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Fluid therapy in caesarean

Yuditiya Purwosunu, Agrifa Hasiholan Haloho
A 33-year-old G2P1 was referred to our hospital due to placenta accreta. During perioperative preparations, the patient was diagnosed with having a peripartum cardiomyopathy. The patient underwent caesarean hysterectomy at 36 weeks with an associated 2 L blood loss. Haemodynamic maintenance and stabilisation during the operation were challenging, with the combinations of fluid therapy, blood transfusions as well as vasoactive, antifibrinolytic and haemostatic drug. Postoperatively, the patient was managed in the intensive care unit and was subsequently transferred to intermediate care after less than 24 hours' observation...
March 23, 2018: BMJ Case Reports
T Pretorius, G van Rensburg, R A Dyer, B M Biccard
BACKGROUND: The optimal fluid management strategy to ensure best outcomes in preeclamptic patients remains a controversial issue, with little evidence to support any one approach. OBJECTIVE: The aim of this systematic review was to investigate the effect of various fluid management strategies on clinical outcomes, haemodynamic indices and biochemical markers in preeclamptic women and their babies. Primary outcome measures were the occurrence of pulmonary oedema and/or the development of renal impairment...
May 2018: International Journal of Obstetric Anesthesia
Lucas-Sebastian Spitzhorn, Md Shaifur Rahman, Laura Schwindt, Huyen-Tran Ho, Wasco Wruck, Martina Bohndorf, Silke Wehrmeyer, Audrey Ncube, Ines Beyer, Carsten Hagenbeck, Percy Balan, Tanja Fehm, James Adjaye
Human amniotic fluid cells are immune-privileged with low immunogenicity and anti-inflammatory properties. They are able to self-renew, are highly proliferative, and have a broad differentiation potential, making them amenable for cell-based therapies. Amniotic fluid (AF) is routinely obtained via amniocentesis and contains heterogeneous populations of foetal-derived progenitor cells including mesenchymal stem cells (MSCs). In this study, we isolated human MSCs from AF (AF-MSCs) obtained during Caesarean sections (C-sections) and characterized them...
2017: Stem Cells International
Roksana Moraghebi, Agnete Kirkeby, Patricia Chaves, Roger E Rönn, Ewa Sitnicka, Malin Parmar, Marcus Larsson, Andreas Herbst, Niels-Bjarne Woods
BACKGROUND: Mesenchymal stromal cells (MSCs) are currently being evaluated in numerous pre-clinical and clinical cell-based therapy studies. Furthermore, there is an increasing interest in exploring alternative uses of these cells in disease modelling, pharmaceutical screening, and regenerative medicine by applying reprogramming technologies. However, the limited availability of MSCs from various sources restricts their use. Term amniotic fluid has been proposed as an alternative source of MSCs...
August 25, 2017: Stem Cell Research & Therapy
Rebecca Spencer, Gareth Ambler, Jana Brodszki, Anke Diemert, Francesc Figueras, Eduard Gratacós, Stefan R Hansson, Kurt Hecher, Angela Huertas-Ceballos, Neil Marlow, Karel Marsál, Eva Morsing, Donald Peebles, Carlo Rossi, Neil J Sebire, John F Timms, Anna L David
BACKGROUND: Fetal growth restriction (FGR) is a serious obstetric condition for which there is currently no treatment. The EVERREST Prospective Study has been designed to characterise the natural history of pregnancies affected by severe early onset FGR and establish a well phenotyped bio-bank. The findings will provide up-to-date information for clinicians and patients and inform the design and conduct of the EVERREST Clinical Trial: a phase I/IIa trial to assess the safety and efficacy of maternal vascular endothelial growth factor (VEGF) gene therapy in severe early onset FGR...
January 23, 2017: BMC Pregnancy and Childbirth
D Vinayagam, S Bampoe, B Thilaganathan, A Khalil
BACKGROUND: Intraoperative haemodynamic monitoring is carried out in high-risk surgical patients, often using invasive methods, including pulmonary artery catheterisation. Early goal-directed therapy in high-risk surgical patients reduces tissue hypoxia, organ failure and improves outcomes. Significant maternal morbidity arises as a result of perioperative haemorrhage. At present, heart rate and brachial blood pressure are used as proxy markers to aid in fluid resuscitation, however, we know that these exhibit minimal change during early stages of shock, and are poor indicators of the adequacy of therapeutic intervention...
