International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1995
Post partum headache after epidural analgesia without dural puncture.
In order to improve our knowledge of post partum headache, during a two-year period we studied a large population of pregnant patients of our institution using a four-stage process including two questionnaires (the first at 12-15 weeks' gestation and the second in the first week after delivery), a pre-anesthetic visit at 36 +/- 2 weeks' gestation and a computer printout obtained at delivery. Of 1058 patients for whom records were complete and who had epidural analgesia during labor not complicated by dural puncture, 128 (12.1%) complained of post partum headache. ⋯ Data from the medical history or from the current pregnancy as well as data obtained during delivery (maternal and fetal-neonatal) were not significantly different between those patients free of pain and those presenting with headache, except for a history of migraine and pregnancy-induced hypertension which were both associated with an increased risk of post partum headache. These risk factors should be considered in both clinical studies and obstetric malpractice claims.
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Int J Obstet Anesth · Jan 1995
A comparison of informed consent for obstetric anaesthesia in the USA and the UK.
The practice of 75 UK and 75 US obstetric anaesthetists in obtaining informed consent for obstetric anaesthesia (for caesarean section) and obstetric analgesia (for labour) was compared using a postal questionnaire. The response rate was approximately 60% for each group. Of the US anaesthetists 47% obtained separate written consent for obstetric anaesthesia compared to 22% of the UK group (P=0.012). ⋯ Significantly more of the listed risks and benefits relating to general anaesthesia were discussed by the US anaesthetists compared to the UK group, median (interquartile range), 6 (4-7) and 3 (1-4), P < 0.001. There was no significant difference in discussion before regional anaesthesia but the US group discussed more information before epidural analgesia for labouring mothers obtunded by pain or drugs. These results suggest that discussion and documentation of informed consent for obstetric anaesthesia and analgesia could be improved in both countries, especially the UK.
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Emergent attainment of uterine relaxation is an occasional need in obstetric practice. Various agents, from amyl nitrate through volatile anesthetics have been used to relax the uterus, with varying degrees of success and side-effects. ⋯ We have used a new sublingual aerosol spray of NTG, at an initial dose of 0.8 mg, in 7 patients for rapid uterine relaxation and have not observed adverse side-effects. Prolonged shelf life, ready availability and ease of use make the sublingual spray attractive for urgent tocolysis.