International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 2005
Case ReportsSpontaneous acute thoracic epidural hematoma causing paraplegia in a patient with severe preeclampsia in early labor.
This is a case of acute spontaneous thoracic epidural hematoma in a laboring patient at term who presented with severe preeclampsia and acute spinal cord compression, paraplegia, and sensory loss below T8. In early labor, at home, the patient experienced sudden lumbar back pain that progressed to mid-scapular pain leading to paraplegia and T8 sensory loss within one hour of onset of pain. Her symptoms were caused by a spontaneous thoracic epidural hematoma. ⋯ Following cesarean section under general anesthesia, thoracic laminectomy was performed and an epidural hematoma compressing the spinal cord to 2-3 mm was evacuated 13 h after the onset of symptoms. After approximately three months of paraplegia, five months with quad-walker and cane use, the patient can now walk with a cane or other minimal support but has remaining bowel and bladder problems. The conflicting anesthetic management objectives of severe preeclampsia and acute paraplegia secondary to spinal epidural hematoma required compromise in the management of her preeclampsia in order to preserve spinal cord perfusion.
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Int J Obstet Anesth · Jul 2005
Predicting prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine.
Intrathecal opioids for labor analgesia are occasionally associated with fetal heart rate abnormalities. We wanted to identify risk factors for this occurrence. ⋯ This case-control study suggests that if the fetal head is not engaged or if the fetus is experiencing variable decelerations, there is an increased risk of prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine. This finding must now be confirmed in a cohort study.
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Int J Obstet Anesth · Jul 2005
Case ReportsA subdural abscess and infected blood patch complicating regional analgesia for labour.
We report two very unusual cases of infection complicating labour analgesia. The first case was a sub-dural abscess presenting with deep-seated backache seven days after combined spinal-epidural analgesia for labour. The second was a painful lumbar swelling and septicaemia that presented three days after a blood patch for a post dural puncture headache. Because of their complicated and unusual presentation, the diagnosis and management of both were initially delayed.
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Int J Obstet Anesth · Jul 2005
Antenatal anaesthetic assessment of high-risk pregnancy: a survey of UK practice.
Anaesthetists are frequently involved in the management of high-risk pregnancy. Antenatal referral permits time to prepare an appropriate management plan for labour and delivery. This survey looked at current methods of referral in the UK and the role of a formal clinic. ⋯ Most hospitals were satisfied with current arrangements for referral of high-risk pregnancy. A mechanism for anaesthetic referral of high-risk pregnancy is vital, but in many units is not via a formal clinic.