Editorial Board
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - July 10, 2020 Category: Anesthesiology Source Type: research

Association of renin-angiotensin-aldosterone system genetic polymorphisms with maternal hypotension during spinal anaesthesia for caesarean delivery – a retrospective cohort study
Hypotension during spinal anaesthesia for caesarean delivery is a common problem, occurring in 70-80%1 of normotensive parturients. The clinical effects of severe intra-operative hypotension are not benign and range from maternal nausea, vomiting and headache to fetal acidosis, neurological injury and weak sucking reflexes.2,3 Spinal anaesthesia-induced hypotension results from blockade of thoracolumbar sympathetic outflow and decrease in systemic vascular resistance, with hypotension exacerbated by impaired venous return to the heart due to vena caval compression and venous pooling in the lower limbs. (Source: Internation...
Source: International Journal of Obstetric Anesthesia - June 27, 2020 Category: Anesthesiology Authors: H.S. Tan, Y.T. Gan, E.C. Tan, S. Nagarajan, R. Sultana, N-L R. Han, A.T.H. Sia, B.L. Sng Tags: Original Article Source Type: research

Reversal of motor block due to epidural analgesia for the second stage of labor
Neuraxial analgesia offers a safe and effective method for pain relief during childbirth. There is an increasing demand for epidural analgesia for labor with an incidence of 60% in the general population, to almost 100% within our unit. One specific concern is whether the timing of administering epidural analgesia could prolong labor.1 Despite the existing controversy over what exactly is defined as a prolonged second stage of labor, an increased duration due to the effect of neuraxial anesthesia might be of clinical significance as a prolonged second stage is associated with adverse outcomes including chorio-amnionitis, p...
Source: International Journal of Obstetric Anesthesia - June 26, 2020 Category: Anesthesiology Authors: J.P. Kennedy, F Hasham Tags: Correspondence Source Type: research

Spiral electrode for continuous fetal heart rate monitoring during in-utero myelomeningocele repair
Fetal surgery offers early intervention of various congenital disorders, resulting in improved functional outcomes. However, these procedures confer a risk of adverse fetal cardiovascular events.1,2 Close fetal monitoring is recommended,1,2 but consistent and continuous fetal monitoring is challenging. Fetal echocardiography is the gold standard in fetal monitoring, but it is often interrupted because of the crowded and dynamic surgical field, particularly when uterine manipulation, fetal positioning, and amniotic fluid replacement are required. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 26, 2020 Category: Anesthesiology Authors: L.G. Segura, K.W. Arendt, H.P. Sviggum, C.R. Haider, M.Y. Qureshi, T.N. Weingarten, J.N. Johnson, R Ruano Tags: Case report Source Type: research

Determining neuraxial block onset in a patient with complete T6 paraplegia
We report a case of combined spinal-epidural (CSE) anesthesia for cesarean delivery in a patient with complete T6 paraplegia, in which skin temperature probe monitoring was used to document the onset of neuraxial blockade. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 24, 2020 Category: Anesthesiology Authors: H. Nguyen, M. Kushelev, P.E. Khoury, J.C. Coffman Tags: Correspondence Source Type: research

Anesthetic management of women with heart failure during pregnancy - a retrospective cohort study
During pregnancy, there is an increase in plasma volume, heart rate and cardiac output,1-5 which may precipitate heart failure in women with underlying cardiac disease. Furthermore, during labor and delivery, additional hemodynamic stresses including tachycardia, increased blood pressure and auto-transfusion occur. Administration of oxytocin and intravenous fluids, physiological effects of an active second stage of labor, and the consequences of regional and general anesthetic techniques on the autonomic nervous system and myocardium further contribute to cardiac decompensation. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - June 23, 2020 Category: Anesthesiology Authors: G. Jayasooriya, C. Silversides, G. Raghavan, M. Balki Tags: Original Article Source Type: research

Massive uvular edema in a parturient after general anesthesia
Uvular edema is a rare complication that has only been reported after general anesthesia in non-obstetric patients. 1 –3 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 30, 2020 Category: Anesthesiology Authors: R. Sharma, N. Charlesworth, S. Prestwich Tags: Correspondence Source Type: research