August 2016: Journal of Maternal-fetal & Neonatal Medicine
Nicolas Brogly, Renato Schiraldi, Laura Puertas, Genaro Maggi, Eduardo Alonso Yanci, Ever Hugo Martinez Maldonado, Emilia Guasch Arévalo, Fernando Gilsanz Rodríguez
BACKGROUND: The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE: To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy...
May 2016: Brazilian Journal of Anesthesiology
Eldrid Langesæter, Matthew Gibbs, Robert A Dyer
PURPOSE OF REVIEW: Haemodynamic monitoring in obstetric patients has evolved during the last decade, with the development of minimally invasive and noninvasive continuous cardiac output (CO) monitors. This review focuses on recent articles that improve our understanding of physiology and haemodynamic changes during spinal anaesthesia in healthy pregnant women, and pathophysiology in women with preeclampsia and other cardiovascular disease. RECENT FINDINGS: Recent research findings in healthy women focus on the haemodynamic changes due to aortocaval compression, fluid administration, vasopressor therapy, and oxytocin during spinal anaesthesia for caesarean delivery...
June 2015: Current Opinion in Anaesthesiology
T Wang, l H Jiang, J B Zhu, X Y Wei, L Li, B Liu
OBJECTIVE: Preeclampsia is a unique disease of pregnancy. Delivery via caesarean section is the most important way of terminating the pregnancy and treating preeclampsia. Perioperative fluid therapy is performed to maintain the circulatory volume and reduce tissue edema. This study evaluated the effects of hypertonic sodium chloride hydroxyethyl starch 40 (HSH40) as perioperative fluid therapy for preeclampsia patients. MATERIALS AND METHODS: Forty preeclamptic women were randomly divided into two groups: the Ringer's solution group and the HSH40 group...
2015: Clinical and Experimental Obstetrics & Gynecology
Neele Schepker, Guillermo-José Garcia-Rocha, Frauke von Versen-Höynck, Peter Hillemanns, Cordula Schippert
PURPOSE: Caesarean delivery (c-section) scar dehiscences may cause bleeding abnormalities, e.g. postmenstrual spotting, dysmenorrhea and abdominal pain, secondary sterility and at worst peripartum uterine rupture. The purpose of this study was firstly to identify the correlation of women's complaints after c-section with scar-related clinical symptoms. Secondly, the effects of corrective surgery on preoperatively existing complaints were analysed and assessed in the patient population of our clinic...
June 2015: Archives of Gynecology and Obstetrics
Nicolas Brogly, Renato Schiraldi, Laura Puertas, Genaro Maggi, Eduardo Alonso Yanci, Ever Hugo Martinez Maldonado, Emilia Guasch Arévalo, Fernando Gilsanz Rodríguez
BACKGROUND: The delivery of cardiac patients is a challenge for the anaesthesiologist, to whom the welfare of both the mother and the foetus is a main issue. In case of caesarean section, advanced monitoring allows to optimize haemodynamic condition and to improve morbidity and mortality. OBJECTIVE: To describe the use of pulse contour analysis calibrated by Trans-pulmonar thermodilution (Picco Plus(®)) for the perioperative management of a caesarean section in a patient with severe cardiomyopathy...
May 2016: Revista Brasileira de Anestesiologia
Tülay Özkan Seyhan, Olgaç Bezen, Mukadder Orhan Sungur, Ibrahim Kalelioğlu, Meltem Karadeniz, Kemalettin Koltka
BACKGROUND: Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV) magnesium sulphate (MgSO4) therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. AIMS: The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section...
June 2014: Balkan Medical Journal
Yasmeen Khooharo, Jabeen Zubair Yousfani, Sara Haider Malik, Aneela Amber, Numan Majeed, Nimra Haider Malik, Hira Pervez, Isra Majeed, Naeem Majeed
BACKGROUND: Obstructed labour with ruptured uterus is a serious obstetrical complication with a high incidence of maternal and foetal morbidity and mortality. This study was conducted to find out the incidence of uterine rupture particularly in the patients of obstructed labour (OL), foeto-maternal outcome of such patients, and its management. METHODS: This two year descriptive study was conducted in the Department of Obstetrics and Gynaecology Unit-I, at Muhammad Medical College Hospital from 1st January 2007 to 31st December 2008, on 40 diagnosed cases of OL...
