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Pregnancy and anesthesia

Houssam Rebahi, Mourad Ait Sliman, Ahmed-Rhassane El Adib
Background: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm related to chromosomal reciprocal translocation t(9;22). Tyrosine kinase inhibitors (TKIs) such as imatinib have drastically revolutionized the course and the prognosis of this hematologic malignancy. As we know, the association pregnancy-CML is an infrequent situation. Also the use of TKI in pregnant women is unsafe with a lack of alternatives and effective therapeutic options. Thus its cessation during gestation puts those patients at high risk of developing blast crisis characterized by poor outcomes...
2018: Case Reports in Obstetrics and Gynecology
Sharon C Reale, Kathryn J Gray, Edward W Boyer, Dominique Y Arce, Michaela K Farber
The anesthetic management of toxic ingestion during pregnancy requires concomitant concerns for both mother and fetus. We describe the management of a parturient at 33 weeks of gestation after a suicide attempt by ingestion of acetaminophen (APAP) and acetylsalicylic acid (ASA). Timing of toxin ingestion must be determined, prompt antidote administration prioritized, and hepatotoxicity-induced hematologic impairment anticipated. Fetal exposure to toxins must also be minimized. The use of point-of-care rotational thromboelastometry in conjunction with standard coagulation testing in such cases facilitates consideration of neuraxial anesthesia and determination of risk for postpartum hemorrhage...
October 11, 2018: A&A practice
Janet F R Waters, Mary Angela OʼNeal, Madison Pilato, Samuel Waters, Jacob C Larkin, Jonathan H Waters
OBJECTIVE: To estimate whether vaginal delivery or neuraxial anesthesia poses a risk of neurologic deterioration in women with uncorrected Chiari I malformation. METHODS: To assemble this case series, electronic record databases were used to identify women with Chiari I malformation who delivered on two busy tertiary care obstetric services over a 5-year period from January 2010 through December 2015. Women who had undergone surgical decompression were not included in the study...
October 5, 2018: Obstetrics and Gynecology
Atakan Tanacan, Canan Unal, Halise Meltem Yucesoy, Sinem Ayse Duru, Mehmet Sinan Beksac
PURPOSE: To evaluate the clinical characteristics, obstetric/neonatal outcomes, and pregnancy complications of pregnant women with Takayasu arteritis (TA). METHODS: We retrospectively evaluated the data of 22 pregnancies of 11 patients with TA between January 1 2000, and December 31 2017. Patient characteristics, severity of disease, obstetric outcomes, pregnancy complications, mode of delivery, and neonatal outcomes were evaluated. RESULTS: Based on the angiographic classification, four, two, one, three, and one patient were classified into groups I, IIa, III, IV, and V, respectively...
October 9, 2018: Archives of Gynecology and Obstetrics
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
Chiara Comito, Lorenzo Bechi, Caterina Serena, Vanni Checcucci, Emanuele Mori, Massimo Micaglio, Federico Mecacci, Felice Petraglia
Cardiac arrest in pregnancy is a rare event due to different cause. When it occurs after spinal anesthesia a cause that can explain this event is the Bezold-Jarish Reflex (BJR). A cardiac arrest occurs in a pregnant women after spinal anesthesia admistered for urgent caesarean section. During this event perimortem caesarean delivery (PMCD) is the rapid surgical way that can improve maternal and fetal outcomes. In this situation, it is very important to have a multidisciplinary team of midwives, obstetricians, anesthetists, neonatologists, intensivists that is able to perform perimortem caesarean delivery according to the guidelines...
September 23, 2018: Journal of Maternal-fetal & Neonatal Medicine
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)
Hye Ji Jeon, Aeli Ryu, Jiwon Min, Nan Seol Kim
RATIONALE: Anaphylaxis is a very rare event in pregnancy, triggering maternal hypotension leading to intrapartum hypoxic-ischemic encephalopathy in infant. Furthermore, cesarean sections are performed at a high rate in anaphylactic pregnant women. PATIENT CONCERNS: A 34-year-old pregnant woman presented with maternal anaphylaxis following prophylactic antibiotic injection for cesarean section. Within a few minutes after initiation of intradermal skin test with cefotetan, the pregnant woman developed generalized itchy rash, chest tightness, and dyspnea...
