International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2022
ReviewThe venous system during pregnancy. Part 2: clinical implications of the venous system.
Maternal positioning, medications, and other modulations to the venous system can affect maternal and fetal well-being. The venous system is a dynamic reservoir for blood volume, in which a virtual point of conversion between unstressed volume (Vu) and stressed volume (Vs) exists. The anatomic and physiologic changes associated with hypotension (e.g. supine and neuraxial technique-induced), hypertension (e.g. preeclampsia), and fluid management (e.g. early recovery after cesarean delivery protocols) are opportunities to consider the important role of the venous system in pregnancy.
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Int J Obstet Anesth · May 2022
Observational StudyComparison of haematological indices and transfusion management in severe and massive postpartum haemorrhage: analysis of a two-year national prospective observational study.
This two-year prospective cohort study compared the management of women experiencing severe or massive postpartum haemorrhage (PPH) to explore the impact of targeted blood product administration on reducing PPH progression (from >1500 mL to ≥2500 mL blood loss). During the study, viscoelastic haemostatic assays (VHA) guided blood product transfusion. ⋯ Hypofibrinogenaemia was less frequent in severe PPH, although coagulopathy was observed across a range of PPH aetiologies, highlighting the importance of coagulation testing for all. Cases of abruption in severe and massive PPH had similar rates of hypofibrinogenaemia. Early VHA-guided fibrinogen replacement may reduce PPH progression in abruption and requires further evaluation.
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Int J Obstet Anesth · May 2022
Intrathecal bupivacaine versus chloroprocaine for transvaginal cervical cerclage placement: a retrospective cohort study.
Bupivacaine is commonly used in spinal anesthesia for cervical cerclage placement, but its long duration of action can delay hospital discharge. Chloroprocaine has a short duration of action and has re-emerged as an agent for ambulatory neuraxial anesthesia. There are limited data comparing intrathecal bupivacaine and chloroprocaine when used for cerclage placement. This retrospective study compares the time to hospital discharge between these drugs when used in spinal anesthesia for cervical cerclage placement. ⋯ When utilized in spinal anesthesia for transvaginal cervical cerclage placement, chloroprocaine may reduce the time to discharge while providing comparable anesthesia to that provided by bupivacaine.
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Int J Obstet Anesth · May 2022
Predictors of patient post-discharge opioid use after cesarean delivery: a prospective study.
The opioid crisis is a public health emergency in the United States of America. It is important to understand factors associated with outpatient opioid use. Our primary aim was to assess post-cesarean outpatient opioid use. The secondary aim was to identify characteristics associated with use. ⋯ Opioids were prescribed in excess of consumption and many patients did not use any opioids. Next steps include developing a prescribing algorithm to incorporate factors we found predictive of opioid use.
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Int J Obstet Anesth · May 2022
Observational StudyAccuracy of visual estimation of blood loss in obstetrics using clinical reconstructions: an observational simulation cohort study.
Postpartum hemorrhage is the leading cause of maternal mortality worldwide, and optimal management requires accurate blood loss estimations. The aim of this study was to assess whether differences exist between visually estimated blood loss vs. actual blood loss based on delivery mode, blood volume or distribution/location and knowledge of patient's current cardiovascular status. ⋯ Most providers significantly overestimated blood loss volumes (by nearly 700 mL). Provider and scenario factors that impact inaccuracies in visual estimated blood loss identified in this study can be used to guide education and training.