International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2020
ReviewExtracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports.
The use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe cardiopulmonary failure has increased significantly in the past decade. However, the use of ECMO in pregnant and peripartum patients has received scant attention. We performed a systematic review of case reports in the literature, documenting indications and outcomes of ECMO in pregnancy and postpartum patients. ⋯ Hemorrhage was the most common complication of ECMO reported (31.9%). Of 96 documented neonatal outcomes, 80 neonates (83.3%) survived while 88 of 97 (90.7%) mothers survived. Extracorporeal membrane oxygenation appears to be a viable life support modality in pregnant and postpartum women with severe cardiopulmonary failure, but publication bias in our study cohort should be considered.
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Int J Obstet Anesth · Aug 2020
Review Case ReportsPeri-operative management of percutaneous fetoscopic spina-bifida repair: a descriptive review of five cases from the United Kingdom, with focus on anaesthetic implications.
We present a case-based review of the first five percutaneous fetoscopic in-utero spina bifida repair procedures undertaken in the UK. Our focus is on implications of anaesthesia and analgesia for the mother and fetus, provision of uterine relaxation and fetal immobilisation while providing conditions conducive to surgical access. Minimising risks for fetal acidosis, placental and fetal hypoperfusion, maternal and fetal sepsis and maternal fluid overload were the foremost priorities. We discuss optimisation strategies undertaken to ensure fetal and maternal well-being under anaesthesia, shortcomings in the current approach, and possible directions for improvement.
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Int J Obstet Anesth · Aug 2020
Post-traumatic stress disorder and postpartum depression and their reported association with recent labor and delivery: a questionnaire survey cohort.
We aimed to investigate the index traumatic event associated with post-traumatic stress disorder (PTSD) and evaluate the timing of the onset of symptoms in relation to the recent delivery. ⋯ PTSD identified postpartum may not be linked to the recent delivery and often pre-dates it. Future studies should identify the trigger traumatic event responsible for PTSD symptoms, to enable a more accurate picture of the reasons for PTSD and fear of childbirth.
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Int J Obstet Anesth · Aug 2020
A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery.
It is not known if the tremor associated with an epidural top-up dose for intrapartum caesarean delivery is thermoregulatory shivering. A tremor is only shivering if it has the same frequency profile as cold stress-induced shivering. Thermoregulatory shivering is a response to a reduction in actual body temperature, whereas non-thermoregulatory shivering may be triggered by a reduction in sensed body temperature. This mechanistic study aimed to compare: 1. the frequency profiles of epidural top-up tremor and cold stress-induced shivering; and 2. body temperature (actual and sensed) before epidural top-up and at the onset of tremor. ⋯ These results suggest that epidural top-up tremor is a form of non-thermoregulatory shivering triggered by a reduction in sensed body temperature.