International journal of obstetric anesthesia
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Mirror syndrome (Ballantyne syndrome, triple edema, maternal hydrops, pseudotoxemia) is a rarely diagnosed condition associated with pregnancy that can be life-threatening for both the mother and fetus. There is limited literature on its pathogenesis and anesthetic management, making prevention and treatment complex. The duration of pregnancy and severity of maternal or fetal presentation often determines outcome. We describe the anesthetic considerations of a morbidly obese parturient with Mirror syndrome.
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Int J Obstet Anesth · Nov 2014
Anesthetic and obstetric outcomes in morbidly obese parturients: a 20-year follow-up retrospective cohort study.
In 1993, Hood and Dewan published the results of a trial comparing obstetric and anesthetic outcomes of 117 morbidly obese parturients with matched controls. The authors demonstrated a higher initial epidural anesthesia failure rate, a higher cesarean delivery rate and an increased risk of obstetric complications. We replicated the previous study to provide updated information on outcomes in the morbidly obese pregnant population. We hypothesized that morbidly obese women would still have higher complication and failure rates compared to matched controls and that general anesthesia would be less commonly used than in the previous study. ⋯ Morbidly obese parturients are still at increased risk for antenatal comorbidities, failed labor analgesia, longer first stage of labor and operative delivery. Replacement labor epidural catheters and general anesthesia for cesarean delivery are less commonly required anesthetic techniques compared to the original study.
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It is unclear whether antenatal fibrinogen concentrations are associated with postpartum haemorrhage. ⋯ Antenatal fibrinogen concentration <3.3g/L may be a risk factor for postpartum haemorrhage among women following vaginal delivery.
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Int J Obstet Anesth · Nov 2014
Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section.
Hypotension is frequently observed after spinal anesthesia for cesarean section and can be detrimental to both mother and baby. We investigated the role of the pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. ⋯ Greater baseline pleth variability index was associated with hypotension after spinal anesthesia for cesarean section, but may not be a clinically useful predictor.
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Int J Obstet Anesth · Nov 2014
Case ReportsExtensive pulmonary embolism after severe postpartum haemorrhage: management with an inferior vena cava filter.
We report the case of a 36-year-old woman with an inferior vena cava thrombosis and extensive pulmonary embolism six days after a severe postpartum haemorrhage. She had undergone caesarean section with bleeding managed by massive transfusion, hysterectomy, and two attempts at uterine artery embolization. ⋯ This was a controversial decision because guidelines from different professional groups offer conflicting recommendations. The therapeutic options for the management of massive postpartum pulmonary embolism when thrombolysis is contraindicated are discussed.