International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2014
The 2013 Gerard W. Ostheimer Lecture: What's New in Obstetric Anesthesia?
The "What's New in Obstetric Anesthesia?" lecture is delivered annually in honor of the eminent obstetric anesthesiologist Gerard. W. Ostheimer. ⋯ The review is a redacted version of the lecture delivered at the Society for Obstetric Anesthesia and Perinatology's Annual Meeting in April 2013. Special emphasis is placed on non-invasive technologies and biomarkers that have the potential to improve clinical care of the pregnant woman. Furthermore, sufficient attention is focused on medical diseases that have their onset or are worsened during pregnancy.
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Int J Obstet Anesth · Feb 2014
Case ReportsManagement of labour and delivery in a woman with refractory supraventricular tachycardia.
Supraventricular tachycardia is uncommon in pregnancy. It is defined as intermittent pathological and usually narrow complex tachycardia >120 beats/min which originates above the ventricle, excluding atrial fibrillation, flutter and multifocal atrial tachycardia. ⋯ We describe a case of a woman in the third trimester of pregnancy who developed treatment-resistant supraventricular tachycardia and required induction of labour and delivery to stop the arrhythmia. A multidisciplinary team approach with a critical care trained nurse and a midwife, continuous arterial blood pressure monitoring, transthoracic echocardiography, and neuraxial analgesia facilitated safe birth in the delivery suite and termination of the arrhythmia.
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Int J Obstet Anesth · Feb 2014
Case ReportsPeripartum cardiomyopathy: postpartum decompensation and use of non-invasive cardiac output monitoring.
The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported. A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction <20%. ⋯ Fifteen hours post-delivery, the patient developed cardiogenic shock, which resolved after aggressive therapy with inotropes and furosemide. NICOM™ can be used to guide treatment during labor and delivery in patients with critical peripartum cardiomyopathy. We suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients.
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Int J Obstet Anesth · Feb 2014
Case ReportsAnaesthesia for parturients with severe cystic fibrosis: a case series.
Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. ⋯ Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.