Successful Spinal Anesthesia for Cesarean Section in a Patient With Marfan Syndrome Complicated by Dural Ectasia
(Int J Obstet Anesth. 2018;35:88–92) Marfan syndrome (MFS) is an autosomal dominant condition characterized by connective tissue abnormalities across multiple systems. Patients with MFS may have a dilated aortic root, and this can place the parturient at increased risk during labor and delivery. Cesarean delivery is sometimes recommended for women with MFS who have an aortic root diameter>40 mm. However, reduced effectiveness of spinal anesthesia has been reported in some patients with MFS. The failure is thought to possibly be related to the dural ectasia that is present in many patients with MFS; this ma...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Livebirth After Uterus Transplantation From a Deceased Donor in a Recipient With Uterine Infertility
This report detailed the first reported case of a successful livebirth following a uterus transplant from a deceased donor. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Transversalis Fascia Plane Block Provides Effective Postoperative Analgesia for Cesarean Section: New Indication for Known Block
(J Clin Anesth. 2018;48:13–14. Doi:10.1016/j.jclinane.2018.04.006) Adequate analgesia after cesarean section (CS) requires sensorial blockade of the subcostal (T12), ilioinguinal (L1), and iliohypogastric (T12-L1) nerves’ cutaneous branches. However, the posterior transversus abdominis plane block, commonly used for CS, may not affect the T12 and L1 cutaneous branches. Therefore, in this study, the authors reported the first effective use of the transversalis fascia plane block (TFPB) in 2 patients, which should provide blockade of the ilioinguinal and iliohypogastric nerves. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Postoperative Analgesia Source Type: research

Patterns of Recovery From Pain After Cesarean Delivery
(Pain. 2018;159:2088–2096) There is a lack of knowledge about patterns of recovery from pain and its predictors after surgery. Often times, clinicians only witness pain experience if the patient returns for routine care after discharge, which overall limits the clinical ability to provide appropriate pain management. In order to establish clinically relevant, generalizable patterns of recovery, as well as identify predictors from preoperative and perioperative data, patients were followed for 2 months after elective cesarean delivery via text-messaging to assess daily pain scores. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Postoperative Analgesia Source Type: research

Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial
(Anesth Analg. 2018;127(6):1434–1439) Postdural puncture headache (PDPH), with the postulated etiology of meningeal traction from low cerebrospinal fluid (CSF) pressure or cerebral vasodilation, is often treated with an epidural blood patch (EBP). A patient with a PDPH received neostigmine and atropine for management of postoperative ileus. Interestingly, her PDPH also resolved with this medication. This case resulted in the authors conducting a randomized controlled trial to study the efficacy of neostigmine and atropine in the management of PDPH. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Anesthesia Source Type: research

Comparison of the ED50 and ED95 of Intrathecal Bupivacaine in Parturients Undergoing Cesarean Delivery With or Without Prophylactic Phenylephrine Infusion: A Prospective, Double-Blind Study
(Reg Anesth Pain Med. 2018;43(8):885–889) Spinal-induced hypotension is a common problem resulting from the sympathectomy associated with the administration of intrathecal local anesthetic for cesarean delivery, and is associated with nausea, vomiting, loss of consciousness, impaired fetal oxygenation, and fetal acidosis. Prophylactic phenylephrine infusion is often used to decrease the risk of spinal-induced hypotension; however, its use has been associated with decreased rostral spread of intrathecal local anesthetic in pregnancy. The purpose of this study was to determine the median effective dose (ED50) and 95% ...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Anesthesia Source Type: research

Body Temperature, Cutaneous Heat Loss, and Skin Blood Flow During Epidural Anaesthesia for Emergency Cesarean Section
This study aimed to determine how dosing of a labor epidural to provide anesthesia for cesarean section would affect mean body temperature and cutaneous vasomotor tone, hypothesizing that active cutaneous vasodilation would be blocked and therefore mean body temperature would increase. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Anesthesia Source Type: research

United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women
(JAMA Netw Open. 2018;1:e186567) Guidelines for levels of maternal care for obstetric analgesia and anesthesia, as per the American College of Obstetricians and Gynecologists, state that anesthesia services should be available in all hospitals offering maternal care. However, there is insufficient research to determine the extent or characteristics of the geographic variability across US states in neuraxial analgesia use. The authors of the present study used multilevel modeling, accounting for patient-level and state-level factors, to assess variability in neuraxial analgesia practices in the United States in 2015. (Sour...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Analgesia Source Type: research

The Impact of Analgesic Intervention During the Second Stage of Labour: A Retrospective Cohort Study
In this study it was hypothesized that an epidural top-up to resolve inadequate analgesia in the second stage of labor may promote vaginal delivery. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Analgesia Source Type: research

Insertion of an Intrathecal Catheter Following a Recognized Accidental Dural Puncture Reduces the Need for an Epidural Blood Patch in Parturients: An Australian Retrospective Study
This study aimed to investigate whether the insertion of an ITC after ADP reduced the rate of PDPH and need for EBP in obstetric patients. They also evaluated whether the length of time the ITC was in place (24 h) affected the efficacy of the treatment. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Anesthesia and Analgesia: Regional Analgesia Source Type: research

Pharmacokinetics of Amlodipine Besylate at Delivery and During Lactation
This study aimed to evaluate the pharmacokinetics of amlodipine besylate in a population of pregnant women during delivery and postpartum lactation. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

