International journal of obstetric anesthesia
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Int J Obstet Anesth · Jan 2003
Regional blockade for delivery in women with scoliosis or previous spinal surgery.
We conducted a prospective observational study between 1992 and 2001 identifying obstetric patients with untreated or surgically corrected scoliosis or lumbar-sacral fusion surgery. The regional techniques for labour and delivery that were offered were epidural analgesia, combined spinal epidural anaesthesia (CSE), single shot spinal or continuous spinal anaesthesia (CSA) depending on the degree of scoliosis, previous surgery, cardio-respiratory compromise and planned mode of delivery. Forty women were included in the study, one woman with two separate deliveries, giving 41 cases for analysis. ⋯ From a total of 19 CSA techniques attempted sixteen catheters were successfully inserted and produced good analgesia or anaesthesia for vaginal or operative delivery in 12 women (63%). There was one case of post dural puncture headache following a CSA for labour and delivery. We discuss the choices available for regional anaesthetic techniques in scoliotic women and the relative merits of each.
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Lymphangioleiomyomatosis is a rare, progressive cystic pulmonary disease related to tuberous sclerosis complex, affecting almost exclusively females of childbearing age. Progression of the disease is variable but may lead to terminal respiratory failure. As the disease may be oestrogen-dependent, it can arise de novo in pregnancy or established disease may undergo exacerbation. We report on the successful labour and delivery of such a patient and present the results of an internet survey of 30 pregnancies in 15 patients worldwide with lymphangioleiomyomatosis conducted by our patient before delivery.
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Int J Obstet Anesth · Jan 2003
Preeclampsia complicated by placental abruption, HELLP, coagulopathy and renal failure - further lessons.
We present a case of preeclampsia complicated by HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome and marked coagulopathy. The severity of the coagulopathy and haemolysis made renal failure and pulmonary oedema inevitable. ⋯ These were the delay to appreciate the haemolysis, the severity of the haemolysis and its interaction with the treatment of coagulopathy and the conservative management of pulmonary oedema. At these points there were shortcomings in our management of this complex case that merit further discussion.