International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2021
ReviewCan measuring blood loss at delivery reduce hemorrhage-related morbidity?
Quantitation of blood loss after vaginal and cesarean delivery has been advocated for the timely detection of postpartum hemorrhage and activation of protocols for resuscitation. Morbidity and mortality from postpartum hemorrhage is considered to be largely preventable and is attributed to delayed recognition with under-resuscitation or inappropriate resuscitation. ⋯ Considerations for the implementation of a quantitative blood loss system on the labor and delivery unit, including its benefits and challenges, will be discussed. The existing evidence for impact of blood loss quantitation in obstetrics on hemorrhage-related morbidity will be delineated, along with knowledge gaps and future research priorities.
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Int J Obstet Anesth · May 2021
ReviewPlacenta accreta spectrum disorder: updates on anesthetic and surgical management strategies.
Placenta accreta spectrum (PAS) is a leading contributor to major obstetric hemorrhage and severe maternal morbidity in the developed world. In the United States, PAS has become the most common cause of peripartum hysterectomy. Over the last 40 years, clinicians have also witnessed a dramatic increase in the incidence of PAS. ⋯ As a consequence, obstetric anesthesiologists are increasingly likely to be called upon to manage women with suspected PAS for delivery. Given the increasing incidence and the morbidity burden associated with PAS, anesthesiologists play a vital role in optimizing maternal outcomes for women with PAS. This review will provide up-to-date information on nomenclature, pathophysiology, risk factors, antenatal detection, systemic preparations (includes timing of delivery, location of surgery, pre-operative evaluation and patient positioning), surgical and anesthetic approach, intra-operative management, invasive radiology and postoperative plans.
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The incidence of maternal hemorrhage and blood transfusion has increased over time. Causes of massive hemorrhage, defined as a transfusion > 10 units of erythrocytes, include abnormal placental insertion, preeclampsia, and placental abruption. ⋯ Autotransfusion, which involves the collection, washing, and filtration of maternal shed blood, avoids many of the complications associated with allogeneic blood transfusion. In this review, we provide an overview of transfusion practices related to the management of obstetric hemorrhage.
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Int J Obstet Anesth · May 2021
Association of uterine activity and maternal volatile anesthetic exposure during open fetal surgery for spina bifida: a retrospective analysis.
Recent warnings postulate a possible damaging effect of volatile anesthetics on the fetus. In our archive of fetal surgeries, we found wide variation in dosing of volatile anesthetics during spina bifida surgeries. We hypothesized that there was an association between volatile anesthetic exposure and uterine activity. ⋯ We found that a lower intra-operative volatile anesthetic exposure than recommended in the MOMS-trial (i.e. <2.0 minimum alveolar concentration [MAC]) was not associated with an increase in intra-operative uterine activity. This is an indication that during spina bifida surgery, 2.0 MAC may not be necessary to avoid potentially harmful uterine activity.
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Int J Obstet Anesth · May 2021
Are we listening? Obstetric anesthesiology and the national call for birth justice and accountability: a perspective from the United States.
Despite declining rates of pregnancy-related deaths worldwide, the United States (US) has seen an increase in maternal mortality. It is widely known that this increased risk of mortality impacts unevenly Black people, who are three-fold more likely to die from pregnancy-related causes than white people. ⋯ On July 25, 2020, activists for reproductive justice and birth justice published an open call in the New York Times entitled "How many Black, Brown, and Indigenous people have to die giving birth? National call for birth justice and accountability." It is a powerful statement that uses an intersectional framework to understand reproductive inequities, while making demands for positive healthcare reforms and radically dreaming of a reality where the struggle for reproductive justice has been actualized. Using personal narrative, this paper reflects on the field of obstetric anesthesiology and how clinicians can make meaningful change to address and eventually help solve this health care inequity.