International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 1998
Epidural analgesia for vaginal delivery in a patient with cystic fibrosis following double lung transplantation.
The anaesthetic management is described of a patient with cystic fibrosis who had had a double lung transplantation for intractable respiratory failure. An epidural block provided analgesia/anaesthesia for vaginal birth and bilateral tubal ligation.
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Int J Obstet Anesth · Jan 1998
Pregnancy and delivery in a patient with recent peripartum cardiomyopathy.
We present a case of successful pregnancy and delivery in a patient with peripartum cardiomyopathy who conceived only 3 months after a vaginal delivery complicated by peripartum cardiomyopathy. Following the onset of labor, an arterial pressure catheter and pulmonary artery catheter were placed. ⋯ After a few hours of labor, the fetal heart rate tracing revealed repetitive variable decelerations, and a decision was made to proceed with operative delivery. The mother's hemodynamic changes are presented, and the specifics of the anesthetic care are outlined.
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Int J Obstet Anesth · Jan 1998
Cough stress rib fractures in two obstetric patients: case report and pathophysiology.
The clinical presentation of fractured ribs and physiology of cough in two obstetric patients are described to explain why a rib fracture, not a pneumothorax, occurred on coughing in these patients. At total lung capacity the outward expansion of the lower thorax (flare) during a cough is limited. ⋯ A direct expiratory action of abdominal muscles predominates over their indirect inspiratory action. The lower ribs are pulled down by the cough and may even fracture from the enormous intrapleural cough pressures which are generated before the glottis opens.