International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2022
ReviewWhat is new in Obstetric Anesthesia in 2020: a focus on research priorities for maternal morbidity, mortality, and postpartum health.
Advances in obstetric anesthesiology have historically exemplified how scientific progress can have a transformational impact on patient safety practices. Profound reductions in anesthesia-related maternal mortality in the 20th century highlighted the specialty of anesthesiology as a leader in safety and care quality. ⋯ Obstetric anesthesiologists have unique perspectives on systems of care, education and training, and device innovation. An interdisciplinary team approach to research and innovation, as well as systems based and health policy work, presents an opportunity for anesthesiologists to contribute to solutions that reduce maternal morbidity and mortality and improve postpartum health for all people.
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Int J Obstet Anesth · Aug 2022
Obstetric comorbidity index and the odds of general vs. neuraxial anesthesia in women undergoing cesarean delivery: a retrospective cohort study.
Maternal and fetal concerns have prompted a significant reduction in general anesthesia (GA) use for cesarean delivery (CD). The obstetric comorbidity index (OB-CMI) is a validated, dynamic composite score of comorbidities encountered in an obstetric patient. We sought to estimate the association between OB-CMI and odds of GA vs. neuraxial anesthesia (NA) use for CD. ⋯ The OB-CMI is associated with increased odds of GA vs. NA use for CD, particularly when emergent. Collected in real time, the OB-CMI may enable prophylaxis (e.g. comorbidity modification, earlier epidural catheter placement, elective CD) or preparation for GA use.
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Int J Obstet Anesth · Aug 2022
Case ReportsA description of the coagulopathy characteristics in amniotic fluid embolism: a case report.
Amniotic fluid embolism is frequently associated with coagulopathy. However, the exact nature and evolution of the bleeding disorder is incompletely understood. ⋯ We measured sequential levels of all individual clotting factors, thrombin generation, fibrinogen, and D-dimer levels over the course of the event, beginning shortly after the patient's initial collapse and during the subsequent resuscitation, to identify the specific abnormalities of coagulation from stored blood samples. A better understanding of amniotic fluid embolism and the associated coagulopathy is an important area of research to inform targeted treatment of the coagulopathy and improve outcomes for patients.