Inhalational induction of general anaesthesia for elective caesarean: ethical acceptability in treatment-resistant needle-phobia?
The patient was a gravida 2, para 1 woman, scheduled for an elective caesarean section (CS), who declined any regional technique or intravenous (IV) access because of the severe needle phobia which she had had since childhood. She stated explicitly that she was traumatised by needles used during medical procedures and, while awake, she would not accept any medical procedures involving needles. She had undergone a previous emergency CS for fetal distress, for which she had been given a general anaesthetic with an inhalational induction. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 29, 2020 Category: Anesthesiology Authors: N. Parrott, P. Prabhu, C. Yeow Tags: Case report Source Type: research

Re: Association between opioid use after intrapartum cesarean delivery and repeat cesarean delivery: a retrospective cohort study
We read with interest the article by Shatil et al. recently published in the journal.1 The authors conducted a retrospective cohort study to compare the postoperative opioid requirements in patients after their first intrapartum cesarean delivery with those who were having a secondary (or greater) cesarean delivery following a trial of labor after cesarean (TOLAC). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 29, 2020 Category: Anesthesiology Authors: R. Komatsu, B. Carvalho, P.D. Flood Tags: Correspondence Source Type: research

Thrombocytopenia in pregnant patients with mild COVID-19
Since its emergence in December 2019, the outbreak of novel coronavirus disease 2019 (COVID-19) has infected over 2 626 321 people globally.1 COVID-19 is associated with wide variability in disease severity, ranging from asymptomatic to severe critical presentations. In initial data from China, mild thrombocytopenia was found to occur in just over a third of non-pregnant patients admitted to hospital with COVID-19. A more recent meta-analysis found that thrombocytopenia is associated with a three-fold greater risk of severe COVID-19. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 29, 2020 Category: Anesthesiology Authors: A. Le Gouez, A.J. Vivanti, D. Benhamou, C. Desconclois, F.J. Mercier Tags: Correspondence Source Type: research

Management of pregnancy complicated by central core disease
Central core disease (CCD) is one of the congenital myopathies and common clinical symptoms include muscle atrophy, lower limb skeletal weakness, floppy infant syndrome, and skeletal deformities such as hip displacement and scoliosis.1,2 It is a rare disorder that exhibits autosomal dominant and recessive mode of inheritance, caused by the mutation of the ryanodine receptor (RYR1) gene.1 The RYR1 gene mutation is also responsible for malignant hyperthermia induced by general anesthesia.3,4 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 28, 2020 Category: Anesthesiology Authors: A. Niki, D. Ochiai, M. Iwai, Y. Sato, K. Yoshino, T. Yamada Tags: Correspondence Source Type: research

Gastric point-of-care ultrasound (PoCUS) during pregnancy and the postpartum period: a systematic review
Gastric point-of-care ultrasound (PoCUS) is emerging as a useful tool in the anaesthetist ’s arsenal as a means of evaluating the patient’s stomach contents before surgery. It enables assessment of the risk of pulmonary aspiration which is a serious complication of general anaesthesia and which has an incidence of 1:4000 in all elective surgeries.1 Pulmonary aspiration occurs more co mmonly in obstetric surgery, where the incidence may rise to 1:700 general anaesthetics.2 A UK Obstetric Surveillance System (UKOSS) study also identified an incidence of 8% following failed intubation in obstetric surgery compared...
Source: International Journal of Obstetric Anesthesia - May 28, 2020 Category: Anesthesiology Authors: R. Howle, P. Sultan, R. Shah, P. Sceales, P. Van de Putte, S. Bampoe Tags: Review article Source Type: research

Enhanced Recovery After Cesarean (ERAC) – beyond the pain scores
Enhanced recovery protocols aim to optimize patient outcomes by modifying the inflammatory and metabolic changes associated with surgery. Multimodal evidence-based interventions that may reduce the surgical stress response have been organized into a specific care pathway which can shorten the recovery period and reduce peri-operative complications.1 More than 20  years ago, Henrik Kehlet, a pioneer in peri-operative pathophysiology and rehabilitation, initiated the first enhanced recovery protocol for colorectal surgery. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 24, 2020 Category: Anesthesiology Authors: L. Bollag, G. Nelson Tags: Editorial Source Type: research

