypotension during cesarean delivery. The finger perfusion index (PI) can predict spinal hypotension by reflecting baseline vasomotor tone, but cannot directly reflect aortocaval compression by the gravid uterus. This study aimed to examine whether baseline toe PIs predict the incidence of maternal hypotension and reflect aortocaval compression by the gravid uterus during cesarean delivery under spinal anesthesia...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28750269/a-comparative-analysis-of-ante-and-postnatal-clinical-characteristics-of-extremely-premature-neonates-suffering-from-refractory-and-non-refractory-hypotension-is-early-clinical-differentiation-possible
#14
Rita P Verma, Shaeequa Dasnadi, Yuan Zhao, Hegang H Chen
BACKGROUND: About 25% of hypotensive ELBW infants are refractory to intravascular volume expansion and inotropic drugs (VI) and require hydrocortisone (HC). Such neonates suffer from complications of prolonged hypotension and extended therapy with VI. ELBW infants with refractory hypotension (RH) are clinically and biochemically indistinguishable from those who respond to VI. OBJECTIVE: Early identification and differentiation of ELBW infants susceptible to steroid dependent hypotension from those who respond to inotropic medications...
July 24, 2017: Early Human Development
https://www.readbyqxmd.com/read/28728156/predicting-the-risk-to-develop-preeclampsia-in-the-first-trimester-combining-promoter-variant-98a-c-of-lgals13-placental-protein-13-black-ethnicity-previous-preeclampsia-obesity-and-maternal-age
#15
Liora Madar-Shapiro, Ido Karady, Alla Trahtenherts, Argryo Syngelaki, Ranjit Akolekar, Liona Poon, Ruth Cohen, Adi Sharabi-Nov, Berthold Huppertz, Marei Sammar, Kata Juhasz, Nandor Gabor Than, Zoltan Papp, Roberto Romero, Kypros H Nicolaides, Hamutal Meiri
BACKGROUND: LGALS13 (placental protein 13 [PP13]) promoter DNA polymorphisms was evaluated in predicting preeclampsia (PE), given PP13's effects on hypotension, angiogenesis, and immune tolerance. METHODS: First-trimester plasma samples (49 term and 18 intermediate) of PE cases matched with 196 controls were collected from King's College Hospital, London, repository. Cell-free DNA was extracted and the LGALS13 exons were sequenced after PCR amplification. Expression of LGALS13 promoter reporter constructs was determined in BeWo trophoblast-like cells with luciferase assays...
July 21, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28726308/the-collateral-venous-system-in-late-pregnancy-a-systematic-review-of-the-literature
#16
REVIEW
Aimee Humphries, Peter Stone, S Ali Mirjalili
Recent literature has reported an association between maternal supine sleep position and stillbirth during late pregnancy. In this position the gravid uterus almost completely obstructs the inferior vena cava. A small number of women experience supine hypotension, thought to be due in part to inadequate collateral venous circulation. The aim of this paper is to review the literature describing the anatomy of the collateral venous system and in particular the azygos system, the abdominal portion of which has not been well studied...
July 20, 2017: Clinical Anatomy
https://www.readbyqxmd.com/read/28718233/haemodynamic-preservation-in-caesarean-sections-by-low-dose-0-5-hyperbaric-bupivacaine
#17
Maqsood Ahmad, Mumtaz Ahmad, Naveel Atif
BACKGROUND: Spinal anaesthesia is technique of choice for caesarean sections and hyperbaric bupivacaine is a recommended drug for this popular block. Although safe but few complications are haemodynamic changes, postdural puncture headache, cauda equina syndrome and radiculopathy. However, hypotension remains the common side effect which is believed to occur in 95% of patients resulting in reduction of uteroplacental perfusion causing foetal acid-base abnormalities. Various doses regimes are in safe anaesthesia practice for providing regional anaesthesia for such patients with least detrimental effects on foetal outcome...
April 2017: Journal of Ayub Medical College, Abbottabad: JAMC
https://www.readbyqxmd.com/read/28704246/the-effect-of-glycopyrrolate-on-the-incidence-of-hypotension-and-vasopressor-requirement-during-spinal-anesthesia-for-cesarean-delivery-a-meta-analysis
#18
Selina D Patel, Ashraf S Habib, Sioned Phillips, Brendan Carvalho, Pervez Sultan
BACKGROUND: The objective of this meta-analysis was to determine the efficacy of glycopyrrolate at reducing spinal hypotension during cesarean delivery. METHODS: A literature search was performed to identify randomized controlled trials investigating the effect of glycopyrrolate on spinal-induced hypotension during cesarean delivery. Primary outcomes were intraoperative hypotension and vasopressor requirement (phenylephrine equivalents). Secondary outcomes included heart rate (HR), nausea and vomiting, dry mouth, and Apgar scores...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28684143/what-s-new-in-clinical-obstetric-anesthesia-in-2015
#19
REVIEW
P E Hess
Each calendar year the Society for Obstetric Anesthesia and Perinatology invites an individual to conduct a review of the medical literature, identifying clinically relevant publications of interest to the obstetric anesthesia provider. This report of that effort covers the publications from 2015 and includes the categories of anesthesia and analgesia, complications of neuraxial procedures, and the effects of anesthesia on the fetus. Neuraxial procedures represent the foundation of obstetric anesthesia; advances in anesthesia and analgesia include novel modes of administration, and refinements in care of the medically complex patient...
November 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28656602/rapid-response-team-calls-to-obstetric-patients-in-a-busy-quaternary-maternity-hospital
#20
Timothy M Crozier, Pauline Galt, Stuart J Wilson, Euan M Wallace
AIMS: There is limited published information regarding intensive care unit (ICU) led rapid response team (RRT) calls to obstetric patients. We examined the characteristics of RRT calls to obstetric patients at a tertiary teaching hospital. METHODS: Details of calls to pregnant and postpartum patients between October 2010 and June 2014 were obtained from the hospital RRT database. Each was retrospectively examined for data on patient demographics, call trigger, interventions and outcomes...
June 28, 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
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