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Pregnancy and anesthesia

Chia-Hung Yu, Shih-Feng Weng, Chung-Han Ho, Yi-Chen Chen, Jen-Yin Chen, Ying-Jen Chang, Jhi-Joung Wang, Ming-Ping Wu, Chin-Chen Chu
BACKGROUND: Whether nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion or adverse delivery outcomes is still unclear. METHODS: We performed a retrospective case-control study using a Longitudinal Health Insurance Database (LHID 2000) containing claim-data of 1 million randomly selected beneficiaries. We compared the incidences and estimated the adjusted odds ratios (aOR) with 95% confidence interval (95% CI) for spontaneous abortion, adverse delivery outcomes, cesarean delivery, and prolonged hospital stay to determine the risk of adverse outcomes in women who had nonobstetric surgery during gestation as compared to those who did not have any surgery during gestation...
November 26, 2018: BMC Pregnancy and Childbirth
Yaofei Jiang, Ruoxi Chen, Suming Xu, Jiaxi Li, Fanqi Yu, Lingdong Kong, Yuhan Sun, Yuan Ye, Yimin Li, Mengqi Yu, Jiaming Wu
Background/Aims: An updated systematic review and meta-analysis was conducted to assess the effect of prophylactic dexamethasone for tracheal intubation of general anesthesia on postoperative sore throat (POST). Methods: Comprehensive literature search of databases for randomized controlled trials (RCTs), including Embase, PubMed, and Cochrane Library, which evaluate the effect of prophylactic dexamethasone on POST was conducted. RevMan 5.0 and STATA 12.0 software were used to perform meta-analyses...
2018: Journal of Pain Research
Anahita R Chauhan
Fibroids in pregnancy are increasingly common, due to advanced maternal age, better diagnostic tools and use of assisted reproductive techniques. Cesarean section (CS) is the commonest mode of delivery in these patients. Cesarean myomectomy (CM) is the term used to describe the removal of fibroids at CS; it has always been a controversial topic, with two schools of thought. Some obstetricians advise against it due to the traditional fear of massive obstetric hemorrhage and its attendant complications. However, recent literature advocates elective or opportunistic myomectomy in well-selected cases during CS...
December 2018: Journal of Obstetrics and Gynaecology of India
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
Marília Cristina Oliveira Souza, Maria Paula Marques, Geraldo Duarte, Vera Lucia Lanchote
Bupivacaine, a drug used in obstetric anesthesia and analgesia, is commercially available as a racemic mixture of the R-bupivacaine and S-bupivacaine enantiomers, which show differences in pharmacokinetics, efficacy and toxicity. Changes in bupivacaine plasma protein binding is of clinical relevance considering its high protein binding (approximately 95%) and its classification as an intermediate hepatic extraction ratio drug (E = 0.38). Furthermore, the plasma protein binding of bupivacaine is also of clinical relevance considering that pregnancy is a physiological condition associated with reduced plasma albumin concentration...
October 23, 2018: Journal of Pharmaceutical and Biomedical Analysis
Philip Hepp, Carsten Hagenbeck, Julius Gilles, Oliver T Wolf, Wolfram Goertz, Wolfgang Janni, Percy Balan, Markus Fleisch, Tanja Fehm, Nora K Schaal
BACKGROUND: Stress and anxiety during pregnancy and childbirth have negative consequences for both mother and child. There are indications that music has a positive effect in this situation. The present study investigates the influence of music during the caesarean on anxiety and stress of the expectant mother. METHODS: The SAMBA study is a single-centre, controlled, randomized study including 304 patients. Women in the intervention group heard music via loudspeakers from one of four self-selected genres...
November 3, 2018: BMC Pregnancy and Childbirth
Julia Rodríguez-Castelán, Dafne Zepeda-Pérez, Maribel Méndez-Tepepa, Marlenne Castillo-Romano, Marlen Espíndola-Lozano, Arely Anaya-Hernández, Pere Berbel, Estela Cuevas-Romero
BACKGROUND: Hypothyroidism has been related to a low-weight births, abortions and prematurity, which have been associated with changes in the content of glycogen and vascularization of the placenta. Since hypothyroidism can also cause dyslipidemia, it may also affect the lipid content in the uterus influenced in the development of fetuses. OBJECTIVE: To investigate the influence of hypothyroidism in the lipid levels in the serum and uterus during pregnancy and their possible association with the size of fetuses...
November 1, 2018: Endocrine, Metabolic & Immune Disorders Drug Targets
Xuefeng Sun, Jun Feng, Juhong Shi
Pregnancy is usually contraindicated in patients with pulmonary hypertension (PH). Risk factors associated with the outcome of this rare disease have not been specifically explored before.Medical records were retrospectively reviewed to identify patients with coexisting PH and pregnancy or delivery at Peking Union Medical College Hospital between January 2009 and June 2018. Demographics, characteristics of PH and pregnancy, management and outcomes were analyzed.Thirty-six pregnant women with PH were identified, including 30 cases in WHO group 1, 5 cases of group 2 and 1 case of group 4...
November 2018: Medicine (Baltimore)
Ashok Reddy Pedaballe, Harvinder Singh Chhabra, Vikas Tandon, Parashuram Chauhan, Rachna Verma
Background: The management of acute traumatic cervical spine injury in a third-trimester pregnancy is challenging with risks involved for both the mother and the fetus. We report one such case that was managed successfully with good maternal and fetal outcomes. Case presentation: A 30 years female, gravida 2, para 1, living 1 at 31 weeks 5 days of pregnancy, met with a RTA and was diagnosed with AIS B C4-C5 extension compression spinal cord injury (SCI) with a viable fetus...
2018: Spinal Cord Series and Cases
Görker Sel, Sadun Sucu, Müge Harma, Mehmet İbrahim Harma
Aim: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The gestational sac is implanted in the myometrium at the site of a previous cesarean section. Mothers with CSP are faced with risks of unpredictable massive bleeding or more fatal complications. The purpose of this retrospective study was to assess the feasibility, efficacy, and reliability of the intraoperative ultrasound-guided vacuum aspiration method as an effective treatment option for CSP. Methods: We undertook a retrospective analysis of CSP patients who had undergone the vacuum aspiration method, by reviewing patient records from the period October 2015 to January 2018...
October 2018: Acute Medicine & Surgery
C Q Li, D X Wang, X Y Wei
Congenital fibrinogen deficiency is an autosomal recessive or dominant disorder in which quantitative (afibrinogenaemia or hypofibrinogenaemia) or qualitative (dysfibrinogenaemia) defects in the fibrinogen Aa, Bb or c protein chains that lead to reduced functional fibrinogen. We now report the perioperative management of 4 pregnant women suffering from hypofibrinogenaemia scheduled for elective caesarean section from December 2012 to October 2016 in Peking University First Hospital and review this disease with reference to classification, symptom, replacement therapy, and selection of the modes of pregnancy termination and anesthesia...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
X Y Guo, H Shao, Y Y Zhao
To investigate the pathophysiology, screening, diagnosis and treatment of the systemic lupus erythematosus (SLE) in pregnancy complicated with pulmonary hypertension. Retrospective analysis was made of one case of SLE in pregnancy complicated with pulmonary hypertension in Peking University Third Hospital. Literature was reviewed to investigate the pathophysiology, screening, diagnosis and treatment of the SLE in pregnancy complicated with pulmonary hypertension. SLE is an autoimmune mediated diffuse connective tissue disease characterized by immunological inflammation...
October 18, 2018: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
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)
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