Enhanced recovery after cesarean (ERAC) - beyond the pain scores
Enhanced recovery protocols aim to optimize patient outcomes by modifying the inflammatory and metabolic changes associated with surgery. Multimodal evidence-based interventions that may reduce the surgical stress response have been organized into a specific care pathway which can shorten the recovery period and reduce peri-operative complications.1 More than 20 years ago, Henrik Kehlet, a pioneer in peri-operative pathophysiology and rehabilitation, initiated the first enhanced recovery protocol for colorectal surgery. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 24, 2020 Category: Anesthesiology Authors: L. Bollag, G. Nelson Tags: Editorial Source Type: research

Hand placement during chest compressions in parturients: a pilot study to identify the location of the left ventricle using transthoracic echocardiography
Cardiac arrest during pregnancy is a rare event. Recent reports estimate its incidence to be between 1:12 000 and 1:36 000.1,2 Maternal survival after cardiac arrest can be higher than 50% if there are timely and structured resuscitative efforts.2 Effective chest compression is one of the few interventions that improves the outcome of cardiopulmonary resuscitation (CPR).3 Current American Heart Association (AHA) guidelines recommend that the hands be placed on the lower half of the sternum for compressions during pregnancy, with manual uterine displacement to alleviate vena cava compression. (Source: International Journal ...
Source: International Journal of Obstetric Anesthesia - May 21, 2020 Category: Anesthesiology Authors: C. Delgado, K. Dawson, B. Schwaegler, R. Zachariah, S. Einav, L. Bollag Tags: Short report Source Type: research

Determining competence in performing obstetric combined spinal-epidural procedures in junior anesthesiology residents: results from the cumulative sum analysis
Deliberate practice and active learning are essential components in mastering the (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 11, 2020 Category: Anesthesiology Authors: E. Lew, J.C. Allen, R.W.L. Goy, F. Ithnin, B.L. Sng Tags: Original Article Source Type: research

Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective caesarean delivery
We applaud Kleinman et al. for their positive findings after the implementation of an enhanced recovery programme after caesarean delivery.1 Since Henrik Kehlet introduced us to the world of fast-track surgery or enhanced recovery after surgery (ERAS), we have seen some impressive improvements in patient quality of care.2 Many surgical specialities have introduced specific ERAS programmes and the Society for Obstetric Anesthesia and Perinatology (SOAP) has recently created a consensus statement advocating the benefits of its implementation after caesarean delivery. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 10, 2020 Category: Anesthesiology Authors: R. Irwin, T. Tan Tags: Correspondence Source Type: research

Radiofrequency treatment of a pelvic schwannoma in pregnancy
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 10, 2020 Category: Anesthesiology Authors: J. Kielty, K. McKeating Tags: Correspondence Source Type: research

Post-traumatic stress disorder and postpartum depression and their reported association with recent labor and delivery: a questionnaire survey cohort
Labor and delivery is usually an affirmative event associated with positive feelings. However, this is not true for all mothers and prior studies reported that a third of all mothers considered their delivery to be traumatic.1 Furthermore, 1-21% of postpartum women have symptoms of post-traumatic stress disorder (PTSD).2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 10, 2020 Category: Anesthesiology Authors: S.A. Freedman, S. Reshef, C.F. Weiniger Tags: Original Article Source Type: research

Anesthetic management for cesarean delivery for a parturient with metaphyseal dysplasia and hypophosphatemic rickets
Hypophosphatemic rickets is a genetic condition, of estimated prevalence 1 per 20 000, that affects bone mineralization due to insufficient phosphate reabsorption. Decreased phosphate reabsorption, secondary to genetic mutations, leads to dysregulation of fibroblast growth factor 23. This can result in bone deformities, fractures, disproportionate short stature, and dental abscesses that may all prove severely debilitating into adulthood.1 Similar in presentation to rickets are the metaphyseal chondrodysplasias, a heterogenous group of disorders characterized by irregularities in the metaphysis of long bones and sparing of...
Source: International Journal of Obstetric Anesthesia - May 10, 2020 Category: Anesthesiology Authors: J.P. Kennedy, A. Crociata, A. Burgess, K. Miller, A.M. Escobar-Botero, F. Hasham Tags: Correspondence Source Type: research

