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https://www.readbyqxmd.com/read/28625309/maternal-mortality-and-the-role-of-the-obstetric-anesthesiologist
#1
REVIEW
Gillian Abir, Jill Mhyre
Maternal mortality is increasing in the United States and remains unacceptably high in many parts of the world. Pre-existing conditions and social determinants of health frequently contribute to maternal death. General solutions to enhance maternal safety focus on systems to identify women at high risk and to tailor the management before, during, and after pregnancy. This review highlights condition-specific solutions for the leading etiologies of maternal death, including cardiac disease, sepsis, hemorrhage, venous thromboembolism, hypertensive disorders of pregnancy, and amniotic fluid embolism...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28611929/epidural-anesthesia-for-cesarean-section-in-a-pregnant-woman-with-marfan-syndrome-and-dural-ectasia
#2
Franco Pepe, Mariagrazia Stracquadanio, Francesco De Luca, Agata Privitera, Elisabetta Sanalitro, Puccio Scarpinati
Marfan syndrome (MFS) is a genetic disorder of connective tissue, characterized by variable clinical features and multisystem complications. The anesthetic management during delivery is debated. Regional anesthesia has been used with success during cesarean delivery, but in some MFS patients there is a probability of erratic and inadequate spread of intrathecal local anesthetics as a result of dural ectasia. In these cases, epidural anesthesia may be a particularly useful technique during cesarean delivery because it allows an adequate spread and action of local anesthetic with a controlled onset of anesthesia, analgesia, and sympathetic block and a low risk of perioperative complications...
2017: Case Reports in Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28608747/spontaneous-pregnancy-with-a-live-birth-after-conventional-and-partial-uterine-fibroid-embolization
#3
João M Pisco, Marisa Duarte, Tiago Bilhim, Jorge Branco, Fernando Cirurgião, Marcela Forjaz, Lúcia Fernandes, José Pereira, Nuno Costa, Joana B M Pisco, António G Oliveira
Purpose To determine pregnancy rates after conventional and partial uterine fibroid embolization (UFE). Materials and Methods The study received institutional review board approval and all patients gave written informed consent. A retrospective analysis of data collected prospectively was performed between June 2004 and June 2014 in a cohort of 359 women (mean age, 35.9 years ± 4.8) with uterine fibroids and/or adenomyosis who were unable to conceive. The median follow-up period was 69 months (range, 6-126 months)...
June 13, 2017: Radiology
https://www.readbyqxmd.com/read/28604473/perioperative-anesthetic-management-for-cesarean-delivery-in-a-parturient-with-type-iv-loeys-dietz-syndrome-a-case-report
#4
Ravish Kapoor, David G Mann, Emad B Mossad
Loeys-Dietz syndrome (LDS) is a rare connective tissue disorder predisposing to aortic and arterial aneurysms. Presentations are classified into subtypes based on gene mutations. Pregnancy in patients with LDS is considered very high risk due to the potential for aortic dissection and uterine rupture. We report successful management of an elective cesarean delivery in a 16-year-old patient with LDS type IV using epidural anesthesia. Perioperative considerations and multidisciplinary management specific to taking care of parturients with LDS are discussed...
June 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28599396/five-years-experience-in-an-anesthesiology-antenatal-clinic-for-high-risk-patients
#5
Daniel Shatalin, Yaacov Gozal, Sorina Grisaru-Granovsky, Alexander Ioscovich
INTRODUCTION: The aim, of this study is to describe our approach and outcomes in an outpatient anesthesia/analgesia antepartum clinic among ambulatory high-risk obstetric patients. METHODS: This was a retrospective evaluation of the activity of the anesthesiology antenatal clinic from its inception in 2010 until 2016 (a 5-year period). The clinic works in collaboration with the Department of Obstetrics and Gynecology. The catchment area of the study University Affiliated Hospital attends a multiethnic population characterized by high parity...
