International journal of obstetric anesthesia
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Int J Obstet Anesth · Aug 2022
ReviewDiagnostic terminology in Placenta Accreta Spectrum: a scoping review.
Anaesthetic management strategies for Placenta Accreta Spectrum (PAS) remain diverse, and literature interpretation is complicated by a range of terminology. The International Federation for Gynaecology and Obstetrics (FIGO) published guidance in 2018 to improve PAS diagnosis and management by standardising definitions. We mapped the range, clarity and consistency of terminology in literature pertaining to both PAS and anaesthesia, and determined whether this changed followed FIGO guidance. ⋯ Despite international consensus criteria for reporting PAS, the language pertaining to PAS and anaesthesia remains heterogeneous, inconsistent and variably defined. Reporting of PAS should adhere to FIGO criteria to allow unambiguous interpretation of work, and generation of evidence that is transferrable into clinical practice.
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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
Randomized Controlled TrialThe incidence of breakthrough pain associated with programmed intermittent bolus volumes for labor epidural analgesia: a randomized controlled trial.
In this randomized, blinded study, we evaluated the effects of different programmed intermittent epidural bolus (PIEB) volumes for labor analgesia on the incidence of breakthrough pain and other analgesic outcomes. ⋯ The larger PIEB volumes were preferred for epidural labor analgesia compared with a smaller volume because of improved analgesia without clinically significant increases in adverse effects.
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Int J Obstet Anesth · Aug 2022
Multicenter StudyQuantitative blood loss after vaginal delivery: a retrospective analysis of 104 079 measurements at 41 institutions.
Peripartum quantitative blood loss (QBL) measurement is recommended over visual estimation. However, QBL measurement after vaginal delivery has been inadequately evaluated. The primary aim of this study was to determine the characteristics of QBL measurements from a large, multicenter cohort of patients having vaginal deliveries. We also determined the incidence of postpartum hemorrhage (PPH) and the relationship between gravimetric QBL from weighed sponges vs. volumetric QBL from liquid drape or suction cannister contents. ⋯ Results from this large set of QBL measurements and the PPH incidence provide normative "real-world" clinical care values that can be expected as hospitals transition from estimated blood loss to QBL to assess the blood loss at vaginal delivery.
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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.