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Obstetric Anesthesia

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144 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
https://www.readbyqxmd.com/read/28709410/identification-of-barriers-and-facilitators-for-optimal-cesarean-section-care-perspective-of-professionals
#1
Sonja Melman, Rachel Hellen Petra Schreurs, Carmen Desiree Dirksen, Anneke Kwee, Jan Gerrit Nijhuis, Nicol Anna Cornelia Smeets, Hubertina Catharina Johanna Scheepers, Rosella Petronella Maria Gemma Hermens
BACKGROUND: The cesarean section (CS) rate has increased over recent decades with poor guideline adherence as a possible cause. The objective of this study was to explore barriers and facilitators for delivering optimal care as described in clinical practice guidelines. METHODS: Key recommendations from evidence-based guidelines were used as a base to explore barriers and facilitators for delivering optimal CS care in The Netherlands. Both focus group and telephone interviews among 29 different obstetrical professionals were performed...
July 14, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28594092/understanding-the-relationship-between-cesarean-birth-and-stress-anxiety-and-depression-after-childbirth-a-nationwide-cohort-study
#2
Hung-Hui Chen, Jerry Cheng-Yen Lai, Shyh-Jou Hwang, Nicole Huang, Yiing-Jenq Chou, Li-Yin Chien
BACKGROUND: Women who undergo cesarean birth might have an increased risk for poor mental health after childbirth, possibly because of maternal and neonatal physical problems, low parental confidence, and decreased levels of oxytocin. However, this relationship remains controversial and requires further examination. The study aimed to examine the effect of cesarean birth on postpartum stress, anxiety, and depression. METHODS: This nationwide population-based cohort study was conducted using the Taiwan National Health Insurance Database...
June 8, 2017: Birth
https://www.readbyqxmd.com/read/28651841/survey-of-nulliparous-parturients-attitudes-regarding-timing-of-epidural-analgesia-initiation
#3
Ghislaine C Echevarria, Gilbert J Grant, Yousun Chung, Jerome Lax
STUDY OBJECTIVE: At our hospital, although >90% of nulliparous parturients eventually choose epidural analgesia for labor, many delay its initiation, experiencing considerable pain in the interim. This survey probed parturients' views about the timing of initiation of epidural labor analgesia. DESIGN: Single-center, nonrandomized quantitative survey. SETTING: Labor and delivery suite in a large tertiary academic medical center. PATIENTS: Two hundred laboring nulliparous women admitted to the labor and delivery suite...
June 23, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28426507/peripartum-anesthetic-management-of-the-opioid-tolerant-or-buprenorphine-suboxone-dependent-patient
#4
Aileen Pan, Mark Zakowski
Opioid abuse and dependence continues to rise in both the general population and pregnancy, with opioid overdose deaths having quadrupled in the last 15 years. Illicit drug use in last 30 days of pregnancy was over 4% with almost 0.6% documented maternal opiate use at time of birth. The management of the opioid-tolerant, buprenorphine-dependent or methadone-dependent patient in the peripartum period is reviewed. Options for treatment of opioid dependence, acute pain management, and perioperative multimodal analgesia are discussed...
June 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/23584382/neuraxial-anesthesia-in-parturients-with-intracranial-pathology-a-comprehensive-review-and-reassessment-of-risk
#5
REVIEW
Lisa R Leffert, Lee H Schwamm
Parturients with intracranial lesions are often assumed to have increased intracranial pressure, even in the absence of clinical and radiographic signs. The risk of herniation after an inadvertent dural puncture is frequently cited as a contraindication to neuraxial anesthesia. This article reviews the relevant literature on the use of neuraxial anesthesia in parturients with known intracranial pathology, and proposes a framework and recommendations for assessing risk of neurologic deterioration, with epidural analgesia or anesthesia, or planned or inadvertent dural puncture...
September 2013: Anesthesiology
https://www.readbyqxmd.com/read/22513749/outcomes-of-hospitalization-in-pregnant-women-with-cns-neoplasms-a-population-based-study
#6
Anna R Terry, Fred G Barker, Lisa Leffert, Brian T Bateman, Irene Souter, Scott R Plotkin
Managing a CNS neoplasm during pregnancy presents complex challenges, and population-based studies are lacking. We designed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) to investigate pregnancy outcomes in women with CNS neoplasms. We constructed a logistic regression model for maternal mortality, preterm labor, intrauterine growth restriction (IUGR), and Caesarean delivery, controlling for age, comorbidities, and demographic characteristics. We identified 379 malignant brain tumors, 437 benign brain tumors, and 44 spine tumors among 19 million pregnancy-related admissions from 1988 through 2009...