Editorial Board
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - May 1, 2020 Category: Anesthesiology Source Type: research

Permanent hearing loss and tinnitus following epidural analgesia complicated by accidental dural puncture
Sudden sensorineural hearing loss consequent to dural puncture is a long-recognised phenomenon.1 To date, it has been described primarily as a complication of spinal anaesthesia in the non-obstetric population. Reports in the obstetric population are confined to case studies, with the largest prospective study showing no difference in audiological outcomes in those women undergoing caesarean section.2 The precise incidence remains unknown due to the absence of large-scale audiometric studies. In previous descriptions, this rare complication typically occurred in younger women, was low frequency in nature and typically reso...
Source: International Journal of Obstetric Anesthesia - April 24, 2020 Category: Anesthesiology Authors: S.M. O'Shaughnessy, C.W.R. Fitzgerald, R. Katiri, S. Kieran, J.P.R. Loughrey Tags: Case report Source Type: research

Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: what we have learned thus far
In late 2019 a pneumonia of unknown cause, subsequently identified as caused by a coronavirus, was first detected in Wuhan, China. The International Committee on Taxonomy of Viruses named it the ‘severe acute respiratory syndrome coronavirus 2’, or SARS-CoV-2, as it is related to the virus that caused the ‘Severe Acute Respiratory Syndrome’ (SARS) outbreak in 2003.1 On 11 February 2019, the World Health Organization (WHO) announced that the official name of the disease it caused wou ld be ‘COVID-19’, a shortened version of ‘coronavirus disease 2019’. (Source: International Jo...
Source: International Journal of Obstetric Anesthesia - April 23, 2020 Category: Anesthesiology Authors: S. Bampoe, P.M. Odor, D.N. Lucas Tags: Review article Source Type: research

Peri-operative management of percutaneous fetoscopic spina-bifida repair: a descriptive review of five cases from the United Kingdom, with focus on anaesthetic implications
Spina bifida results from abnormal development and incomplete closure of the neural tube and affects 33 –48 per 100 000 live births globally.1 Current practice is surgical repair within 1–2 days of birth. Recently, several animal and human reports have suggested that prenatal repair could offer better postnatal neurological function.2,3 In 2011, the Management of Myelomeningocele Study (MOMS) compared open (hysterotomy) prenatal repair with the standard postnatal technique. They found reduced rates of neurosurgical intervention for hydrocephalus in a significant proportion of those treated prenatally and an...
Source: International Journal of Obstetric Anesthesia - April 20, 2020 Category: Anesthesiology Authors: C.D. Goonasekera, V.A. Skelton, B. Zebian, K. Nicolaides, D. Araujo Lapa, M. Santorum-Perez, C. Bleil, A. Hickey, R. Bhat, B.E. Oliva Gatto Tags: Review article Source Type: research

Considerations and strategies in the organisation of obstetric anaesthesia care during the 2019 COVID-19 outbreak in Singapore
Since the outbreak of the coronavirus disease in 2019 (COVID-19), Singapore has seen the emergence of 1309 cases with six mortalities (as of 5 April 2020).1 The ‘Disease Outbreak Response System Condition’ (DORSCON) Orange alert was declared by our local health authorities in early February, signifying a severe disease of limited community spread.2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - April 20, 2020 Category: Anesthesiology Authors: J.S.E. Lee, R.W.L. Goy, B.L. Sng, E. Lew Tags: Short report Source Type: research

Extracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports
Extracorporeal membrane oxygenation (ECMO) has become an important tool in the care of adults and children with severe cardiac and pulmonary dysfunction which is resistant to conventional management. Extracorporeal membrane oxygenation is a form of modified cardiopulmonary bypass that provides artificial ventilatory and/or mechanical circulatory support to critically ill patients in intensive care units (ICU). Venous blood is removed from the patient and pumped through an artificial membrane lung (the oxygenator), where carbon dioxide is removed and oxygen is added. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - April 20, 2020 Category: Anesthesiology Authors: J. Ong, J. Zhang, R. Lorusso, G. MacLaren, K. Ramanathan Tags: Review article Source Type: research

