Antenatal anaesthetic assessment of high risk obstetric patients
Publication date: Available online 14 June 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Nosakhare A. Uwubamwen, Dipali VermaAbstractEarly identification and anaesthetic assessment of high-risk patients in pregnancy is important and best delivered through a formal assessment clinic. It provides the opportunity to provide information, agree management plans, and carry out necessary investigations and referrals to other specialists prior to labour and delivery. Clear referral criteria and lines of communication are necessary for an effective service.
Recently the US Food and Drug Administration called for cautious use of anesthetic drugs during pregnancy. In 0.2-2% of pregnancies non-obstetric surgery is being performed. The consequences of anesthesia during pregnancy on fetal development remain unclear and preclinical studies in relevant animal models may help elucidate that.
Subglottic stenosis is characterised by narrowing of the lower larynx and upper trachea. Conventional intubation can be impossible, whilst in the parturient the anatomical and physiological changes of pregnancy further complicate management.
Worldwide, infection is one of the leading causes of both maternal and neonatal mortality.1 Antibiotics have made maternal sepsis-related mortality a rare event and the frequency of maternal-fetal infections has fallen substantially.2 Overall, 15% of pregnant women receive antibiotics during pregnancy3 and 55% receive them at delivery.4 β-lactams are among the most useful antibiotics because of their efficacy, tolerability and safety during pregnancy. Streptococcus agalactiae is responsible for more than half the maternal-fetal infections,5 and almost all isolates are highly susceptible to penicillins.
Conclusions Maternal and newborn outcomes should be jointly reported because hospital rates of maternal morbidity and newborn morbidity are poorly correlated. This can be done using a childbirth composite measure alongside separate measures of maternal and newborn outcomes.
Authors: Eslick R, McLintock C Abstract Around 1 in 10 pregnant women will develop thrombocytopenia during an otherwise unremarkable pregnancy. While the most frequent cause is gestational thrombocytopenia, a benign clinical entity which typically induces a mild platelet fall in late pregnancy, a number of important pregnancy-specific causes must be excluded, particularly pre-eclampsia and its severe form hemolysis with elevated liver enzymes and low platelets (HELLP). For women who do not have an identifiable pregnancy-related cause of thrombocytopenia, an underlying medical condition should be considered. The mos...
ConclusionManagement of SE in pregnancy is influenced by etiology of SE and duration of pregnancy. It carries a good prognosis if detected early and treated appropriately. Large-scale multicentric studies are warranted for formulating definite guidelines for management of SE in pregnancy.This article is part of the Special Issue “Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures”.
CONCLUSION: Management of SE in pregnancy is influenced by etiology of SE and duration of pregnancy. It carries a good prognosis if detected early and treated appropriately. Large-scale multicentric studies are warranted for formulating definite guidelines for management of SE in pregnancy. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures". PMID: 31303443 [PubMed - as supplied by publisher]
Discussion: Target-controlled infusion of remifentanil is an effective drug to reduce pain during CVC insertion in association with lidocaine-based local anesthesia, in conscious patients.
BACKGROUND Intrathecal morphine (ITM) is a widely used technique for postcaesarean section analgesia but entails a high risk of postoperative nausea and vomiting (PONV). The transversus abdominis plane (TAP) block is an alternative. OBJECTIVE We tested the hypothesis that a TAP block including clonidine reduces the incidence of PONV after caesarean section when compared with ITM. DESIGN A randomised, controlled, double-blinded study. SETTING Geneva University Hospitals, Switzerland, from October 2013 to February 2017. PATIENTS A total of 182 patients undergoing elective caesarean section were studied. Reasons...
The objective of this study was to evaluate the course of pregnancy and delivery of obstetric patients admitted for intensive care, and determine the health status of their infants.