International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2020
Multicenter StudyA population-based analysis of French transfusion practices for women experiencing severe postpartum hemorrhage.
Transfusion is a major therapy for severe postpartum hemorrhage but there are few population-based descriptions of practice. The objective of this retrospective French population-based study was to describe transfusion practices in women with severe postpartum hemorrhage and the compliance with guidelines. ⋯ One in five women with severe postpartum hemorrhage and a low hemoglobin concentration did not receive blood transfusion, which does not comply with French national recommendations. Over-transfusion occurred in women in whom bleeding had been controlled. The use of tools to help clinicians with transfusion decision-making should be developed.
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Int J Obstet Anesth · May 2020
Multicenter StudyProtocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia.
Accidental awareness during general anaesthesia (AAGA) is a complex and rare outcome to investigate in surgical patient populations, particularly obstetric patients. We report the protocol of the Direct Reporting of Awareness in Maternity patients (DREAMY) study, illustrating how the research was designed to address practical and methodological challenges for investigating AAGA in an obstetric cohort. ⋯ The DREAMY study will provide data on incidence, experience and implications of AAGA for obstetric patients, using a robust methodology that will reliably detect and translate subjective AAGA reports into objective outcomes. In addition, the study is expected to improve vigilance for AAGA in participating hospitals and encourage adoption of recommendations for support of patients experiencing AAGA.
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The Gerard W. Ostheimer Lecture presented at the annual meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) is a one-year summary of the literature published in domains of interest to anesthesiologists who manage and care for obstetric patients. ⋯ Ostheimer Lecture presented at the 2019 SOAP meeting; the relevant literature from 2018 was summarized. The topics included in this review are maternal morbidity, antibiotic prophylaxis, anaphylaxis, the Lancet series on increasing cesarean delivery rates, the Robson Ten-Group Classification System, pelvic floor disorders, timing of delivery in nulliparous women, placenta accreta disorders, anesthesia for cesarean delivery, labor analgesia (including parturients with thrombocytopenia and tattoos, and epidural maintenance with the programmed intermittent epidural bolus technique), ultrasound use in obstetric anesthesia, and drugs in pregnancy.
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Int J Obstet Anesth · May 2020
Antisepsis for neuraxial procedures in Irish obstetric units and its possible impact on patient safety. A survey of national practice and associated complications.
The Association of Anaesthetists' guidelines recommend 0.5% chlorhexidine gluconate for skin antisepsis before obstetric neuraxial procedures. In this national survey, we identified the practice of all 19 obstetric units in Ireland. A secondary aim was to investigate complications in units not following guidelines. ⋯ Twenty-one percent of obstetric anaesthesia units in Ireland, catering for one-third of the total deliveries, use the ChloraPrep™ swab-stick and consider it the safest form of application. Chlorhexidine gluconate has been implicated in devastating neurological injury, however there is no evidence that a less concentrated solution such as 0.5% is safer. We suggest a meticulous application technique should be considered more important for patient safety than the concentration of solution.
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Int J Obstet Anesth · May 2020
Inadvertent neuraxial block placement at or above the L1-L2 interspace in the super-obese parturient: a retrospective study.
Increasing body mass index (BMI) increases the difficulty of neuraxial procedures. We hypothesized that it may put patients at risk for inappropriately high dural puncture. The accuracy of anesthesiologists' estimates of the interspinous level in super-obese parturients has not been studied. We evaluated the frequency of inadvertently high epidural and/or intrathecal catheter placement (at or above the L1/L2 interspace) in parturients of BMI ≥50 kg/m2. ⋯ A high rate of inadvertently high epidural or intrathecal catheter placement occurs in super-obese parturients. Ultrasound did not prevent this.