International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2016
Programmed intermittent epidural boluses for maintenance of labor analgesia: an impact study.
The aim of this impact study was to compare the analgesic efficacy and side effect profile of programmed intermittent epidural boluses (PIEB)+patient-controlled epidural analgesia (PCEA) to continuous epidural infusion (CEI)+PCEA for maintenance labor analgesia after the introduction of PIEB at our institution. ⋯ Using PIEB compared to CEI as the background maintenance epidural analgesia method in conjunction with PCEA reduced the number of women requiring clinician rescue boluses while providing comparable labor analgesia. The findings of this clinical care impact study confirm the results of randomized controlled studies and suggest PIEB may be a preferable technique to CEI for the maintenance of labor analgesia.
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A contemporary, robust immunologic explanation for common obstetric conditions remains elusive; why some pregnant women are more susceptible to developing preeclampsia or preterm labor is not completely understood. We explore the immunology behind four important and commonly encountered pregnancy-related conditions: preeclampsia, recurrent miscarriage, preterm labor and gestational diabetes. For each condition, we summarize the current understanding of cytokines implicated in the pathogenesis, discuss the impact of anesthesia and analgesia on selected cytokine profiles, and suggest potential opportunities for clinical and research interventions.
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Int J Obstet Anesth · May 2016
Comparative StudyDifferences in lumbar dural sac dimension in supine and lateral positions in late pregnancy: a magnetic resonance imaging study.
This study was designed to quantitatively investigate differences in lumbar dural sac dimensions between the lateral and supine positions in late pregnancy. ⋯ The axial section area and the transversal maximum diameter of the dural sac in the lumbar area are reduced in the supine compared with the lateral position in late pregnancy.
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Int J Obstet Anesth · May 2016
Review Case ReportsHeparin-induced thrombocytopenia in pregnancy: an interdisciplinary challenge-a case report and literature review.
Heparin-induced thrombocytopenia is a serious adverse event of anticoagulation with a high risk of thromboembolic complications. As a consequence, anticoagulants other than heparins must be administered. ⋯ Impaired coagulation bears the risk of adverse events following neuraxial procedures and of peripartum hemorrhage. We describe the case of heparin-induced thrombocytopenia in a 29-year-old pregnant woman at 27weeks of gestation with severe valvular heart disease.
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Successful pregnancy requires a state of immune homeostasis. Maternal tolerance of the genetically distinct fetoplacental unit is in part mediated by maternal and fetal pro- and anti-inflammatory cytokines; these cytokines have also been implicated in different pregnancy-related pathologic states. ⋯ In part one, we review basic and pregnancy-related elements of the immune system, with an emphasis on the role of cytokines. From this foundation, we offer a perspective of a unique phenomenon witnessed within obstetric anesthesia - maternal temperature elevation associated with labor epidural analgesia.