International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 2013
Case ReportsThrombolysis for the management of massive pulmonary embolism in pregnancy.
Massive pulmonary embolism in pregnancy is a major cause of maternal mortality; the management is challenging, and often requires aggressive therapy. Thrombolysis has been used, often with favorable outcome, but has not been previously reported in a patient presenting with an intrauterine death. We present a 29-year-old nulliparous patient who had a massive pulmonary embolus associated with fetal death in the third trimester of pregnancy. Diagnosis of pulmonary embolus was aided by transthoracic echocardiography and the patient was successfully treated with streptokinase.
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Int J Obstet Anesth · Apr 2013
Does body mass index influence the degree of pelvic tilt produced by a Crawford wedge?
A pelvic tilt of 15° is standard practice when positioning a woman for caesarean section, and is commonly produced by tilting the operating table or placing a wedge under the right hip. This study investigated whether body mass index affects the degree of pelvic tilt produced when a wedge is used. ⋯ Variability in pelvic tilt increased with body mass index and was greatest with a booking body mass index >35kg/m(2).
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Int J Obstet Anesth · Apr 2013
Use of thromboelastography to assess the combined role of pregnancy and obesity on coagulation: a prospective study.
Thromboelastography (TEG®) is a point of care monitor of whole blood coagulation and has previously demonstrated hypercoagulability in both pregnant and obese populations. However, the individual and combined contribution of pregnancy and obesity on coagulation status has not been defined. We carried out a study to assess the effect of both pregnancy and body mass index (BMI) on blood coagulation using laboratory tests of coagulation and thromboelastography. ⋯ The combined effect of pregnancy and obesity on coagulation has not previously been investigated. Thromboelastographic comparison of pregnant and non-pregnant females separated into low or high BMI cohorts in the current study suggests that obesity correlates more with a hypercoagulable state than with pregnancy, particularly in pregnant patients at the extremes of low and high body weight.
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Int J Obstet Anesth · Apr 2013
Review Meta AnalysisA meta-analysis of the effect of inspired oxygen concentration on the incidence of surgical site infection following cesarean section.
There has been interest in using high inspired oxygen concentrations to reduce surgical site infections in the obstetric population. Previous meta-analyses looking at the effect of high-concentration oxygen in other surgical populations have reported conflicting results. However, no meta-analysis has been performed on women undergoing cesarean section, who are generally a healthier population and thus may have different outcomes. The aim of this study was to complete a meta-analysis comparing high (>60%) and low (<40%) inspired concentrations of oxygen and determine the risk of surgical site infections in patients undergoing cesarean section. ⋯ There is no evidence to suggest a difference in risk of surgical site infection by administration of high inspired oxygen concentrations among women undergoing cesarean section. Future studies with better adherence to the intervention may affect the results of this analysis.