International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2021
ReviewTranexamic acid and obstetric hemorrhage: give empirically or selectively?
Antifibrinolytic agents such as tranexamic acid (TXA) inhibit the fibrinolytic pathway and protect blood clots from being degraded, thereby promoting hemostasis. They have been used to reduce blood loss in various settings including obstetrics. Based on current evidence, TXA can be considered as a therapeutic adjunct to control postpartum hemorrhage (PPH) after vaginal and cesarean deliveries, with earlier administration preferred. ⋯ As a proposed prophylactic agent to prevent PPH, the level of evidence is currently insufficient to recommend the routine use of TXA to prevent blood loss after vaginal and cesarean deliveries. The results of large new multicenter studies assessing the impact of TXA on maternal blood loss-related outcomes after cesarean delivery are awaited. While most studies to date have focused on empirical and one-size-fit-all dosing of TXA, more selective and individualized treatment protocols (possibly guided by functional coagulation assays) are needed to pave the way for safer and more effective use of this inexpensive and widely used medication.
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Int J Obstet Anesth · Nov 2021
Observational StudyFetal heart rate monitoring during fetoscopic repair of open spinal neural tube defects: a single-centre observational cohort study.
During fetal surgery, the haemodynamic stability of the fetus depends on the haemodynamic stability of the mother. The primary objective of this study was to assess changes in fetal heart rate (FHR) throughout the different stages of surgery. The secondary objective was to assess potential changes in maternal physiological parameters and their association with FHR. ⋯ The FHR remained stable during intra-uterine fetoscopic repair of open spina bifida. Maternal carbon dioxide tension and heart rate may have a mild influence on FHR.
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Int J Obstet Anesth · Nov 2021
Observational StudyProficiency-based progression training: implementing a novel approach to training for epidural analgesia in labour.
Epidural insertion is a challenging anaesthetic procedural skill to learn and may require up to 75 attempts to achieve competency. Proficiency-based progression (PbP) training based on unambiguously defined metrics was associated with a 53% reduction in epidural failure rate. The aim of this observational study was to examine the feasibility of implementation of innovative PbP training for labour epidural insertion performed by novices in a busy tertiary hospital. ⋯ In our experience, PbP training in epidural placement is feasible within existing departmental resources in a busy tertiary teaching hospital setting.
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Int J Obstet Anesth · Nov 2021
Anesthetic management for the peripartum care of women with Fontan physiology.
As outcomes for surgical palliation have improved, women with single ventricle congenital heart disease are surviving into their reproductive years and may become pregnant. The cardiovascular changes of pregnancy may stress the Fontan circulation and pose significant risk to the mother and fetus. ⋯ Epidural anesthesia is safe and effective for both vaginal and cesarean deliveries. Judicious fluid management is critical in minimizing postpartum cardiovascular complications. Many patients do not require a higher level of care, invasive monitoring or central venous access during the peripartum period.