International journal of obstetric anesthesia
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Int J Obstet Anesth · May 2014
Case ReportsSciatic nerve ischaemia after iliac artery occlusion balloon catheter placement for placenta percreta.
Placenta percreta is a complex obstetric condition and a cause of life-threatening peripartum haemorrhage. National guidelines advise preoperative placement of internal iliac artery occlusion balloon catheters in such cases to reduce haemorrhage, avoid caesarean hysterectomy and preserve fertility. ⋯ Presentation of ischaemic nerve injury attributable to iliac artery thrombosis secondary to the presence of an occlusion balloon catheter is as yet unreported. Awareness of this possible complication and local unit guidelines may allow early detection and treatment.
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Int J Obstet Anesth · May 2014
CommentAll patients with a postdural puncture headache should receive an epidural blood patch.
Postdural puncture headache (PDPH) is an important complication of obstetric epidural anaesthesia and analgesia. Though often self-limiting, PDPH is unpleasant, at times incapacitating, and associated with complications, some of which are serious. ⋯ The epidural blood patch (EBP) has been used for PDPH treatment for over 50 years.(1) It is probably the most efficacious of therapies, although this is unproven, and plays an important part in the management of this condition.(2) However, PDPH is often complex, of variable severity and duration, and merits a cautious and individualized approach to its diagnosis and treatment. An EBP may be part of that treatment but administering it to all women with PDPH is not the optimal management approach.