Perioperative management of percutaneous fetoscopic spina-bifida repair: A descriptive review of five cases from the United Kingdom, with focus on anaesthetic implications
Spina bifida results from abnormal development and incomplete closure of the neural tube and affects 33-48 per 100 000 live births globally.1 Current practice is surgical repair within 1-2 days of birth. Recently, several animal and human reports have suggested that prenatal repair could offer better postnatal neurological function.2,3 In 2011, the Management of Myelomeningocele Study (MOMS) compared open (hysterotomy) prenatal repair with the standard postnatal technique. They found reduced rates of neurosurgical intervention for hydrocephalus in a significant proportion of those treated prenatally and an improved composi...
Source: International Journal of Obstetric Anesthesia - April 20, 2020 Category: Anesthesiology Authors: C. Goonaseker, V. Skelton, B. Zebian, K. Nicolaides, D. Araujo Lapa, M. Santorum-Perez, C. Bleil, A. Hickey, R. Bhat, B.E. Oliva Gatto Tags: Review article Source Type: research

Assessment of the reliability and validity of a novel point-of-care fibrinogen (F-Point) device against an industry standard at fibrinogen levels > 2  g/L in non-haemorrhage scenarios
The detection and correction of coagulopathy is an important aspect of the management of obstetric haemorrhage.1 Fibrinogen concentration has been shown to be an independent predictor of progression to severe postpartum haemorrhage (PPH), with a fibrinogen level of4  g/L having a negative predictive value of 79% for the progression to severe PPH.2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - April 16, 2020 Category: Anesthesiology Authors: R. Katz, V. Efremov, C. Mooney, A. El-Khuffash, L. Heaphy, D. Cosgrave, J. Loughrey, P. Thornton Tags: Short report Source Type: research

Assessment of the reliability and validity of a novel point of care fibrinogen (F-Point) device against an industry standard at fibrinogen levels > 2 g/L in non-haemorrhage scenarios
The detection and correction of coagulopathy is an important aspect of the management of obstetric haemorrhage.1 Fibrinogen concentration has been shown to be an independent predictor of progression to severe postpartum haemorrhage (PPH), with a fibrinogen level of4 g/L having a negative predictive value of 79% for the progression to severe PPH.2 (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - April 16, 2020 Category: Anesthesiology Authors: R. Katz, V. Efremov, C. Mooney, A. El-Khuffash, L. Heaphy, D. Cosgrave, J. Loughrey, P. Thornton Tags: Short report Source Type: research

Resilience of the restructured obstetric anaesthesia training programme during the COVID-19 outbreak in Singapore
We would like to report our experience from the restructuring of our obstetric anaesthesia training programme in order to mitigate the impact of infection control measures during the COVID-19 outbreak in Singapore. Our institution, KK Women ’s and Children’s Hospital, is responsible for obstetric anaesthesia training for the Singhealth Anaesthesiology Residency Program and has about 90 residents rotating through three different institutions under the Singhealth cluster of healthcare institutions. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - April 11, 2020 Category: Anesthesiology Authors: J.S.E. Lee, J.J.I. Chan, F. Ithnin, R.W.L. Goy, B.L. Sng Tags: Correspondence Source Type: research

Resilience of the restructured obstetric anaesthesia training program during the COVID-19 outbreak in Singapore
We would like to report our experience from the restructuring of our obstetric anaesthesia training program in order to mitigate the impact of infection control measures during the COVID-19 outbreak in Singapore. Our institution, KK Women ’s and Children’s Hospital, is responsible for obstetric anaesthesia training for the Singhealth Anaesthesiology Residency Program and has about 90 residents rotating through three different institutions under the Singhealth cluster of healthcare institutions. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - April 11, 2020 Category: Anesthesiology Authors: J.S.E. Lee, J.J.L. Chan, F. Ithnin, R.W.L. Goy, B.L. Sng Tags: Correspondence Source Type: research

