International journal of obstetric anesthesia
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Recent advances in the diagnosis, pathogenesis, and understanding of preeclampsia-related morbidity provide opportunities to optimize clinical management of the mother and fetus. These discoveries are timely, as contemporary data suggest that the prevalence of preeclampsia, affecting 7.5% of pregnancies globally and 2-5% in the USA, has increased by up to 30% over the last decade. Managing pregnant patients with preeclampsia can be challenging for all members of the obstetric care team due to the disease's multi-organ system maternal and fetal effects. This review presents recent updates in the definition of preeclampsia, etiology, comorbidities and therapeutic interventions and discusses how they impact the care of these high-risk patients.
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Int J Obstet Anesth · Aug 2015
Randomized Controlled TrialThe effect of co-administration of intravenous calcium chloride and oxytocin on maternal hemodynamics and uterine tone following cesarean delivery: a double-blinded, randomized, placebo-controlled trial.
Oxytocin administration to prevent uterine atony following cesarean delivery is associated with adverse effects including hypotension, tachycardia, and nausea. Calcium chloride increases mean arterial pressure, systemic vascular resistance, and uterine smooth muscle contractility. This study evaluated whether the co-administration of calcium chloride with oxytocin following cesarean delivery could alter maternal hemodynamics. Secondary outcomes included uterine tone and blood loss. ⋯ The decrease in blood pressure associated with oxytocin administration following cesarean delivery was not attenuated with co-administration of calcium chloride at the doses evaluated. Vasopressor use, uterine tone, and blood loss were also unaffected.
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Int J Obstet Anesth · Aug 2015
Blood pressure assessment and first-line pharmacological agents in women with eclampsia.
Eclampsia is a life-threatening complication of pregnancy. Timely blood pressure assessment and administration of magnesium sulphate are essential management. In this retrospective single-centre study we examined the timing and magnitude of maternal blood pressure before eclampsia, and whether magnesium sulphate was administered as the first agent for treatment. ⋯ Our study highlights the need for vigilance when managing pregnant women with hypertension, especially in the third trimester as eclampsia is most likely preceded by raised blood pressure. It also highlights the need for timely commencement of magnesium sulphate in the community and during transfer to hospital for the treatment of eclampsia, and for prevention of eclampsia in hospital when thresholds for severe preeclampsia are met.
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Int J Obstet Anesth · Aug 2015
Letter Case ReportsSpinal subdural haematoma after an epidural blood patch.