Articles: outcome.
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We review the evidence base for fluid management in pre-eclampsia. Current understanding of the relevant pathophysiology and the possible impact of styles of fluid management on maternal and fetal outcome are presented. There is little evidence upon which to base the management of fluid balance in pre-eclampsia. ⋯ Pulmonary oedema and oliguria receive particular attention. There is no evidence of long-term renal damage in pre-eclampsia, but there are strong suggestions that pulmonary oedema is linked to fluid administration. Monitoring is discussed and some principles of management are suggested
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Int J Obstet Anesth · Oct 1999
Anaesthetic management of parturients with the antiphospholipid syndrome: a review of 27 cases.
A description of antiphospholipid syndrome (APS) and associated maternal and fetal complications is presented along with a review of the management at National Women's Hospital (NWH), Auckland, of 27 pregnancies complicated by APS. Because the obstetric outcome for parturients with APS continues to improve, anaesthetists are more likely to become involved in their management. It is recommended that policies and protocols are implemented to avoid unnecessary denial of regional anaesthesia arising from confusion about any parturients anticoagulation status.
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Objective. To evaluate effectiveness of spinal cord stimulation (SCS) applied to complex regional pain syndrome I (CRPS I). To analyze trends to focus the design of a multicenter prospective study. ⋯ Frequencies > 250Hz were necessary in some patients to maintain or re-establish pain control. Bilateral multielectrode leads appear superior with application of multiple arrays, permitting paresthesia steering without need for surgical revision. A multicenter, prospective design is needed applying dual-lead multichannel systems with high frequency capabilities in the treatment of CRPS I.
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Int J Obstet Anesth · Jul 1999
A patient who was found to be pregnant unexpectedly during hysteromyomectomy.
We present a case of an unexpected pregnancy and an ultimately successful obstetric outcome. The patient underwent abdominal myomectomy under spinal anaesthesia for a uterine leiomyoma with menorrhagia and infertility. ⋯ The blastocyst survived the surgical manipulation and anaesthesia, resulting in a successful pregnancy. The literature on the endocrinological stress response during anaesthesia and surgery suggests that spinal anaesthesia administered in this case was potentially helpful in maintaining progesterone levels and avoiding increased prolactin levels; increased prolactin levels might be deleterious to implantation of the blastocyst.