Management of a patient with shapiro syndrome variant during pregnancy
A 29-year-old primigravida woman (weight 57 kg, height 160 cm) was admitted to our maternity unit with preterm premature rupture of membranes (PPROM) at 33 weeks ’ gestation. Her medical, surgical, and family histories were unremarkable. She had good general health status and normal vital signs (temperature 35.8°C) at admission. The cardiotocograph showed good fetal heart reactivity and no uterine contractions.Laboratory tests were normal (hemoglobin 13 g /dl, white blood cell count 12x103/mm3, C-reactive protein negative). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - March 27, 2020 Category: Anesthesiology Authors: A. Elkoundi, K. Mounir, W. Atmani, H. Balkhi Source Type: research

Enhanced recovery after caesarean delivery versus standard care studies: a systematic review of interventions and outcomes
Enhanced recovery is a multimodal care pathway designed to improve postoperative outcomes, reduce complication rates and decrease hospital length of stay.1 Obstetric units throughout the world now use enhanced recovery after caesarean delivery (ERAC) programs. Despite this, the interventions included in ERAC pathways and the outcomes that have been used to assess the impact of ERAC appear to be inconsistent and heterogeneous.2 The Society for Obstetric Anesthesia and Perinatology (SOAP) in the USA has taken steps towards providing guidance in this area by recently publishing its ERAC implementation consensus recommendation...
Source: International Journal of Obstetric Anesthesia - March 26, 2020 Category: Anesthesiology Authors: P. Sultan, N. Sharawi, L. Blake, B. Carvalho Tags: Review article Source Type: research

What's new in obstetric anesthesia in 2018?
The lecture entitled ‘What’s New in Obstetric Anesthesia?’ is an opportunity to update the obstetric anesthesiology community on novel and relevant publications from the preceding calendar year. The lecture was first given at the Society for Obstetric and Perinatology (SOAP) annual meeting in 1975 and since 1995 t he annual lecture has been named in honor of Gerard W. Ostheimer, an eminent obstetric anesthesiologist. The 2019 lecture presented articles published throughout the 2018 calendar year. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - March 18, 2020 Category: Anesthesiology Authors: C.F. Weiniger Tags: Review article Source Type: research

oaWhat's New in Obstetric Anesthesia in 2018?
The lecture entitled ‘What’s New in Obstetric Anesthesia?’ is an opportunity to update the obstetric anesthesiology community on novel and relevant publications from the preceding calendar year. The ‘What’s New in Obstetric Anesthesia?’ lecture was first given at the Society for Obstetric and Perinatology (S OAP) annual meeting in 1975 and since 1995 the annual lecture has been named in honor of Gerard W. Ostheimer, an eminent obstetric anesthesiologist. The 2019 lecture presented articles published throughout the 2018 calendar year. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - March 18, 2020 Category: Anesthesiology Authors: C.F. Weiniger Tags: Review article Source Type: research

Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis
Dilation and evacuation (D&E) is a surgical uterine evacuation procedure commonly performed for pregnancy termination or intra-uterine fetal demise. While D&E is considered a safe surgical procedure, access has become increasingly restricted due to pre-viability abortion bans, limits on medication-induced abortion and lack of insurance coverage.1 While abortion is legal in South Carolina, patient proximity to abortion centers varies widely among states, with travel time and associated travel costs further constraining patient access to care. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - March 6, 2020 Category: Anesthesiology Authors: K.H. Bridges, B.J. Wolf, A. Dempsey, W.B. Ellison, D.Y. Williams, S.H. Wilson Tags: Original Article Source Type: research

A mechanistic study of the tremor associated with epidural anaesthesia for intrapartum caesarean delivery
Tremor is a common side effect of epidural anaesthesia for intrapartum caesarean delivery that may have a negative impact on maternal satisfaction.1,2 The term “shivering” is often used to describe epidural top-up tremor but it is unclear if this form of tremor is the same as cold stress-induced shivering. Tremors are identified by their frequency profiles and their triggers.3 For example, Parkinsonian tremor has a frequency of 4–6 Hz and is triggere d by inactivity.3 Consequently, in order for epidural top-up tremor to be considered a form of shivering, the frequency profile of its oscillation must match...
Source: International Journal of Obstetric Anesthesia - February 21, 2020 Category: Anesthesiology Authors: C.J. Mullington, D.A. Low, P.H. Strutton, S. Malhotra Tags: Original Article Source Type: research

