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Obstetric Anesthesia

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196 papers 100 to 500 followers Articles of interest for anesthesiologist who work with obstetrics either general or subspecialized
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
Amirhossein Moaddab, Gary A Dildy, Haywood L Brown, Zhoobin H Bateni, Michael A Belfort, Haleh Sangi-Haghpeykar, Steven L Clark
OBJECTIVE: To quantitate the contribution of various demographic factors to the U.S. maternal mortality ratio. METHODS: This was a retrospective observational study. We analyzed data from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics database and the Detailed Mortality Underlying Cause of Death database (CDC WONDER) from 2005 to 2014 that contains mortality and population counts for all U.S. counties. Bivariate correlations between the maternal mortality ratio and all maternal demographic, lifestyle, health, and medical service utilization characteristics were calculated...
March 8, 2018: Obstetrics and Gynecology
Léa Poggi, Nelly Goutaudier, Natalène Séjourné, Henri Chabrol
OBJECTIVES: Given that prepartum psychiatric symptoms have been reported to be associated with postpartum disorders, focusing on the prepartum period appears of prime importance. The aim of the current study was threefold: (a) to identify the prevalence rates of women suffering from fear of childbirth (FOC) and tokophobia (b) to explore the association between FOC, obstetrical and psychopathological variables and (c) to identify the independent predictors of the intensity of FOC symptoms, FOC and tokophobia...
February 26, 2018: Maternal and Child Health Journal
Dana Vitner, Inna Bleicher, Eyal Levy, Ronen Sloma, Einav Kadour-Peero, Yossi Bart, Shlomi Sagi, Amir Aviram, Ron Gonen
OBJECTIVE: We aimed to compare maternal morbidity and mortality of cesarean sections (CS) in the second versus first stage of labor. STUDY DESIGN: Retrospective study of all CS at a single, university-affiliated medical center, between January 2010 and December 2014. Eligibility was limited to term, singleton pregnancies with cephalic presentation. Maternal outcomes of second-stage CS were compared to those of first-stage CS. The primary outcome was defined as estimated blood loss >1000 ml...
February 22, 2018: Journal of Maternal-fetal & Neonatal Medicine
Nicole T Brown, Jessica M Turner, Sailesh Kumar
BACKGROUND: Sleep-disordered breathing is an increasingly common condition in non-obstetric populations and is associated with significant morbidity. The incidence of sleep-disordered breathing in pregnancy is unknown and it is likely that many cases go undiagnosed. OBJECTIVE: A systematic review and meta-analysis was undertaken to determine if pregnant women diagnosed with sleep-disordered breathing are more likely to have adverse intrapartum and perinatal outcomes compared to controls...
February 15, 2018: American Journal of Obstetrics and Gynecology
Katherine L Grantz, Rajeshwari Sundaram, Ling Ma, Stefanie Hinkle, Vincenzo Berghella, Matthew K Hoffman, Uma M Reddy
OBJECTIVE: To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications. METHODS: In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications...
February 2018: Obstetrics and Gynecology
T K Allen, B M Mishriky, R Y Klinger, A S Habib
Neuraxial clonidine improves postoperative analgesia in the general surgical population. The efficacy and safety of neuraxial clonidine as a postoperative analgesic adjunct in the Caesarean section population still remains unclear. This systematic review and meta-analysis aims to evaluate the effect of perioperative neuraxial clonidine on postoperative analgesia in women having Caesarean section under neuraxial anaesthesia. We included randomized controlled trials comparing the analgesic efficacy of the perioperative administration of neuraxial clonidine alone or in combination with a local anaesthetic and/or opioids in women having elective Caesarean section under neuraxial anaesthesia when compared with placebo...
February 2018: British Journal of Anaesthesia
Chiraag Talati, Jose C A Carvalho, Alice Luca, Mrinalini Balki
BACKGROUND: Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administration for induction and augmentation of labor is inconsistent with regard to maternal outcomes. We aimed to determine the effect of intermittent versus continuous oxytocin preexposure on myometrial responsiveness to subsequent oxytocin...
