International journal of obstetric anesthesia
-
Int J Obstet Anesth · Nov 2018
Multicenter StudyRetrospective study to investigate fresh frozen plasma and packed cell ratios when administered for women with postpartum hemorrhage, before and after introduction of a massive transfusion protocol.
Administration of packed red blood cells (PRBC) and fresh frozen plasma (FFP) to women with postpartum hemorrhage (PPH) before and after introduction of a massive transfusion protocol. ⋯ Among women with PPH receiving ≥3 PRBC units within a short period of time, it appears that factors other than the existence of our massive transfusion protocol influence the number and ratio of PRBC and FFP units transfused. Blood products were not transfused according to exact ratios, even when guided by a protocol.
-
Int J Obstet Anesth · Nov 2018
Observational StudyEpidemiology of acute kidney injury and the role of urinary [TIMP-2]·[IGFBP7]: a prospective cohort study in critically ill obstetric patients.
There are few data regarding acute kidney injury in critically-ill obstetric patients. A combination of urinary cell cycle arrest markers, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein7 (IGFBP7), is validated for the early prediction of acute kidney injury in non-obstetric patients. ⋯ Acute kidney injury is common in critically-ill obstetric patients, increasing mortality and duration of hospitalization. It was significantly more common in patients with septic shock. Previously validated results of urinary [TIMP-2]·[IGFBP7] that successfully predict early acute kidney injury or mortality are not applicable to obstetric patients.
-
Int J Obstet Anesth · Nov 2018
Myocardial tissue characterisation and detection of myocardial oedema by cardiovascular magnetic resonance in women with pre-eclampsia: a pilot study.
Pre-eclampsia is characterised by increased left ventricular wall thickness on transthoracic echocardiography (TTE). This is assumed to be myocardial hypertrophy, however TTE cannot determine myocardial structure which may be muscle, oedema or fibrosis. Given the high incidence of peripheral oedema in pre-eclampsia, we hypothesised that increased thickness could represent oedema. Cardiovascular magnetic resonance (CMR) characterises myocardial tissue, differentiating between hypertrophy, oedema and fibrosis. This pilot study was designed to characterise myocardial composition using CMR in pregnant women (healthy or with pre-eclampsia) and to compare cardiac output and left ventricular mass using TTE and CMR. ⋯ Cardiovascular magnetic resonance was used to characterise the myocardial tissue in women with pre-eclampsia. Data suggest that some women with pre-eclampsia have myocardial oedema rather than hypertrophy.
-
Int J Obstet Anesth · Nov 2018
Risk factors for post-dural puncture headache following injury of the dural membrane: a root-cause analysis and nested case-control study.
Post-dural puncture headache following trauma to the dural membrane during neuraxial anaesthesia occurs in 0.13-6.5% of pregnant patients. Identifying factors beyond individual performance that contribute to this adverse event is crucial to developing improvement strategies. ⋯ Post-dural puncture headache in this setting is not the result of the individual anaesthetist's characteristics alone. Additional factors including team composition, the presence of obstetrical perinatal pathology, and associated patient's conditions, are also associated with this event. Improvement strategies should consider all these factors.