January 2013: Journal of Ayub Medical College, Abbottabad: JAMC
R Schiraldi, L Calderón, G Maggi, N Brogly, E Guasch, F Gilsanz
Massive postpartum haemorrhage is a major worldwide cause of maternal mortality. Management requires intensive fluid resuscitation and blood transfusion. Although fluid therapy is often directed by the results of a full blood count and clotting screen, recent technological advances allow monitoring of haemodynamic function and cardiac output. Transoesophageal Doppler technology has been used during haemorrhagic shock in non-obstetric patients. We present the case of a caesarean delivery complicated by massive haemorrhage where transoesophageal Doppler monitoring with the CardioQ-ODM™ was used to guide fluid therapy and the use of vasoactive drugs...
February 2014: International Journal of Obstetric Anesthesia
Costantino Di Carlo, Fabiana Savoia, Virginia Gargano, Stefania Sparice, Giuseppe Bifulco, Carmine Nappi
We here report two cases of spontaneous, familial, recurrent ovarian hyperstimulation syndrome ended in a successful pregnancy. First case was a 26-year-old woman, gravida 3 para 0 and two previous terminations of pregnancy due to spontaneous ovarian hyperstimulation syndrome (OHSS). During her pregnancy, patient was treated with IV fluid therapy, albumin and thromboembolic prophylaxis and required pleural and peritoneal drainage. She was referred to the hospital twice, at 8 and 28 weeks'. At 32 weeks due to worsening of clinical condition, decision was made for a caesarean section...
October 2013: Gynecological Endocrinology
Feroza Dawood, Therese Dowswell, Siobhan Quenby
BACKGROUND: Several factors may influence the progression of normal labour. It has been postulated that the routine administration of intravenous fluids to keep women adequately hydrated during labour may reduce the period of contraction and relaxation of the uterine muscle, and may ultimately reduce the duration of the labour. It has also been suggested that intravenous fluids may reduce caesarean sections (CS) for prolonged labour. However, the routine administration of intravenous fluids to labouring women has not been adequately elucidated although it is a widely-adopted policy, and there is no consensus on the type or volume of fluids that are required, or indeed, whether intravenous fluids are at all necessary...
June 18, 2013: Cochrane Database of Systematic Reviews
Manal Kassab, Wadah M Khriesat, Hiba Bawadi, Jasim Anabrees
BACKGROUND: Transient tachypnoea of the newborn (TTN) results from delayed clearance of lung liquid and is a common cause of admission of full term infants to neonatal intensive care units. The condition is particularly common after elective caesarean section. Conventional treatment involves appropriate oxygen administration and continuous positive airway pressure in some cases. Most infants receive antibiotic therapy. Hastening the clearance of lung liquid may shorten the duration of the symptoms and reduce complications...
June 5, 2013: Cochrane Database of Systematic Reviews
Andrzej Marciniak, Maria Wujtewicz, Radosław Owczuk
BACKGROUND: Fluid therapy is the most commonly used treatment to prevent hypotension associated with spinal anaesthesia. The aim of this study was to test the hypothesis that a balanced solution of 6% hydroxyethyl starch will have a more beneficial impact on the condition of newborns at birth than an unbalanced 6% solution of HES. METHODS: The study participants included 51 healthy parturients undergoing elective caesarean section with spinal anaesthesia. Patients received a transfusion of 500 mL of unbalanced 6% HES (Voluven) or balanced 6% HES (Tetraspan) prior to anaesthesia...
January 2013: Anaesthesiology Intensive Therapy
Siba Prosad Paul, Bryony Alexis Smith, Karun Kumar Luthra
Pregnant women in labour are generally encouraged by their carers to continue taking plenty of oral fluids. This is sometimes supplemented by intravenous fluids either due to a clinical necessity or in preparation for a caesarean section. It is important that there is clear documentation of the amount of fluids received by pregnant women in the perinatal period as excessive maternal fluid has been associated with low serum sodium in neonates. This often goes under-recognised; therefore it is important to consider this in a neonate presenting with hyponatraemia in the first day of life...
February 2013: Practising Midwife
N F Collins, M Bloor, N J McDonnell
Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. Soon after the collapse, coagulopathy developed...
January 2013: International Journal of Obstetric Anesthesia
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