International journal of obstetric anesthesia
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Int J Obstet Anesth · Nov 2023
ReviewUse of high-flow nasal oxygen for pregnant women with COVID-19 in the labour ward setting.
The presentation and management of SARS-CoV-2 (COVID-19) infection in the obstetric population is affected by the hormonal and mechanical changes of pregnancy. The increased oxygen demands in pregnancy in the face of conventional oxygen therapy, risks of tracheal intubation and discomfort from non-invasive positive pressure ventilation all support the use of high-flow nasal oxygen (HFNO) as an alternative therapy. The lack of published guidance for the use of HFNO has led to the development of local-level guidance based on expert consensus. More evidence exploring the use of HFNO therapy in the pregnant population is required to assist in developing clinical guidelines.
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Int J Obstet Anesth · Nov 2023
Improving blood product management in placenta accreta patients with severe bleeding: institutional experience.
Placenta accrete spectrum (PAS) is a significant risk factor for postpartum hemorrhage and effective blood product management is critical in ensuring patient safety. In PAS patients undergoing cesarean section (CS) blood transfusion management guided by the combined clinical experience of the anesthesiologist and surgeon with point-of-care coagulation testing appears safe and effective. We describe and evaluate our experience and identify potential areas for improvement with blood product management in this patient population. ⋯ Given no significant morbidity or mortality, clinical judgment in experienced centers appears safe for the management of PAS patients undergoing CS. The adoption of an institutional protocol and point-of-care coagulation testing could decrease over-transfusion and associated complications.
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Int J Obstet Anesth · Nov 2023
Inadequate neuraxial anaesthesia during caesarean delivery: a survey of practitioners.
We aimed to determine the knowledge, training, practices and attitudes of obstetric anaesthetic practitioners with regard to failed neuraxial anaesthesia for caesarean delivery. ⋯ Our study survey found that the consent process may not always be adequately comprehensive, and that standardised documentation and testing of the block and focused training may be beneficial to prevent patient dissatisfaction and the chance of litigation.
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Int J Obstet Anesth · Nov 2023
Role of cosyntropin in the management of postpartum post-dural puncture headache: a two-center retrospective cohort study.
Research suggests that postpartum post-dural puncture headache (PDPH) might be prevented or treated by administering intravenous cosyntropin. ⋯ Our data show no benefits from the use of cosyntropin for preventing or treating postpartum PDPH.