February 2, 2018: Anesthesia and Analgesia
B L Sng, M Tan, C J Yeoh, N-L R Han, R Sultana, P N Assam, A T Sia
INTRODUCTION: Epidural re-siting is one of the significant events during labour epidural analgesia that may result in decreased patient satisfaction. The aim of our study was to investigate the incidence of and factors associated with epidural re-siting in parturients using epidural analgesia, with an emphasis on those with breakthrough pain. METHODS: A retrospective cohort study of 10170 parturients who received labour epidural analgesia. The primary outcome was the incidence of epidural re-siting (binary data)...
December 8, 2017: International Journal of Obstetric Anesthesia
Payton Schmidt, Mitchell B Berger, Lori Day, Carolyn W Swenson
AIM: To quantify home opioid use after cesarean delivery and identify factors associated with increased opioid use. METHODS: A convenience sample of women discharged by postoperative day 2 following a term cesarean delivery of a singleton fetus from May 2015 to May 2016 were contacted 2 weeks post-partum and questioned regarding opioid use, pain control and pain expectations. RESULTS: Among 141 women included in the analysis, the median number of opioid tablets used was 36 (interquartile range 16-45) and the median number prescribed was 60 (interquartile range 42-65)...
January 23, 2018: Journal of Obstetrics and Gynaecology Research
Priscilla J Hall, Jennifer Whitman Foster, Kathryn M Yount, Bonnie Mowinski Jennings
OBJECTIVE: To explore the complexity of women's birth experiences in the context in which they occur and to describe how these influence women's well-being in labor. DESIGN: Qualitative method with a phenomenological approach, following the analysis principles of van Manen. PARTICIPANTS AND SETTING: Eight women from different ethnic and socioeconomic backgrounds in Atlanta, Georgia, United States with a recent, healthy birth were interviewed twice about their experience of the labor journey...
March 2018: Midwifery
Elizabeth M S Lange, Cynthia A Wong, Paul C Fitzgerald, Wilmer F Davila, Suman Rao, Robert J McCarthy, Paloma Toledo
BACKGROUND: Programmed intermittent boluses of local anesthetic have been shown to be superior to continuous infusions for maintenance of labor analgesia. High-rate epidural boluses increase delivery pressure at the catheter orifice and may improve drug distribution in the epidural space. We hypothesized that high-rate drug delivery would improve labor analgesia and reduce the requirement for provider-administered supplemental boluses for breakthrough pain. METHODS: Nulliparous women with a singleton pregnancy at a cervical dilation of less than or equal to 5 cm at request for neuraxial analgesia were eligible for this superiority-design, double-blind, randomized controlled trial...
January 19, 2018: Anesthesiology
Elena Rita Magro-Malosso, Gabriele Saccone, Mariarosaria Di Tommaso, Michele Mele, Vincenzo Berghella
BACKGROUND: External cephalic version is a medical procedure in which the fetus is externally manipulated to assume the cephalic presentation. The use of neuraxial analgesia for facilitating the version has been evaluated in several randomized clinical trials, but its potential effects are still controversial. OBJECTIVE: The objective of the study was to evaluate the effectiveness of neuraxial analgesia as an intervention to increase the success rate of external cephalic version...
September 2016: American Journal of Obstetrics and Gynecology
Laurie A Chalifoux, Jeanette R Bauchat, Nicole Higgins, Paloma Toledo, Feyce M Peralta, Jason Farrer, Susan E Gerber, Robert J McCarthy, John T Sullivan
BACKGROUND: Breech presentation is a leading cause of cesarean delivery. The use of neuraxial anesthesia increases the success rate of external cephalic version procedures for breech presentation and reduces cesarean delivery rates for fetal malpresentation. Meta-analysis suggests that higher-dose neuraxial techniques increase external cephalic version success to a greater extent than lower-dose techniques, but no randomized study has evaluated the dose-response effect. We hypothesized that increasing the intrathecal bupivacaine dose would be associated with increased external cephalic version success...
