International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2021
Observational StudyIncidence, severity, and determinants of uterine contraction pain after vaginal delivery: a prospective observational study.
Postpartum uterine contraction pain has not been studied sufficiently. We aimed to assess the incidence, intensity, and risk factors for postpartum uterine contraction pain. ⋯ Postpartum uterine contraction pain is common and severe in some women. Parity and history of dysmenorrhea are significant risk factors for significant postpartum uterine contraction pain.
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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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Int J Obstet Anesth · May 2021
ReviewWhen does obstetric coagulopathy occur and how do I manage it?
Anticipating obstetric coagulopathy is important when obstetric anaesthetists are involved in the clinical management of women with postpartum haemorrhage. Although the incidence of coagulopathy in women with postpartum haemorrhage is low, significant hypofibrinogenaemia is associated with major haemorrhage-related morbidity and thus early identification and treatment is essential to improve outcomes. Point-of-care viscoelastic haemostatic assays, including thromboelastography and rotational thromboelastometry, provide granular information about alterations in clot formation and hypofibrinogenaemia, allow near-patient interpretation of coagulopathy, and can guide goal-directed treatment. If these assays are not available, anaesthetists should closely monitor the maternal coagulation profile with standard laboratory testing during the active phase of postpartum bleeding in order to rule coagulopathy 'in or out', decide if pro-haemostatic therapies are indicated, and assess the response to haemostatic support.
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Int J Obstet Anesth · May 2021
Multicenter Study Observational StudyMaternal temperature in emergency caesarean section (MATES): an observational multicentre study.
Temperature regulation in women undergoing emergency caesarean section is a complex topic about which there is a paucity of evidence-based recommendations. The adverse effects of inadvertent peri-operative hypothermia are well described. Hyperthermia is also associated with adverse neonatal outcomes, an increased risk of obstetric intervention and increased treatment for suspected sepsis. We conducted a multi-centre observational cohort study to identify the prevalence of hypothermia and hyperthermia during emergency caesarean section. S: Participants undergoing emergency caesarean section were recruited across 14 sites in the UK. The primary end point was maternal temperature in the recovery room. Temperature was measured using a zero heat-flux temperature monitoring device. ⋯ Both hypothermia and hyperthermia are prevalent findings in mothers who undergo emergency caesarean section. Therefore, accurate temperature measurement is essential to ensure that an appropriate intra-operative temperature management strategy is employed.