International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2014
An audit of the efficacy of a structured handover tool in obstetric anaesthesia.
The SAFE handover tool was developed to reduce critical omissions during handovers in obstetric anaesthesia. It comprises a simple proforma onto which the outgoing team documents patients who fall into one of four anaesthetically relevant categories: Sick patients; At-risk patients (of emergency caesarean section, major haemorrhage or anaesthetic problems); Follow-ups; and Epidurals. We hypothesised that its use would reduce the number of critical omissions at handover. ⋯ The SAFE handover tool significantly increased handover rates of anaesthetically relevant parturients. It is easy to remember and consistent with UK National Health Service Litigation Authority's guidance on risk management in maternity units.
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Int J Obstet Anesth · May 2014
Case ReportsConcealed paracetamol overdose treated as HELLP syndrome in the presence of postpartum liver dysfunction.
Paracetamol is the most frequently used analgesic during pregnancy and the most common drug involved in suicidal overdose in the UK. Manifestation of toxicity classically occurs over four phases with clinical and laboratory features resembling HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. We report a case that was erroneously managed as HELLP syndrome before a paracetamol overdose was diagnosed. This case highlights current practice in managing paracetamol overdose and focuses on the importance of addressing mental health issues to mitigate the risk of self-harm in pregnancy.
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Int J Obstet Anesth · May 2014
Observational StudyThe effect of antenatal anaesthetic consultation on maternal decision-making, anxiety level and risk perception in obese pregnant women.
Obese parturients are recognised as high risk and an antenatal anaesthetic consultation is recommended. The potential positive and negative effects of this consultation have not been investigated. This prospective observational study aimed to determine if antenatal anaesthetic consultation affects decisional conflict, anxiety scores or risk perception in obese women planning vaginal delivery. ⋯ Our results support the current practice of referral of obese parturients for anaesthetic consultation, but demonstrate that most women remain unaware of the risks of obesity in pregnancy despite anaesthetic consultation.
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Int J Obstet Anesth · May 2014
Case ReportsSciatic nerve ischaemia after iliac artery occlusion balloon catheter placement for placenta percreta.
Placenta percreta is a complex obstetric condition and a cause of life-threatening peripartum haemorrhage. National guidelines advise preoperative placement of internal iliac artery occlusion balloon catheters in such cases to reduce haemorrhage, avoid caesarean hysterectomy and preserve fertility. ⋯ Presentation of ischaemic nerve injury attributable to iliac artery thrombosis secondary to the presence of an occlusion balloon catheter is as yet unreported. Awareness of this possible complication and local unit guidelines may allow early detection and treatment.
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Int J Obstet Anesth · May 2014
CommentAll patients with a postdural puncture headache should receive an epidural blood patch.
Postdural puncture headache (PDPH) is an important complication of obstetric epidural anaesthesia and analgesia. Though often self-limiting, PDPH is unpleasant, at times incapacitating, and associated with complications, some of which are serious. ⋯ The epidural blood patch (EBP) has been used for PDPH treatment for over 50 years.(1) It is probably the most efficacious of therapies, although this is unproven, and plays an important part in the management of this condition.(2) However, PDPH is often complex, of variable severity and duration, and merits a cautious and individualized approach to its diagnosis and treatment. An EBP may be part of that treatment but administering it to all women with PDPH is not the optimal management approach.