International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2018
Randomized Controlled TrialA randomised comparison of bolus phenylephrine and ephedrine for the management of spinal hypotension in patients with severe preeclampsia and fetal compromise.
Studies in healthy patients undergoing elective caesarean delivery show that, compared with phenylephrine, ephedrine used to treat spinal hypotension is associated with increased fetal acidosis. This has not been investigated prospectively in women with severe preeclampsia. ⋯ In patients with severe preeclampsia and fetal compromise, fetal acid-base status is independent of the use of bolus ephedrine versus phenylephrine to treat spinal hypotension.
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Int J Obstet Anesth · Feb 2018
Case ReportsHereditary haemorrhagic telangiectasia in pregnancy: regional and general anaesthesia.
Hereditary haemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is a rare autosomal dominant multisystem disorder, characterised by mucocutaneous telangiectases and arteriovenous malformations affecting any organ. The physiological changes in pregnancy pose significant obstetric and anaesthetic challenges for women affected by the disease. ⋯ This case report describes the successful management of a patient with this disease and severe pulmonary involvement, who received both regional and general anaesthesia as a result of a complication in the initial anaesthetic plan. The report demonstrates the benefits of a multidisciplinary approach to a complex case, achieved through providing care in a tertiary centre with appropriate expertise and resources.
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Int J Obstet Anesth · Feb 2018
Thrombosis after aortic balloon occlusion during cesarean delivery for abnormally invasive placenta.
Abnormally invasive placenta is a major cause of postpartum hemorrhage and cesarean hysterectomy. An increasing number of obstetricians worldwide employ prophylactic aortic balloon occlusion to manage bleeding during cesarean delivery in these patients. However, the safety of this procedure in pregnant women has not been confirmed. ⋯ Aortic balloon occlusion for the management of bleeding in women with an abnormally invasive placenta may not uncommonly result in thrombosis. Therefore, the risks and benefits of the procedure must be carefully weighed before it is utilized in these patients.