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Labor anesthesia

Misgav Rottenstreich, Hen Y Sela, Ori Shen, Rachel Michaelson-Cohen, Arnon Samueloff, Orna Reichman
BACKGROUND: Repeat cesarean delivery (CD) accounts for approximately 15% of all annual deliveries in the US with an estimated 656,250 operations per year. We aimed to study whether prolonged operative time (OT; skin incision to closure) is a risk marker for post-operative maternal complications among women undergoing repeat CD. METHODS: We conducted a cross-sectional retrospective study in a single tertiary center including all women who underwent repeat CD but excluding those with cesarean hysterectomy...
December 4, 2018: BMC Pregnancy and Childbirth
Sara L Zettervall, Andrew Amata, Jeffery S Berger, Paul Dangerfield, Ruth Derkenne, Ramon Go, Deborah Jeon, Kiera Murphy, Molly Phillips, Marian Sherman, Khashayar Vaziri
Background: The use of epidural analgesia for laboring women is generally unavailable at public hospitals in Guyana despite favorable utilization rates in private institutions. In 2014, a healthcare team completed a targeted mission aimed at neuraxial analgesia training of providers at the preeminent public hospital in Georgetown, Guyana. This study evaluates the impact of the training, including provider attitudes, use, and barriers. Methods: A prospective, mixed methods study of all obstetric, nursing, and anesthesiology providers at Georgetown Public Hospital Corporation was completed...
July 2018: Journal of Education in Perioperative Medicine: JEPM
D Shatalin, C F Weiniger, I Buchman, Y Ginosar, S Orbach-Zinger, A Ioscovich
BACKGROUND: This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016. METHODS: Prospective survey questionnaire was emailed to obstetric anesthesia unit directors/chairperson of all 25 labor and delivery services units within the jurisdiction of the Israeli Ministry of Health. RESULTS: The response rate was 100%. Nineteen (76%) units have dedicated anesthesiologist cover...
November 2, 2018: International Journal of Obstetric Anesthesia
Ramsis F Ghaly, Tatiana Tverdohleb, Kenneth D Candido, Nebojsa Nick Knezevic
Background: Ependymomas represent 50-60% of all brain and central nervous system tumors. Previous lumbar spine surgery for resection of an ependymoma should not be considered a relative contraindication for the administration of epidural/subarachnoid anesthesia to patients in labor. Case Description: A 34-year-old G1P0, who underwent resection of an L1-L3 intramedullary ependymoma 8 years previously, presented in active labor with residual left leg numbness and tingling...
2018: Surgical Neurology International
Michal Lipschuetz, Sarah M Cohen, Aya A Lewkowicz, Hagai Amsalem, Rani Haj Yahya, Lorinne Levitt, Simcha Yagel
INTRODUCTION: Professional bodies have published guidelines defining the length of the second stage of labor and when it is "prolonged", according to parity and epidural anesthesia administration. Recently these guidelines have been extended, aiming to reduce rates of unplanned cesarean deliveries. AIMS: To examine the risk factors and outcomes of a prolonged second stage of labor, in order to understand its causes and implications for mothers and neonates, including the delivery mode...
November 2018: Harefuah
K W Arendt, K J Lindley
Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology...
September 27, 2018: International Journal of Obstetric Anesthesia
Katy Meeker, Susan K Brown, Michele Lamping, Michael R Moyer, M Joyce Dienger
OBJECTIVE: To use high-fidelity human patient simulation to enhance teamwork and communication during maternity care emergencies. DESIGN: Quality improvement initiative. SETTING/LOCAL PROBLEM: The labor and delivery team at a large suburban Level 2 facility in the Midwestern United States sought to apply evidence and use simulation to improve communication and teamwork. PARTICIPANTS: Approximately 170 maternity care staff members, including nurses, anesthesia providers, and pediatric and obstetric physicians...
October 30, 2018: Nursing for Women's Health
H Y Zhong, W P Zhang
BACKGROUND: Magnesium sulfate (MgSO4 ) is the standard therapy for the treatment of preeclampsia and prevention of eclamptic seizures in labor. This study aimed to determine the effect of the magnesium administered intravenously as a bolus prior to spinal anesthesia on the speed of onset and duration of the spinal anesthesia in preeclamptic women. METHODS: Sixty women undergoing caesarean section were randomly divided into the MgSO4 group and the control group. The MgSO4 group received 50 mg/kg MgSO4 (total 50 ml) infused intravenously within 15 min and the control group received the same volume normal saline, then spinal anesthesia was administered using a standardized technique...