Quadratus lumborum block for postoperative analgesia after cesarean delivery: a systematic review and meta-analysis
Postoperative pain after cesarean delivery (CD) negatively affects ambulation, breastfeeding and even maternal bonding.1,2 Use of intrathecal opioids, the current analgesic method of choice for CD, may lead to adverse reactions such as nausea, vomiting, itchiness and sedation.3 Despite the use of such potent measures for postoperative pain relief, the optimal control of pain with few adverse reactions remains a challenge following CD. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - February 20, 2020 Category: Anesthesiology Authors: M. Xu, Y Tang, J. Wang, J. Yang Tags: Original Article Source Type: research

Anaesthetic management of a parturient with left ventricular noncompaction cardiomyopathy
Left ventricular noncompaction (LVNC) cardiomyopathy is a rare type of cardiomyopathy which occurs when the left ventricle fails to undergo compaction during embryogenesis. This results in a two layered ventricular wall, with a thinner compact epicardial layer and an inner noncompacted endocardial layer with large trabeculations. 1 It is often genetic in aetiology. A key difference compared to other cardiomyopathies is the increased risk of arrhythmias. Arrhythmias are associated with a poor prognosis due to ventricular failure, thrombo-embolic events and sudden death. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - February 13, 2020 Category: Anesthesiology Authors: S.C. Nelson, S.C. Lamb, I.A. Montague, E.J. Drake Tags: Correspondence Source Type: research

Protocol for direct reporting of awareness in maternity patients (DREAMY): a prospective, multicentre cohort study of accidental awareness during general anaesthesia in obstetric patients
The 5th National Audit Project in the UK and Ireland (NAP5)1 was the largest study to investigate accidental awareness during general anaesthesia (AAGA). The NAP5 methodology combined national surveillance for spontaneous patient reports of AAGA and a parallel snapshot survey of general anaesthetic activity.2 Obstetric patients undergoing caesarean delivery were markedly over-represented, constituting almost 10% of all NAP5 AAGA reports but only 0.8% of general anaesthetic activity. Importantly, NAP5 adopted a different approach to study design from most previous investigations, relying solely upon descriptions spontaneous...
Source: International Journal of Obstetric Anesthesia - February 13, 2020 Category: Anesthesiology Authors: P.M. Odor, S. Bampoe, D.N. Lucas, S.R. Moonesinghe, J. Andrade, J.J. Pandit, DREAMY Investigators Group Tags: Original Article Source Type: research

Do quantitative blood loss measurements and postpartum hemorrhage protocols actually make a difference? Yes, no, and maybe
Postpartum hemorrhage (PPH) continues to be a leading cause of severe maternal morbidity and preventable maternal mortality worldwide.1 Quality improvement tools such as the United States (US) National Partnership for Maternal Safety (NPMS) Consensus Bundle for Obstetric Hemorrhage and the California Maternal Quality Care Collaborative (CMQCC) bundle promote a structured, reproducible approach to the care of a mother with PPH.2,3 Intensive statewide implementation of the NPMS bundle in 99 California hospitals was associated with a 20.8% reduction in severe maternal morbidity compared with 1.2% in hospitals without bundle i...
Source: International Journal of Obstetric Anesthesia - February 11, 2020 Category: Anesthesiology Authors: A. Chau, M.K. Farber Tags: Editorial Source Type: research

Association between opioid use after intrapartum cesarean delivery and repeat cesarean delivery: a retrospective cohort study
Current recommendations for post-cesarean analgesia promote neuraxial morphine, scheduled oral opioid-sparing analgesics, and on-request oral opioids for breakthrough pain,1 irrespective of the obstetric indication for the cesarean delivery (CD). (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - February 11, 2020 Category: Anesthesiology Authors: B.S. Shatil, B. Daoud, J. Guglielminotti, R. Landau Tags: Correspondence Source Type: research