May 24, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28598915/anesthetic-and-obstetric-management-of-syringomyelia-during-labor-and-delivery-a-case-series-and-systematic-review
#6
Gráinne Patricia Garvey, Vibhangini S Wasade, Kellie E Murphy, Mrinalini Balki
BACKGROUND: Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. METHODS: A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken...
June 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28591085/influence-of-oprm1-polymorphism-on-post-operative-pain-after-intrathecal-morphine-administration-in-italian-patients-undergoing-elective-cesarean-section
#7
Eleonora Pettini, Massimo Micaglio, Ubaldo Bitossi, Angelo Raffaele De Gaudio, Duccio Rossi Degl'Innocenti, Lorenzo Tofani, Vittorio Limatola, Chiara Adembri, Alessandro Di Filippo
OBJECTIVES: the aim of this prospective observational study was to evaluate the influence of OPRM1 polymorphism on the analgesic efficacy (including VAS scores and requirement for rescue analgesia) of a standard dose of intrathecal morphine METHODS:: an Italian cohort of 63 parturients, scheduled for elective cesarean section at a tertiary University Hospital, received a spinal anesthesia with hyperbaric bupivacaine and morphine 100 mcg. For the first 48 hours in the post-operative period the patients received acetaminophen 1 g IV q6hr...
June 6, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28560194/short-term-effects-of-catheter-pressure-and-time-control-in-vacuum-aspiration-abortion-for-early-high-risk-pregnancies
#8
Lingna Sun, Yan Yu, Xiaoxia Qi
BACKGROUND: We aimed to evaluate an approach to induced abortions during early pregnancies that controls the suction pressure and restricts the duration of the procedure. METHODS: Three hundred patients programmed for induced early pregnancy abortions, hospitalized in the Shandong Provincial Maternity & Child-care Hospital from October 2013 to October 2015, were enrolled. Patients were randomly assigned to either research or control group. In the research group, operation pressure was controlled at 400 mmHg and operation time in the uterine cavity was kept at less than 75 s...
May 2017: Iranian Journal of Public Health
https://www.readbyqxmd.com/read/28559097/von-willebrand-disease-type-2-in-pregnancy-a-critical-clinical-association
#9
REVIEW
Anca A Simionescu, Natalia F Buinoiu, Nicoleta Berbec
Von Willebrand disease (vWD) is the most common inherited bleeding disorder. Its association with pregnancy is infrequent. Here we report three cases of vWD associated with pregnancy. The clinical features of this combination are very suggestive. However, difficulties are still encountered during the diagnosis process. The first case was diagnosed for the first time during the patient's second pregnancy despite several episodes of vaginal bleeding and suggestive clinical symptomatology. The second case was diagnosed during childhood and the patient was properly managed during this pregnancy...
May 18, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28535940/-postpartum-hemorrhage-and-pregnancy-induced-hypertension-during-emergency-lower-segment-cesarean-section-dexmedetomidine-to-our-rescue
#10
Uma Hariharan
Dexmedetomidine is a highly selective α-2 agonist which has recently revolutionized our anesthesia and intensive care practice. An obstetric patient presented for emergency cesarean delivery under general anesthesia, with pre-eclampsia and postpartum hemorrhage. In carefully selected cases with refractory hypertension and postpartum hemorrhage, dexmedetomidine can be used for improving overall patient outcome. It was beneficial in controlling both the blood pressure and uterine bleeding during cesarean section in our patient...
May 20, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28526467/bloqueio-cir%C3%A3%C2%BArgico-do-plano-transverso-abdominal-versus-guiado-por-ultrassom-em-pacientes-obesas-ap%C3%A3-s-ces%C3%A3-rea-estudo-prospectivo-e-randomizado
#11
Aykut Urfalıoğlu, Murat Bakacak, Ömer Faruk Boran, Fatih Mehmet Yazar, Mahmut Arslan, Hafize Öksüz
BACKGROUND AND OBJECTIVES: Ultrasound-guided transversus abdominis plane block demonstrated efficacy in providing post-operative analgesia by prolonging the time to first analgesic requirement and reducing the total analgesic consumption. The surgical transversus abdominis plane block, a novel technique, can be performed safely in obese patients in whom muscle layers cannot be sufficiently exposed. Here, we compared applicability, efficacy and complications of surgical transversus abdominis plane and ultrasound-guided transversus abdominis plane blocks in obese pregnant women following cesarean section under general anesthesia...
