International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2011
Case ReportsProphylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series.
Endovascular occlusion balloon catheters can be placed preoperatively in internal iliac vessels of patients perceived to be at risk of major obstetric haemorrhage during caesarean section. Their safety and efficacy remains undefined, and we report our experience of 14 patients over four years. ⋯ Internal iliac balloon catheters can be inserted electively or in an emergency in patients at risk of major obstetric haemorrhage. Although useful in some, they are not universally effective; patients are still at risk of significant blood loss and at high risk of requiring a hysterectomy. In our experience, catheters can be placed electively or in an emergency but have been associated with adverse outcomes. These lessons have been important learning points in perioperative management.
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Int J Obstet Anesth · Jan 2011
Letter Case ReportsDangers of rapid oxytocin administration in Eisenmenger's Syndrome.
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When investigating different methods of maternal pain relief in labour, neonatal outcome has not always been at the forefront, or else maternal changes, such as haemodynamics, fever, length of labour, need for oxytocin or type of delivery, are taken as surrogates for neonatal outcome. It is essential to examine the actual baby and to appreciate that labour pain itself has adverse consequences for the baby. For systemic analgesia, pethidine has been most extensively studied and compared with neuraxial analgesia. ⋯ The effect on breast feeding has yet to be established, though it is certainly no worse than that of systemic opioid analgesia. Variations in neuraxial technique have little impact on the newborn. Widespread ignorance of the benefit to the newborn of neuraxial labour analgesia in the UK among non-anaesthetists needs to be combated.
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Int J Obstet Anesth · Jan 2011
Case ReportsMultiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta.
The incidence of placenta praevia/accreta is increasing, placing women at significant risk of postpartum haemorrhage with associated morbidity and mortality. National guidelines recommend prophylactic placement of internal iliac artery balloon occlusion catheters for women with abnormal placentation. ⋯ She developed bilateral pseudoaneurysms, unilateral arterial rupture and compromised vascular supply to her right leg secondary to thrombus formation, and suffered massive haemorrhage, both despite and as a result of intervention. This is the first case report of multiple complications in an obstetric patient after temporary internal iliac balloon occlusion in an elective setting.
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Int J Obstet Anesth · Jan 2011
ReviewImaging evaluation of the pregnant patient with suspected pulmonary embolism.
Pulmonary embolism is the leading cause of maternal death in the developed world. The clinical diagnosis of pulmonary embolism is particularly challenging in pregnant patients as physiologic changes of pregnancy can mimic symptoms of pulmonary embolism or deep venous thrombosis. Clinical decision and imaging algorithms for venous thromboembolic disease have been proposed in the literature for the general population, but have not undergone wide-scale validation in pregnant patients. ⋯ Additional factors beyond test performance must be weighed during pregnancy: radiation exposure to the fetus and maternal breast tissue, the safety of intravenous contrast administration and the diagnostic accuracy of the various testing options so that diagnosis and proper management are not delayed. The epidemiology of pregnancy-related venous thromboembolic disease and the different diagnostic methods are reviewed, with emphasis on the pregnant patient. Finally, a diagnostic imaging algorithm is proposed for the evaluation of the pregnant patient when a clinical suspicion of pulmonary embolism exists.