International journal of obstetric anesthesia
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Int J Obstet Anesth · Jul 1998
Randomized Controlled Trial Clinical TrialThe effect of early epidural block administration on the progression and outcome of labor.
This study was undertaken to prospectively evaluate the effect of early administration of epidural bupivacaine (0.25%) on the progression and outcome of labor in 60 nulliparous patients. Patients were randomly divided into two groups. ⋯ There were no statistically significant differences between the two groups in rate of cervical dilatation, duration of the second stage, numbers of instrumental deliveries or cesarean sections or Apgar scores at 1 and 5 min. We conclude that there is no need to restrict epidural top-ups until cervical dilatation of 4 cm, when active management of labor is advocated.
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Int J Obstet Anesth · Jul 1998
General anesthesia for cesarean section at a tertiary care hospital 1990-1995: indications and implications.
Complications of general anesthesia for cesarean section remain the leading cause of anesthesia-related maternal mortality. General anesthesia, however, is becoming less popular for obstetric anesthesia, and thus fewer cesarean sections are conducted using this technique. As the number of general anesthesia cases decrease, the number of difficult intubations witnessed and managed by residents decreases. ⋯ Although the incidence of difficult intubations in those years ranged from 16.3% to 1.3%, only one failed intubation with resultant maternal mortality occurred. Few residency programs offer instruction on the difficult airway in the parturient population. Organized airway management programs specifically for the obstetric population may assist efforts to decrease the morbidity and mortality associated with the provision of general anesthesia for cesarean section.
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Int J Obstet Anesth · Jul 1998
Management of a parturient with an uncorrected atrioventricular canal defect.
A 24-year-old woman at 37 weeks gestation, with an uncorrected atrioventricular canal defect and incipient congestive heart failure is presented. This rare defect is part of the larger group of endocardial cushion defects. ⋯ Her pregnancy was maintained until she developed symptoms of congestive heart failure. We discuss her peripartum management, monitoring and anesthetic choices.
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Int J Obstet Anesth · Jul 1998
Severe mitral stenosis in a parturient with congestive cardiac failure and hypoglycaemia.
We report a case of maternal mortality in a 34-year-old multipara who presented at the 35th week of gestation with severe hypoglycaemia. She had no history of diabetes mellitus. This episode was a prelude to catastrophic and refractory congestive cardiac failure due to previously undiagnosed severe mitral stenosis. ⋯ She also developed deranged liver function with disseminated intravascular coagulation, which mimicked acute fatty liver of pregnancy. The problems of diagnosis and management are discussed. Unfortunately the patient died before mitral valvular commissurotomy could be effected.