December 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Cihun-Siyong Alex Gong, Huang-Chang Lee, Yin Chang, Chien-Kun Ting, Po-Hsun Tu
Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia, post-operative pain control and painless childbirth. Method: Ex vivo study of auto-fluorescence spectroscopy was performed for the para-vertebral tissues contained fat, interspinous ligament, supraspinous ligament and ligamentumflavum by multimode microplate reader at wavelength 405 nm for the purpose of tissue differentiation...
October 23, 2018: Sensors
Sankalp Dudeja, Pooja Sikka, Kajal Jain, Vanita Suri, Praveen Kumar
OBJECTIVE: To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process. DESIGN: Quality improvement study. SETTING: Labor Room-Operation Theatre of a tertiary care hospital. PARTICIPANTS: Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia. PROCEDURE: A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis...
September 15, 2018: Indian Pediatrics
Roberto Romero, Nardhy Gomez-Lopez, Juan Pedro Kusanovic, Percy Pacora, Bogdan Panaitescu, Offer Erez, Bo Hyun Yoon
Clinical chorioamnionitis is the most common infection related diagnosis made in labor and delivery units worldwide. It is traditionally believed to be due to microbial invasion of the amniotic cavity, which elicits a maternal inflammatory response characterized by maternal fever, uterine tenderness, maternal tachycardia and leukocytosis. The condition is often associated with fetal tachycardia and a foul smelling amniotic fluid. Recent studies in which amniocentesis has been used to characterize the microbiologic state of the amniotic cavity and the inflammatory response show that only 60% of patients with the diagnosis of clinical chorioamnionitis have proven infection using culture or molecular microbiologic techniques...
June 2018: Nőgyógyászati és szülészeti továbbképző szemle
Alison G Cahill, Sindhu K Srinivas, Alan T N Tita, Aaron B Caughey, Holly E Richter, W Thomas Gregory, Jingxia Liu, Candice Woolfolk, David L Weinstein, Amit M Mathur, George A Macones, Methodius G Tuuli
Importance: It is unclear whether the timing of second stage pushing efforts affects spontaneous vaginal delivery rates and reduces morbidities. Objective: To evaluate whether immediate or delayed pushing results in higher rates of spontaneous vaginal delivery and lower rates of maternal and neonatal morbidities. Design, Setting, and Participants: Pragmatic randomized clinical trial of nulliparous women at or beyond 37 weeks' gestation admitted for spontaneous or induced labor with neuraxial analgesia between May 2014 and December 2017 at 6 US medical centers...
October 9, 2018: JAMA: the Journal of the American Medical Association
Z L Bao, J Zhang
Objective: To summarize and analyze the methods of termination of pregnancy in the first and second trimester of pregnancy with severe cardiovascular disease. Methods: A retrospective analysis of 27 cases of termination of pregnancy in the first and second trimester of pregnancy in Beijing Anzhen Hospital from January 1, 2016 to December 30, 2017. All of these pregnant women were pregnancy complicated with severe cardiovascular disease in grade Ⅴ pregnancy risk. Results: (1) The age of 27 pregnant women was 22-40 years, gestational age was 6-27 weeks; cardiac function grade before induced labor was: 5 cases of grade Ⅱ, 15 cases of grade Ⅲ, 7 cases of grade Ⅳ...
September 25, 2018: Zhonghua Fu Chan Ke za Zhi
Luca De Lipsis, Rossella Belmonte, Maria Cusano, Maria Antonietta Giannetti, Carmine Franco Muccio, Mauro Mancinelli
Subdural hematoma (SDH) following labor epidural analgesia is a rare neurological complication. SDH is a late complication of this procedure; it is caused by a leak of cerebrospinal fluid that may damage the vascular structures of the brain. Persistent headache in the days after labor epidural analgesia is a nonspecific clinical symptom caused by hematoma. Preexisting vascular malformations can be a concomitant cause of headache. Clinical cases have been reported even after epidural anesthesia. The differential diagnosis includes unspecified headache, sinusitis headache, drug-induced headache, cortical vein thrombosis, fistula of the dura mater, and bacterial, viral, and aseptic meningitis...