June 2012: Neuro-oncology
https://www.readbyqxmd.com/read/28622143/epidural-analgesia-at-trial-of-labor-after-cesarean-tolac-a-significant-adjunct-to-successful-vaginal-birth-after-cesarean-vbac
#7
Sorina Grisaru-Granovsky, Maayan Bas-Lando, Lior Drukker, Fred Haouzi, Rivka Farkash, Arnon Samueloff, Alexander Ioscovich
INTRODUCTION: Epidural analgesia has been considered a risk factor for labor dystocia at trial of labor after cesarean (TOLAC) and uterine rupture. We evaluated the association between exposure to epidural during TOLAC and mode of delivery and maternal-neonatal outcomes. MATERIALS AND METHODS: A single center retrospective study of women that consented to TOLAC within a strict protocol between 2006 and 2013. Epidural "users" were compared to "non-users". Primary outcome was the mode of delivery: repeat in-labor cesarean or vaginal birth after cesarean (VBAC)...
June 5, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28622178/labor-analgesia-onset-with-dural-puncture-epidural-versus-traditional-epidural-using-a-26-gauge-whitacre-needle-and-0-125-bupivacaine-bolus-a-randomized-clinical-trial
#8
Sylvia H Wilson, Bethany J Wolf, Kellie N Bingham, Quiana S Scotland, John M Fox, Erick M Woltz, Latha Hebbar
BACKGROUND: Lumbar epidurals (LEs) provide excellent analgesia. Combined spinal epidural and dural puncture epidural (DPE) are 2 techniques to expedite neuraxial analgesia onset. In DPE, dura is punctured but medication is not administered in the cerebrospinal fluid. Expedited analgesia onset has been demonstrated with DPE, using 0.25% bupivacaine; however, this concentration may impede an unassisted vaginal birth and is not currently used for induction and maintenance of labor analgesia...
June 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28598915/anesthetic-and-obstetric-management-of-syringomyelia-during-labor-and-delivery-a-case-series-and-systematic-review
#9
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/28599396/five-years-experience-in-an-anesthesiology-antenatal-clinic-for-high-risk-patients
#10
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/28236650/retrospective-analysis-of-placenta-previa-with-abnormal-placentation-with-and-without-prophylactic-use-of-abdominal-aorta-balloon-occlusion
#11
Shihong Cui, Yunxiao Zhi, Guomei Cheng, Kai Zhang, Lindong Zhang, Linna Shen
OBJECTIVE: To evaluate the effectiveness of prophylactic abdominal aorta balloon occlusion in cases of placenta previa with abnormal placentation. METHODS: In a retrospective study, data were analyzed for patients who had placenta previa with placenta accreta and underwent elective cesarean delivery (>34 weeks) with or without temporary aortic balloon occlusion at a center in Zhengzhou, China, between October 2015 and September 2016. The primary clinical outcomes were operative time, estimated blood loss, intraoperative blood transfusion volume, hemoglobin, hysterectomy, and hospitalization...
June 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28383323/risk-of-epidural-hematoma-after-neuraxial-techniques-in-thrombocytopenic-parturients-a-report-from-the-multicenter-perioperative-outcomes-group
#12
Linden O Lee, Brian T Bateman, Sachin Kheterpal, Thomas T Klumpner, Michelle Housey, Michael F Aziz, Karen W Hand, Mark MacEachern, Christopher G Goodier, Jeffrey Bernstein, Melissa E Bauer
BACKGROUND: Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large perioperative database and performed a systematic review to further define the risk of epidural hematoma requiring surgical decompression in this population. METHODS: The authors performed a retrospective cohort study using the Multicenter Perioperative Outcomes Group database to identify thrombocytopenic parturients who received a neuraxial technique and to estimate the risk of epidural hematoma...
June 2017: Anesthesiology
https://www.readbyqxmd.com/read/28558667/the-meaning-of-labour-pain-how-the-social-environment-and-other-contextual-factors-shape-women-s-experiences
#13
Laura Y Whitburn, Lester E Jones, Mary-Ann Davey, Rhonda Small
BACKGROUND: The majority of women experience pain during labour and childbirth, however not all women experience it in the same way. In order to develop a more complete understanding of labour pain, this study aimed to examine women's experiences within the perspective of modern pain science. A more complete understanding of this phenomenon can then guide the development of interventions to enhance women's experiences and potentially reduce their need for pharmacological intervention...
