International journal of obstetric anesthesia
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A primigravida at 41+ weeks gestation presented with spontaneous rupture of membranes. Labour was induced and later an emergency caesarean section was performed for failure to progress. The patient suffered a per-operative uterine tear and post-partum haemorrhage and required postoperative ventilatory support in the intensive care unit. ⋯ The differential diagnosis, diagnostic difficulties, investigations and clinical management of this case are all discussed. An examination of existing literature highlights some of the focal neurological abnormalities that present with eclampsia and the possible need for more sophisticated neuroradiological investigations in these cases. Finally, it is emphasized that anaesthetists and intensivists need to be aware of atypical and delayed presentations of eclampsia.
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Int J Obstet Anesth · Oct 1999
Anaphylaxis during caesarean section in a patient with undiagnosed placenta accreta: it never rains but it pours!
Published guidelines exist for the management and investigation of suspected anaphylactic reactions associated with anaesthesia. We report a woman who had a life-threatening anaphylactic reaction during caesarean section under spinal anaesthesia, complicated by undiagnosed placenta accreta. We discuss the particular problems of the case and the practical difficulties of testing survivors of anaphylaxis: despite following the recommendations, we have been unable to identify the cause.
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Int J Obstet Anesth · Oct 1999
Benign intracranial hypertension and anaesthesia for caesarean section.
Benign intracranial hypertension (idiopathic hypertension, pseudomotor cerebrii) describes the syndrome of elevated intracranial pressure without clinical, laboratory or radiological evidence of a focal lesion. Unlike conditions where intracranial pressure is raised due to a space-occupying lesion, dural puncture is not contraindicated. In this report we describe the delivery by caesarean section of a parturient with this rare condition using the needle through needle combined spinal-epidural technique.