October 2017: Anesthesiology
Lisa R Leffert, Heloise M Dubois, Alexander J Butwick, Brendan Carvalho, Timothy T Houle, Ruth Landau
Venous thromboembolism remains a major source of morbidity and mortality in obstetrics with an incidence of 29.8/100,000 vaginal delivery hospitalizations; cesarean delivery confers a 4-fold increased risk of thromboembolism when compared with vaginal delivery. Revised national guidelines now stipulate that the majority of women delivering via cesarean and women at risk for ante- or postpartum venous thromboembolism receive mechanical or pharmacological thromboprophylaxis. This practice change has important implications for obstetric anesthesiologists concerned about the risk of spinal epidural hematoma (SEH) among anticoagulated women receiving neuraxial anesthesia...
July 2017: Anesthesia and Analgesia
Lisa Leffert, Alexander Butwick, Brendan Carvalho, Katherine Arendt, Shannon M Bates, Alex Friedman, Terese Horlocker, Timothy Houle, Ruth Landau, Heloise Dubois, Roshan Fernando, Tim Houle, Sandra Kopp, Douglas Montgomery, Joseph Pellegrini, Richard Smiley, Paloma Toledo
Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in obstetric patients receiving thromboprophylaxis or higher dose anticoagulants...
March 2018: Anesthesia and Analgesia
Inês Nunes, Diogo Ayres-de-Campos, Austin Ugwumadu, Pina Amin, Philip Banfield, Antony Nicoll, Simon Cunningham, Paulo Sousa, Cristina Costa-Santos, João Bernardes
OBJECTIVE: To evaluate whether intrapartum fetal monitoring with computer analysis and real-time alerts decreases the rate of newborn metabolic acidosis or obstetric intervention when compared with visual analysis. METHODS: A randomized clinical trial carried out in five hospitals in the United Kingdom evaluated women with singleton, vertex fetuses of 36 weeks of gestation or greater during labor. Continuous central fetal monitoring by computer analysis and online alerts (experimental arm) was compared with visual analysis (control arm)...
January 2017: Obstetrics and Gynecology
(no author information available yet)
BACKGROUND: Continuous electronic fetal heart-rate monitoring is widely used during labour, and computerised interpretation could increase its usefulness. We aimed to establish whether the addition of decision-support software to assist in the interpretation of cardiotocographs affected the number of poor neonatal outcomes. METHODS: In this unmasked randomised controlled trial, we recruited women in labour aged 16 years or older having continuous electronic fetal monitoring, with a singleton or twin pregnancy, and at 35 weeks' gestation or more at 24 maternity units in the UK and Ireland...
April 29, 2017: Lancet
Gabriel A Brat, Denis Agniel, Andrew Beam, Brian Yorkgitis, Mark Bicket, Mark Homer, Kathe P Fox, Daniel B Knecht, Cheryl N McMahill-Walraven, Nathan Palmer, Isaac Kohane
OBJECTIVE: To quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population. DESIGN: Retrospective cohort study. SETTING: Surgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016. PARTICIPANTS: 1 015 116 opioid naive patients undergoing surgery. MAIN OUTCOME MEASURES: Use of oral opioids after discharge as defined by refills and total dosage and duration of use...
January 17, 2018: BMJ: British Medical Journal
Laura B Attanasio, Katy B Kozhimannil, Kristen H Kjerulff
OBJECTIVE: To examine correlates of shared decision making during labor and delivery. METHODS: Data were from a cohort of women who gave birth to their first baby in Pennsylvania, 2009-2011 (N = 3006). We used logistic regression models to examine the association between labor induction and mode of delivery in relation to women's perceptions of shared decision making, and to investigate race/ethnicity and SES as potential moderators. RESULTS: Women who were Black and who did not have a college degree or private insurance were less likely to report high shared decision making, as well as women who underwent labor induction, instrumental vaginal or cesarean delivery...
January 5, 2018: Patient Education and Counseling
Mathilde Revert, Patrick Rozenberg, Jonathan Cottenet, Catherine Quantin
OBJECTIVE: To compare the rates of invasive procedures (surgical or vascular) for hemorrhage control between a perinatal network that routinely used intrauterine balloon tamponade and another perinatal network that did not in postpartum hemorrhage management. METHODS: This population-based retrospective cohort study included all women (72,529) delivering between 2011 and 2012 in the 19 maternity units in two French perinatal networks: a pilot (in which balloon tamponade was used) and a control network...
January 2018: Obstetrics and Gynecology
2018-01-19 16:21:40
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