International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2012
Case ReportsPeripartum management of two parturients with ornithine transcarbamylase deficiency.
Ornithine transcarbamylase deficiency is a rare X-linked disorder in which female carriers are usually heterozygous for the ornithine transcarbamylase deficiency gene. In pregnancy it has been associated with altered mental status, seizures, coma and death, especially in the postpartum period. ⋯ Neuraxial techniques were used for pain relief in labor and anesthesia for operative delivery. A dextrose infusion provided caloric intake during labor and perioperatively.
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Int J Obstet Anesth · Jan 2012
Effect of μ-opioid receptor A118G polymorphism on the ED50 of epidural sufentanil for labor analgesia.
A common polymorphism of the μ-opioid receptor gene (OPRM1, p.118A/G), which has been shown to effect the response to neuraxial opioids, occurs in 30% of Caucasian women. This double-blind up-down sequential allocation study was designed to examine the effect of p.118A/G on the ED50 of epidural sufentanil for labor analgesia. ⋯ Women carrying the variant allele of p.118A/G of OPRM1 (G118) had a lower ED50 for epidural sufentanil given for early labor analgesia than women homozygous for the wild-type allele.
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Int J Obstet Anesth · Jan 2012
Maternal sepsis during pregnancy or the postpartum period requiring intensive care admission.
Previous studies on severe maternal sepsis during pregnancy or the postpartum period are rare and have focused on septic abortion. Voluntary abortion was legalized in France in 1975. This study was conducted to reassess the characteristics of maternal sepsis that have been managed in a French intensive care unit. ⋯ Over time, our intensive care unit has seen fewer cases of septic abortion. However, maternal sepsis remained a cause of intensive care admission and both maternal and fetal death. The percentages of antepartum and non-bacterial infections have increased over time. A prospective multicentre study is required to confirm these results and to investigate questions such as the effect of maternal sepsis on long-term fetal outcome.
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Int J Obstet Anesth · Jan 2012
Case ReportsTransfusion practice in major obstetric haemorrhage: lessons from trauma.
The management of massive haemorrhage with blood products is changing as evidence arrives from civilian and military trauma. Rapid early replacement of coagulation factors and platelets is now becoming central to improving outcome, usually given in higher ratios with respect to red cell units than previously recommended and using empiric transfusion based on clinical rather than laboratory parameters. The management of three cases of major obstetric haemorrhage based on these principles is presented. ⋯ Each patient had acceptable full blood count and coagulation results after surgery and all made an uneventful recovery. These outcomes support the opinion that major obstetric haemorrhage can be managed in a similar fashion to blood loss in trauma. Recommendations from the Association of Anaesthetists of Great Britain and Ireland, and the UK National Patient Safety Agency should be considered during major obstetric haemorrhage.
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Int J Obstet Anesth · Jan 2012
Assessment of salivary amylase as a stress biomarker in pregnant patients.
Chronic stress during pregnancy has been associated with worsened maternal and fetal outcomes. Acute stress immediately before spinal anaesthesia for caesarean section may contribute to hypotension. Therefore objective measures of acute stress may help identify women at risk of adverse outcomes. Salivary alpha-amylase is a stress biomarker that has so far been poorly investigated during pregnancy. The reference change value is the difference between two sequential results that must be exceeded for a change to be considered clinically relevant. Our first aim was to determine if salivary alpha-amylase increased in pregnant patients when subjected to the stress of transfer to the operating room. Our second aim was to determine if changes in salivary alpha-amylase were likely to be clinically significant by measuring reference change value in healthy volunteers. ⋯ When pregnant women are taken to the operating room, a clinically and statistically significant increase in salivary alpha-amylase was observed. Further studies are required to define its clinical usefulness.