May 16, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28525510/zika-virus-obstetric-and-pediatric-anesthesia-considerations
#12
Jacqueline L Tutiven, Benjamin T Pruden, James S Banks, Mario Stevenson, David J Birnbach
As of November 2016, the Florida Department of Health (FDH) and the Centers for Disease Control and Prevention have confirmed more than 4000 travel-related Zika virus (ZIKV) infections in the United States with >700 of those in Florida. There have been 139 cases of locally acquired infection, all occurring in Miami, Florida. Within the US territories (eg, Puerto Rico, US Virgin Islands), >30,000 cases of ZIKV infection have been reported. The projected number of individuals at risk for ZIKV infection in the Caribbean and Latin America approximates 5 million...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28524032/-preoperative-risk-factors-analysis-of-pulmonary-hypertension-crisis-during-perioperative-period-for-caesarean-section-of-woman-with-severe-pulmonary-hypertension
#13
Chunlei Zhang, Yaguang Liu, Enming Qing, Jun Ma
OBJECTIVE: To analyze preoperative risk factors of perioperative pulmonary hypertension crisis (PHC) for pregnant woman with severe pulmonary artery hypertension (PAH), and approach its clinical value. METHODS: A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not...
May 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28496360/epidural-anesthesia-for-labor-and-delivery-in-a-patient-with-may-hegglin-anomaly-a-case-report
#14
Annas Muhammad Muzannar, Mohammed Al Harbi, Raza Rathore, Nasser Tawfeeq, Freddie Wambi, Nasir Mahmood, Sonia Albrechtova, Vassilios Dimitriou
We report a case of May-Hegglin anomaly (MHA) in a woman who had a successful labor and delivery under epidural anesthesia. MHA is an inherited thrombocytopenia easily misdiagnosed as idiopathic (immune) thrombocytopenic purpura (ITP). Early and appropriate diagnosis of MHA during pregnancy is essential for optimal maternal and neonatal delivery outcome. Additionally, it can avoid unnecessary diagnostic studies, such as bone marrow aspiration and biopsy, and even harmful therapies with corticosteroids, immunosuppressive agents, and splenectomy...
2017: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/28491126/developing-obstetric-medicine-training-in-latin-america
#15
José Rojas-Suarez, Niza Suarez, Oier Ateka-Barrutia
Maternal mortality is an important indicator of health in populations around the world. The distribution of maternal mortality ratio globally shows that middle- and low-income countries have ∼99% of the mortality burden. Most countries of Latin America are considered to be middle- or low-income countries, as well as areas of major inequities among the different social classes. Medical problems in pregnancy remain an important cause of morbidity and mortality in this region. Previous data indicate the need for a call to action for adequate diagnosis and care of medical diseases in obstetric care...