September 2018: Medicine (Baltimore)
Nicole Look, Christopher J Kleck, Evalina L Burger
CASE: Low back pain affects >50% of pregnant women. However, cauda equina syndrome (CES) during pregnancy is rare. Because a delay in treatment increases the risk of irreversible neurologic damage, acute onset is regarded as a surgical emergency. We describe 3 cases of CES in pregnant women at 24, 27, and 30 weeks' gestation, respectively. CONCLUSION: All 3 of the patients underwent surgical decompression in the prone position under general anesthesia with continuous external monitoring of the fetal heart rate...
July 2018: JBJS Case Connector
L Grondin-Depraetre, M Soussoko, S Gisbert, O Morel, C Bertholdt
OBJECTIVES: In recent years, active neonatal care in case of prematurity leads to an increase of cesarean delivery rate. Data remains sparse on maternal morbidity induced by preterm cesareans and especially before 32 weeks of gestation. The main aim of this study was to evaluate per-partum maternal morbidity in case of cesarean performed before 32 week of gestation. As secondary objectives, we assessed post-partum maternal morbidity and factors associated with maternal morbidity. METHODS: This is a retrospective single-center study conducted in a tertiary care unit between 2014 and 2016 including cesareans performed before 32 week of gestation in the study period...
September 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Nitin Hayaran, Rohit Malhotra, Swati Tyagi, Aruna Jain
Acute fatty liver of pregnancy is one of the most common causes of fulminant hepatic failure. A 28-year-old G3P1L1A1 presented at 37 weeks with diagnosis of acute fatty liver of pregnancy with grade 3 hepatic encephalopathy. Laboratory findings were suggestive of coagulopathy, metabolic acidosis, and liver and renal dysfunction. Ultrasound-guided transversus abdominis plane block with ilioinguinal-iliohypogastric nerve block is widely used for postoperative analgesia. We applied these blocks, supplemented with intravenous ketamine for breakthrough visceral pain, to conduct cesarean delivery with a favorable outcome...
August 29, 2018: A&A practice
R K Kazal, S A Chowdhury, T T Mirza, H H Pervin, F Noor, B Chakma, F Z Aalpona
Thalassaemia is one of the commonest inherited disorders in Bangladesh. Since population is rapidly increasing in Bangladesh, therefore birth of large number of new cases is expected every year. Chorionic villus sampling (CVS) is an invasive diagnostic procedure done in early pregnancy to obtain fetal cells for the prenatal diagnosis of chromosomal and genetic disorders like thalassemia. To investigate the feasibility, safety, and outcome of transabdominal Chorionic Villus Sampling (CVS) for prenatal diagnosis of Beta Thalassemia, this retrospective analytical study was carried out on women who had undergone transabdominal CVS for prenatal diagnosis of Beta thalassemia...
July 2018: Mymensingh Medical Journal: MMJ
Jae Yeon Lee, Hyeonji Kim, Dong-Heon Ha, Jong Chul Shin, Ahyoung Kim, Hyun Sun Ko, Dong-Woo Cho
Although recent invasive fetal surgeries have improved fetal outcomes, fetal membrane rupture remains a major complication, leading to premature delivery, thus undermining the complete benefits of such procedures. A biocompatible amnion-analogous medical device (AMED) consisting of polycaprolactone framework and decellularized amniotic membrane (dAM)-derived hydrogel for restoration of amniotic membrane defect is developed using 3D printing technology. Its efficacy on healing iatrogenic fetal membrane defects in vitro is evaluated, showing that the dAM gel contains migratory and proliferative properties...