May 30, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28504988/the-labor-analgesia-requirements-in-nulliparous-women-randomized-to-epidural-catheter-placement-in-a-high-or-low-intervertebral-space
#14
Albert Moore, Valerie Villeneuve, Bruno Bravim, Aly El-Bahrawy, Eva El-Mouallem, Ian Kaufman, Roupen Hatzakorzian, William Li Pi Shan
BACKGROUND: We hypothesized that an epidural catheter placed in a lower vertebral interspace will require less medication for labor analgesia. METHODS: Nulliparous women requesting neuraxial labor analgesia were randomized to epidural catheter placement at the ultrasound-confirmed L1-2 or L4-5 interspace. Patient-controlled epidural analgesia and breakthrough manual epidural boluses of 10 mL of 0.125% bupivacaine with 50 µg of fentanyl or 8 mL of 2% lidocaine were utilized...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28505479/women-s-self-reported-experience-of-unplanned-caesarean-section-results-of-a-swedish-study
#15
Annika Karlström
BACKGROUND: women´s experience of emergency caesarean section is often described as less positive compared to a vaginal birth or a planned caesarean section. Midwifery care for women where deviations from a normal birth process are present is a challenge. The aim of study was to compare self-reported birth outcomes for women undergoing birth through spontaneous onset of labour between those who actually had a vaginal birth and those who eventually had an emergency caesarean section. DESIGN AND SETTING: the study was part of a prospective longitudinal cohort study of parents' experiences, attitudes, and beliefs related to childbirth...
April 27, 2017: Midwifery
https://www.readbyqxmd.com/read/27089000/the-effect-of-intrathecal-morphine-dose-on-outcomes-after-elective-cesarean-delivery-a-meta-analysis
#16
REVIEW
Pervez Sultan, Stephen H Halpern, Ellile Pushpanathan, Selina Patel, Brendan Carvalho
BACKGROUND: The intrathecal morphine dose achieving optimal analgesia for cesarean delivery while minimizing side effects has not yet been deduced. In this meta-analysis, our objective was to determine whether low- or high-dose intrathecal morphine provides acceptable duration and intensity of analgesia with fewer side effects. METHODS: A literature search (PubMed, EMBASE, MEDLINE, Scopus, Web of Science, and CINAHL) was performed to identify randomized controlled trials involving patients undergoing elective cesarean delivery under spinal anesthesia comparing low-dose (LD; 50-100 μg) morphine with higher dose (HD; >100-250 μg)...
July 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28474356/patients-preferences-for-labor-analgesic-counseling-a-qualitative-analysis
#17
Paloma Toledo, Javiera Pumarino, William A Grobman, Cynthia A Wong, Jane L Holl, Romana Hasnain-Wynia
BACKGROUND: The decision to use, or not use, neuraxial labor analgesia is complex, with both maternal and fetal considerations. Fears and concerns about neuraxial analgesia may influence analgesic decision-making. Little is known about patients' preferences for analgesic counseling. Therefore, the objectives of this qualitative study were to evaluate the sources of information used by patients, the timing and content of antepartum counseling about labor analgesia, and patients' preferences for such counseling...
May 5, 2017: Birth
https://www.readbyqxmd.com/read/28445702/an-early-history-of-anesthesia-in-labor
#18
Mary E Gibson
Fear of pain often overshadows childbirth, and each woman must decide whether to receive anesthesia to combat labor pain. Historically, this choice resulted in unintended consequences and marked the beginnings of medical interventions in labor and birth. The purpose of this article is to trace the use of anesthesia in childbirth from the mid-19th to the mid-20th centuries and to explore its influence on childbearing women and nurses.
April 23, 2017: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/28407220/patient-controlled-analgesia-with-remifentanil-versus-alternative-parenteral-methods-for-pain-management-in-labour
#19
REVIEW
Stephanie Weibel, Yvonne Jelting, Arash Afshari, Nathan Leon Pace, Leopold Hj Eberhart, Johanna Jokinen, Thorsten Artmann, Peter Kranke
BACKGROUND: Multiple analgesic strategies for pain relief during labour are available. Recently remifentanil, a short-acting opioid, has recently been used as an alternative analgesic due to its unique pharmacological properties. OBJECTIVES: To systematically assess the effectiveness of remifentanil intravenous patient-controlled analgesia (PCA) for labour pain, along with any potential harms to the mother and the newborn. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 December 2015), ClinicalTrials...
April 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28351670/preemptive-analgesia-for-postoperative-hysterectomy-pain-control-systematic-review-and-clinical-practice-guidelines
#20
REVIEW
Adam C Steinberg, Megan O Schimpf, Amanda B White, Cara Mathews, David R Ellington, Peter Jeppson, Catrina Crisp, Sarit O Aschkenazi, Mamta M Mamik, Ethan M Balk, Miles Murphy
OBJECTIVE: The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy. DATA SOURCES: Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY: We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy...
March 27, 2017: American Journal of Obstetrics and Gynecology
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