March 2017: Obstetric Medicine
https://www.readbyqxmd.com/read/28489765/anesthetic-management-of-cesarean-delivery-in-parturients-with-ruptured-sinus-of-valsalva-aneurysm-care-compliant-2-case-reports-and-literature-review
#16
Gang Fang, Man Li, Jian Li, Li Lin, Wei Mei
RATIONALE: Ruptured sinus of Valsalva aneurysm is rare and dangerous in parturients. Few cases of ruptured SVA in pregnancy are reported, and the anesthetic management for cesarean delivery has scarcely been described. PATIENT CONCERNS: A parturient at 37-week gestation complained of a sore throat and cough that started 3 days before admission, followed 1 day later by fever, dizziness, breathlessness, and palpitation on exertion. Case two at 36-week gestation complained of a 1-day history of bloating in the lower abdomen...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28474273/outpatient-appendectomy-in-an-emergency-outpatient-surgery-unit-24%C3%A2-h-a-day-an-intention-to-treat-analysis-of-194-patients
#17
Adeline Aubry, Arnaud Saget, Gilles Manceau, Matthieu Faron, Mathilde Wagner, Christophe Tresallet, Bruno Riou, Olivier Lucidarme, Frédéric le Saché, Mehdi Karoui
OBJECTIVE: To evaluate the feasibility and outcomes of patients operated on for uncomplicated acute appendicitis (UAA) in our 24-h emergency outpatient surgery unit. METHODS: This was a prospective observational study with intention-to-treat (ITT) analysis. From 12/2013 to 03/2015, all consecutive patients admitted for acute appendicitis (AA) were prospectively screened. A computed tomography or abdominal ultrasound confirmed the diagnosis of AA. Eligibility criteria for outpatient appendectomy were: UAA, no comorbidity, no physical or mental condition preventing participation in the study, absence of pregnancy, age older than 15 years, an accompanying adult person available for the hospital discharge and place of residence within 1 h of our hospital...
May 4, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28472830/definitive-contraception-trends-in-a-ten-year-interval
#18
Cecília Maria Ventuzelo Marques, Magda Maria do Vale Pinto Magalhães, Maria João Leal da Silva Carvalho, Giselda Marisa Costa Carvalho, Francisco Augusto Falcão Santos Fonseca, Isabel Torgal
Objective To evaluate the trends in definitive contraception in a ten-year interval comprising the years 2002 and 2012. Method Retrospective analysis of the tubal sterilization performed in our service in 2002 and 2012, analyzing the demographic characteristics, personal history, previous contraceptive method, definite contraception technique, effectiveness and complications. Results Definitive contraception was performed in 112 women in 2002 (group 1) and in 60 women in 2012 (group 2). The groups were homogeneous regarding age, parity, educational level and personal history...
May 4, 2017: Revista Brasileira de Ginecologia e Obstetrícia
https://www.readbyqxmd.com/read/28461175/in-office-hysteroscopic-extraction-of-intrauterine-devices-in-pregnant-patients-who-underwent-prior-ultrasound-guided-extraction-failure
#19
Shlomo B Cohen, Jerome Bouaziz, Alexandra Bar-On, Eyal Schiff, Motti Goldenberg, Roy Mashiach
STUDY OBJECTIVE: To determine an effective method of intrauterine device (IUD) retrieval from pregnant women who had previous unsuccessful ultrasound-guided IUD extraction failure. DESIGN: A retrospective cohort study (Canadian task force classification II-1). SETTING: A gynecology department of an outpatient clinic. PATIENTS: Pregnant patients in their first trimester with IUD in situ who underwent prior unsuccessful ultrasound-guided IUD extraction...
April 28, 2017: Journal of Minimally Invasive Gynecology
https://www.readbyqxmd.com/read/28451033/-epidural-analgesia-in-20-parturients-at-the-sylvanus-olympio-university-hospital-center-in-lom%C3%A3-togo
#20
Pilakimwé Egbohou, Tabana Mouzou, Hamza Doles Sama, Pikabalo Tchétike, Sarakawabalo Assénouwé, Gnimdou Akala-Yoba, Kadjika Tomta
We conducted a prospective and descriptive study on epidural analgesia (EA) at the Sylvanus Olympio University Hospital Center in Lomé from February to June 2014. After taking consent from pregnant women selected by simple random sampling and in the absence of contraindication for anesthesia (pre-anesthetic assessment performed in their 8th month of pregnancy), women were enrolled. Out of 29 selected women, 20 (69%) underwent EA. The average age was 30.6 ± 6.6 years: primiparas 35%, multiparas 50%, Obese women (BMI> 30)25%...
2017: Pan African Medical Journal
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