International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 2011
Case ReportsAnaesthetic management of caesarean delivery in a parturient with malaria.
Malaria is a life-threatening illness with significant maternal and infant morbidity and mortality worldwide. Due to the rarity of its diagnosis in the UK population, there is little information about the number of pregnant women affected by malaria. ⋯ A brief overview of malaria in pregnancy as relevant to this case and its outcome is presented. The report highlights the need for vigilance of all healthcare providers to allow timely recognition and management of rare but treatable disorders.
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Int J Obstet Anesth · Oct 2011
Case ReportsRole of prophylactic uterine artery balloon catheters in the management of women with suspected placenta accreta.
Placenta praevia and accreta are leading causes of major obstetric haemorrhage and peripartum hysterectomy. Detection is largely based on a high index of clinical suspicion, though the diagnostic accuracy of radiological imaging is improving. Interventional radiological techniques can reduce blood loss and the incidence of hysterectomy. ⋯ In our case series in women with suspected placenta accreta, prophylactic use of uterine artery balloons was associated with a low requirement for blood transfusion but with possible increased risk of fetal compromise. Performing the interventional procedure at a different site from the operative room complicated management.
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Int J Obstet Anesth · Oct 2011
Case ReportsAnaesthetic management of a parturient with Laron syndrome.
We report a case of a parturient with Laron syndrome, a rare form of dwarfism which results from an inability to generate insulin-like growth factor 1. In addition to dwarfism these patients may have craniofacial abnormalities, atlantoaxial instability, spinal stenosis and metabolic, musculoskeletal and genitourinary abnormalities. The patient underwent an urgent caesarean section using combined spinal-epidural anaesthesia. Laron syndrome is reviewed and its anaesthetic implications discussed.
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Int J Obstet Anesth · Oct 2011
Case ReportsUse of a 23-gauge continuous spinal catheter for labor analgesia: a case series.
Seven women received labor analgesia with 0.125% bupivacaine and fentanyl 2 μg/mL delivered through a new generation of over-the-needle 23-gauge spinal catheters. The first patient was managed with intermittent bolus injections but inadequate pain control prompted a conversion to a continuous infusion for subsequent patients. One patient developed a postdural puncture headache following catheterization for 5 h, but there were no headaches in those who had an indwelling catheter for 8h or longer. ⋯ One patient with labor lasting over 17 h developed pain and paresthesia that resolved in 24 h without treatment. Two patients had motor block that necessitated a temporary reduction in rate or discontinuation of the infusion. The continuous spinal catheter appeared to be acceptable to patients but the optimal choice of drugs, concentration, and mode of administration remains to be determined.