International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2016
Review Case ReportsHeparin-induced thrombocytopenia in pregnancy: an interdisciplinary challenge-a case report and literature review.
Heparin-induced thrombocytopenia is a serious adverse event of anticoagulation with a high risk of thromboembolic complications. As a consequence, anticoagulants other than heparins must be administered. ⋯ Impaired coagulation bears the risk of adverse events following neuraxial procedures and of peripartum hemorrhage. We describe the case of heparin-induced thrombocytopenia in a 29-year-old pregnant woman at 27weeks of gestation with severe valvular heart disease.
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Int J Obstet Anesth · May 2016
ReviewThe 2016 Hughes Lecture: What's new in maternal morbidity and mortality?
Each year, the Board of Directors of the Society for Obstetric Anesthesia and Perinatology selects an individual to review a given year's published obstetric anesthesiology literature. This individual then produces a syllabus of the year's most influential publications, delivers the Ostheimer Lecture at the Society's annual meeting, the Hughes Lecture at the following year's Sol Shnider meeting, and writes corresponding review articles. ⋯ This is followed by a discussion of specific coexisting diseases and specific causes of severe maternal mortality. The review ends with a discussion of worldwide maternal mortality and the 2014 publications that examined the successes and the shortfalls in the work to make childbirth safe for women throughout the entire world.
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Int J Obstet Anesth · May 2016
Comparative StudyDifferences in lumbar dural sac dimension in supine and lateral positions in late pregnancy: a magnetic resonance imaging study.
This study was designed to quantitatively investigate differences in lumbar dural sac dimensions between the lateral and supine positions in late pregnancy. ⋯ The axial section area and the transversal maximum diameter of the dural sac in the lumbar area are reduced in the supine compared with the lateral position in late pregnancy.
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Int J Obstet Anesth · May 2016
Case ReportsRefractory status epilepticus after inadvertent intrathecal injection of tranexamic acid treated by magnesium sulfate.
We present a case of accidental injection of tranexamic acid during spinal anesthesia for an elective cesarean delivery. Immediately following intrathecal injection of 2mL of solution, the patient complained of severe back pain, followed by muscle spasm and tetany. As there was no evidence of spinal block, the medications given were checked and a 'used' ampoule of tranexamic acid was found on the spinal tray. ⋯ Unfortunately, on postoperative day three the patient died from cardiopulmonary arrest after an oxygen supply failure that was not associated with the initial event. This report underlines the importance of double-checking medications before injection in order to avoid a drug error. As well, it suggests that magnesium sulfate may be useful in stopping seizures caused by the intrathecal injection of tranexamic acid.
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Int J Obstet Anesth · May 2016
Case ReportsEarly postpartum mitral valve thrombosis requiring extra corporeal membrane oxygenation before successful valve replacement.
Pregnancy is associated with an increased risk of thrombosis in women with mechanical prosthetic heart valves. We present the case of a 29-year-old woman who developed early postpartum mitral valve thrombus after an elective cesarean delivery. The patient had a mechanical mitral valve and was treated with warfarin in the second trimester, which was replaced with high-dose dalteparin during late pregnancy. ⋯ Transesophageal echocardiography revealed a mitral valve thrombus. The patient underwent a successful mitral valve replacement after three days on extra corporeal membrane oxygenation. This case highlights the importance of multidisciplinary care and frequent monitoring of anticoagulation during care of pregnant women with prosthetic heart valves.