September 2018: Advanced Healthcare Materials
Yuan Wang, Shao-Wei Yin, Nan Zhang, Ping Zhao
Sevoflurane is the most commonly used volatile anesthetic during pregnancy. The viability of neural stem cells directly affects the development of the brain. However, it is unknown whether the use of sevoflurane during the second trimester affects the survival of fetal neural stem cells. Therefore, in this study, we investigated whether exposure to sevoflurane in mid-gestation induces apoptosis of neural stem cells and behavioral abnormalities. On gestational day 14, pregnant rats were anesthetized with 2% or 3...
September 2018: Neural Regeneration Research
Rati Chadha
Background: Klippel-Trenaunay-Weber syndrome is a rare neurocutaneous syndrome with vascular involvement. Given the rarity of the syndrome, its management in pregnancy is based on the outcome of a few case reports and expert opinion. Case Summary: The management of a complicated case with its antepartum, intrapartum, and postpartum concerns has been addressed in this review. Conclusions: Prenatal consults with anesthesia, general surgery, intervention radiology, and internal medicine should be arranged, prior to delivery in anticipation of all the possible complications...
2018: Case Reports in Obstetrics and Gynecology
Amanda L Faulkner, Eric Swanson, Thomas L McLarney, Cortney Y Lee, Annette Rebel
Dexmedetomidine is a selective α2-agonist, frequently used in perioperative medicine as anesthesia adjunct. The medication carries a Food and Drug Administration pregnancy category C designation and is therefore rarely used for parturients undergoing nonobstetric surgery. We are reporting the use of dexmedetomidine in the anesthetic management of a parturient undergoing minimally invasive unilateral adrenalectomy for pheochromocytoma during the second trimester of pregnancy. Additionally, because of the multiple endocrine neoplasia type 2A constellation with diagnosis of medullary thyroid cancer, the patient underwent a total thyroidectomy 1 week after the adrenalectomy...
August 7, 2018: A&A practice
Allison J Lee, Stephanie R Goodman, Shawn E Banks, Meiko Lin, Ruth Landau
Background: Teaching trainees the knowledge and skills to perform general anesthesia (GA) for cesarean delivery (CD) requires innovative strategies, as they may never manage such cases in training. We used a multistage design process to create a criterion-referenced multiple-choice test as an assessment tool to evaluate CA1's knowledge related to this scenario. Methods: Three faculty created 33 questions, categorized as: (1) physiologic changes of pregnancy (PCP), (2) pharmacology (PHA), (3) anesthetic implications of pregnancy (AIP), and (4) crisis resource management principles (CRM)...
April 2018: Journal of Education in Perioperative Medicine: JEPM
N Parikh, N Parikh
Headaches are a common symptom during pregnancy. The thunderclap headache is a sudden onset headache reaching maximal intensity within seconds to minutes. It is typically a subarachnoid hemorrhage caused by rupture of an intracranial aneurysm or arteriovenous malformation. Physiologic changes of pregnancy, such as increased cardiac output and plasma volume, may increase the risk of aneurysmal rupture. The relationship between the mode of delivery and incidence of rupture is not well defined. In this case report, we discuss the anesthetic management for cesarean delivery of a parturient with an unruptured aneurysm, located on the left ophthalmic-internal carotid artery...
July 6, 2018: International Journal of Obstetric Anesthesia
Jeffrey W Parker, Paula D James, Susan L Haley
Type 3 von Willebrand disease is a rare and severe inherited bleeding disorder that carries an elevated risk for epidural and spinal hematoma as well as pregnancy-associated complications. Neuraxial anesthesia in these patients is controversial but may be considered if the parturient has received appropriate factor replacement. We present the case of a woman with type 3 von Willebrand disease and a severe bleeding history that underwent successful spinal anesthesia during successive cesarean deliveries. Our case highlights the importance of early multidisciplinary consultation and advance planning in the care of these rare events...
July 25, 2018: A&A practice
Annemarie E Fogerty
PURPOSE OF REVIEW: This manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment. RECENT FINDINGS: The obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted. VTE during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality...
July 23, 2018: Current Treatment Options in Cardiovascular Medicine
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