Editorial Board
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - February 1, 2020 Category: Anesthesiology Source Type: research

International Journal of Obstetric Anesthesia Referees 2019
(Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - February 1, 2020 Category: Anesthesiology Source Type: research

Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use
Cesarean delivery (CD) is one of the most common surgical procedures performed worldwide and the most common major surgery performed in the United States, with over 1.25 million patients undergoing this operation annually.1 As enhanced recovery programs have been shown to accelerate postoperative recovery and decrease dependence on postoperative opioids in other surgical specialties,2 they have begun to gain popularity for CD.3,4 Such a program for CD presents an opportunity to affect outcomes for patients who could benefit from a multidisciplinary, multimodal, and opioid-sparing approach to improving their recovery. (Sour...
Source: International Journal of Obstetric Anesthesia - January 21, 2020 Category: Anesthesiology Authors: S.A. Lester, B. Kim, M.D. Tubinis, C.J. Morgan, M.F. Powell Tags: Original Article Source Type: research

Intrathecal diamorphine: a challenger for morphine ’s ‘gold standard’ status?
In reference to the excellent review article published by Yurashevich and Habib,1 diamorphine is mentioned briefly in the abstract and article, leaving the article ’s primary focus to be intrathecal morphine. Morphine is repeatedly referred to as the ‘gold standard analgesic method’. Considering the focus of the article was the side-effects of long-acting neuraxial opioids for post-caesarean analgesia, it can be argued that intrathecal diamorphine provid es a challenge to morphine’s ‘gold standard’ status. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - January 20, 2020 Category: Anesthesiology Authors: P. Attard Cortis Tags: Correspondence Source Type: research

Dual epidural catheter therapy for labor analgesia in a patient with prior lumbar spine surgery
This journal recently featured discussion of remifentanil for labor analgesia.1,2 We would like to highlight another approach to labor analgesia when traditional epidural catheter techniques prove inadequate. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - January 20, 2020 Category: Anesthesiology Authors: G. Martinez, L. Powell Tags: Correspondence Source Type: research

Fentanyl concentration in maternal and umbilical cord plasma following intranasal or subcutaneous administration in labour
Pethidine has been removed from the South Australian Medicines Formulary due to unfavourable drug properties and its potential to cause adverse maternal and neonatal effects. Traditionally, the opioids most commonly used for labour analgesia were pethidine and morphine.1 However, due to its differing pharmacokinetic profile, fentanyl has been suggested as a suitable alternative to both pethidine and morphine when administered for pain relief during labour. Benefits of fentanyl for labour analgesia include rapid absorption and no active metabolites. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - January 17, 2020 Category: Anesthesiology Authors: J-A. Fleet, I. Belan, A.L. Gordon, A.M. Cyna Tags: Original Article Source Type: research

Corrigendum to “A triple-blinded randomized trial comparing spinal morphine with posterior quadratus lumborum block after cesarean section” [Int. J. Obstet. Anesth. 40 (2019) 32–38]
The authors regret that there was an error in Fig. 1 of their article. (Source: International Journal of Obstetric Anesthesia)
Source: International Journal of Obstetric Anesthesia - January 13, 2020 Category: Anesthesiology Authors: T. Tamura, S. Yokota, M. Ando, Y. Kubo, K. Nishiwaki Tags: Corrigendum Source Type: research

In reply - Induction opioids for caesarean section: A word on fentanyl
We read with interest the letter titled ‘Combating myths and misinformation’ by Norris1 His letter made some valid comments on the way in which statistical significance relates to clinical significance. His perspective on the results presented in our paper on induction opioids2 is that the reduction in Apgar scores caused by fentanyl is unlikely to be of any clinical significance. We believe that the difference in interpretation of the findings regarding fentanyl as an induction opioid for general anaesthesia (GA) for caesarean section (CS) stems from his initial clinical question. (Source: International Journa...
Source: International Journal of Obstetric Anesthesia - January 8, 2020 Category: Anesthesiology Authors: L.D. White, A. Hodsdon, G.H. An, C. Thang, T.M. Melhuish, R. Vlok Tags: Correspondence Source Type: research