International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2014
Letter Observational StudyQT interval prolongation following carbetocin in prevention of post-cesarean delivery hemorrhage.
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Int J Obstet Anesth · Feb 2014
Observational StudyMajor obstetric haemorrhage: monitoring with thromboelastography, laboratory analyses or both?
Haemorrhage is a common cause of morbidity and mortality in the obstetric population. The aim of this study was to compare the use of thromboelastography and laboratory analyses to evaluate haemostasis during major obstetric haemorrhage. A secondary aim was to evaluate correlations between the results of thromboelastography, laboratory analyses and estimated blood loss. ⋯ Impaired haemostasis, demonstrated by thromboelastography and laboratory analyses, was found after an estimated blood loss of 2000 mL. Thromboelastography provides faster results than standard laboratory testing which is advantageous in the setting of on-going obstetric haemorrhage. However, laboratory analyses found greater differences in coagulation variables, which correlated better with estimated blood loss.
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Int J Obstet Anesth · Feb 2014
Impact of a third stage of labor oxytocin protocol on cesarean delivery outcomes.
There are currently no standard recommendations regarding the dose, rate, or duration of intravenous oxytocin administration for the active management of the third stage of labor in the USA. In 2008, we initiated a standardized postpartum oxytocin protocol for active management of the third stage of labor. In cesarean deliveries, upon clamping of the umbilical cord, an oxytocin infusion of 18 U/h was started and adjusted upward if there was ongoing uterine atony. The aim of this study was to compare intraoperative data on oxytocin dose, estimated blood loss, supplemental uterotonic use and vasopressor use before and after the implementation of this protocol. We hypothesized that implementation of the protocol would result in lower intraoperative oxytocin doses without increasing estimated blood loss. ⋯ We found that the use of an oxytocin management protocol reduced the amount of intraoperative oxytocin administered without increasing the rate of postpartum hemorrhage or the need for additional uterotonics. Clinicians may consider using a rate of 18 U/h as a starting point for administration of oxytocin to achieve adequate uterine tone in healthy parturients for prevention of postpartum hemorrhage.
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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.