July 2018: Asian Journal of Neurosurgery
Xiao Xu, Henry C Lee, Haiqun Lin, Lisbet S Lundsberg, Katherine H Campbell, Heather S Lipkind, Christian M Pettker, Jessica L Illuzzi
BACKGROUND: Trial of labor after cesarean delivery (TOLAC) is an effective and safe option for women without contraindications. OBJECTIVES: To examine hospital variation in utilization and success of TOLAC and identify associated institutional characteristics and patient outcomes. STUDY DESIGN: Using linked maternal and newborn hospital discharge records and birth certificate data in 2010-2012 from the state of California, we identified 146,185 term singleton mothers with one prior cesarean delivery and no congenital anomalies or clear contraindications for trial of labor at 249 hospitals...
September 29, 2018: American Journal of Obstetrics and Gynecology
Angélica de Fátima de Assunção Braga, Vanessa Henriques Carvalho, Franklin Sarmento da Silva Braga, Rosa Inês Costa Pereira
INTRODUCTION: Lumbar epidural block is an effective and routinely used technique for labor pain relief, and the combined spinal-epidural block has the benefit of using lower doses of local anesthetics and rapid onset of analgesia. The objective of this study was to evaluate the effectiveness and safety of two anesthetic techniques: combined spinal-epidural block and continuous epidural block in pregnant women for labor analgesia. METHODS: Eighty patients, ASA II and III, with cephalic presentation and cervical dilation between 5 and 6 centimeters, undergoing labor analgesia, allocated in two groups according to the anesthetic technique: combined spinal-epidural (GI) and continuous epidural (GII)...
September 12, 2018: Revista Brasileira de Anestesiologia
Yimeng Xia, Xin Ma, Brian B Griffiths, Yan Luo
RATIONALE: Being required to perform neurosurgery on a pregnant woman is rare, but occasionally unavoidable. In these cases, clinical anesthesiologists are confronted with conflicting information and few evidence-based guidelines. PATIENT CONCERNS: Here, we describe the successful anesthetic management of a 24-week pregnant woman with macroprolactinoma who underwent endonasal transsphenoidal resection of pituitary adenoma. DIAGNOSES: According to the prolactin (PRL) level and magnetic resonance imaging (MRI) results, the patient was diagnosed with macroprolactinoma and kept stable after taking the regular bromocriptine treatment...
September 2018: Medicine (Baltimore)
Brian T Bateman
The Gerard W. Ostheimer lecture is given each year at the Society for Obstetric Anesthesia and Perinatology annual meeting and is intended to summarize important new scientific literature relevant to practicing obstetric anesthesiologists. This review highlights some of the most consequential papers covered in this lecture. It discusses landmark clinical trials that are likely to change the practice of obstetrics and obstetric anesthesia. It summarizes several articles that focus on how to optimize the provision of neuraxial anesthesia and postoperative pain control...
September 5, 2018: Anesthesia and Analgesia
Michelle A Creamer-Hente, Fironica K Lao, Zala P Dragos, Linda L Waterman
The 2013 edition of the AVMA Guidelines for the Euthanasia of Animals recommends a 10% to 30% volume displacement rate (VDR) per minute for CO2 euthanasia of rodents. Here we sought to evaluate behavior and plasma catecholamine levels in multiple strains of male and female mice, euthanized individually or in a group, with CO2 VDR of 10% to 100%. Behavioral observations included ataxia, labored breathing, time to recumbency, time to surgical plane of anesthesia, and the number of jumps or paws at the face during the euthanasia process...
September 1, 2018: Journal of the American Association for Laboratory Animal Science: JAALAS
Samira Foji, Manijeh Yousefi Moghadam, Hosein TabasiAsl, Milad Nazarzadeh, Hamid Salehiniya
INTRODUCTION: The purpose of the present study was to compare the effect of ENTONOX inhalation and spinal injection on the reduction of labor pain, the Apgar score of the neonates, and their side effects on new-born children and pregnant women. MATERIAL AND METHODS: The present clinical trial study is conducted among the pregnant women in the maternity ward of a child delivery hospital in Iran. All Participants were divided in two groups ENTONOX Inhalation and Spinal Anesthesia...
September 2018: BioMedicine
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