The Mediating Effects of Gestational Diabetes on Fetal Growth and Adiposity in Women Who are Overweight and Obese: Secondary Analysis of the LIMIT Randomized Trial
(BJOG. 2018;125:1558–1566.) Overweight and obesity represent a significant impact on the world’s public health, and are associated with increased risks of adverse maternal and infant outcomes during pregnancy and delivery. As maternal body mass index (BMI) increases, gestational diabetes mellitus (GDM) also increases in prevalence. GDM is associated with adverse perinatal outcomes similar to those seen in obese pregnant women, including the need for induction of labor and cesarean section, and having an infant born large for gestational age or birthweight over 4 kg. The aim of this secondary analysis fr...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

An Evaluation of Fetal Heart Rate Characteristics Associated With Neonatal Encephalopathy: A Case-Control Study
The objective of the study was to identify predelivery fetal heart rate (FHR) characteristics associated with NE. The hypothesis was category III FHR tracings would be associated with NE. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

“Is It Safe?”: The Many Unanswered Questions about Medications and Breast-feeding
(N Engl J Med. 2019;380(14):1296–1297. Doi:10.1056/NEJMp1817420) While an estimated 83% of mothers in the United States breastfeed, and more than half of mothers worldwide take medication in the postpartum period, there has been a lack of clinical studies examining the effects of drugs on breastfeeding mothers and children. In 2006, LactMed, an online database from the National Library of Medicine, published information on the levels of 1408 drugs in breast milk and infant blood and the effects of these drugs on lactation. However, the recommendations for more than half of those drugs were not based on lactation-spe...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Labor Pain in Women With and Without Severe Fear of Childbirth: A Population-based, Longitudinal Study
(Birth. 2018;45:469–477) It has been suggested that antenatal fear regarding labor pain can alter patient pain thresholds. In particular, a severe fear of childbirth can cause the release of catecholamines that enervate uterine contractility and alter nociceptive receptors, resulting in augmented pain perception and prolonged labor. However, current literature lacks prospective population-based studies that investigate the link between fear of childbirth and degree of experienced labor pain. The aim of the present study thereby was to investigate the association between severe fear of childbirth and pain perceptions...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Prepregnancy and Early Pregnancy Calcium Supplementation Among Women at High Risk of Preeclampsia: A Multicenter, Double-blind, Randomized, Placebo-controlled Trial
(Lancet. 2019;393:330–339) Approximately 14% of maternal deaths worldwide are directly caused by hypertensive disorders of pregnancy, including preeclampsia. On the basis of surprisingly low rates of preeclampsia in low-income countries with high-calcium diets, it has been suggested that calcium deficiency may be linked to preeclampsia and several randomized controlled trials (RCTs) have tested the hypothesis that calcium supplementation may prevent preeclampsia. One study found reductions in the severity of preeclampsia, maternal morbidity and mortality and neonatal mortality, but no significant effect on preeclamp...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Risk of Repeat Cesarean Delivery in Women Undergoing Trial of Labor: A Population-based Cohort Study
This study aimed to investigate the risk of TOLAC resulting in CD based on cervical dilation during labor for the first CD as well as the indication for the first CD. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Prophylactic Insertion of Large Bore Peripheral Intravenous Catheters in Maternity Patients for Postpartum Haemorrhage: A Cohort Study
(Aust N Z J Obstet Gynaecol. 2018;58:548–552) In Australia, most women undergoing labor and vaginal delivery receive a peripheral intravenous catheter (PIVC) for any needed IV fluids, blood products or medications. While the smallest gauge catheter necessary is recommended by guidelines for intravenous access, many women receive a large-bore, 16 or 18 G, PIVC due to concerns about potential obstetric hemorrhage. Insertion of large-bore PIVCs can be very painful, especially when inserted in the back of the hand or wrist. This current study aimed to assess the necessity of large bore PIVCs in laboring parturien...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Contribution of Hypertension to Severe Maternal Morbidity
(Am J Obstet Gynecol. 2018;219(4):405.e1–405.e7.) In the United States, maternal morbidity and mortality are growing public health concerns, with severe maternal morbidity (SMM) affecting>50,000 women in 2014. SMM includes renal failure, shock, sepsis, blood transfusion, and peripartum hysterectomy. Hypertensive disorders of pregnancy are strongly associated with maternal morbidity and mortality and are often responsive to intervention. The primary objective of this study was to evaluate the association between preeclampsia with severe features and SMM at a regional perinatal referral center. They hypothesized th...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery
(N Engl J Med. 2019;380:1012–1021) It is unclear whether or not antibiotic prophylaxis prior to surgery to complete spontaneous abortion (removal of retained products of conception) can reduce postoperative pelvic infection. Evidence is lacking and international guidelines regarding this issue are also inconsistent. This issue is particularly concerning for women in low-income and middle-income countries, where rates of surgery for incomplete spontaneous abortion are high, and where pelvic infection can lead to serious illness and death. In order to help clarify this issue, the authors of the present study assessed ...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Influence of Pregnancy on Cardiac Function and Hemodynamics in Women With Ebstein’s Anomaly
(Acta Obstet Gynecol Scand. 2018;97:1025–1031) Ebstein’s anomaly is a rare congenital abnormality that is characterized by tricuspid regurgitation (TR) in association with apical displacement of the septal leaflet of the valve along with a small right ventricle. The severity of symptoms varies among patients with Ebstein’s anomaly and depends on factors such as right ventricular function, the severity of TR, and the presence of associated cardiac malformations. Atrial septal defect (ASD) and patent foramen ovale (PFO) have been reported in at least 50% of patients with Ebstein’s anomaly and Wolff-P...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Echocardiographic Determination of Resting Hemodynamics and Optimal Positioning in Term Pregnant Women
This study aimed to determine whether there was any significant difference in maternal cardiac output between the ramped position combined with left lateral pelvic tilt compared with the ramped position alone determined by calculations based on transthoracic echocardiographic measurements. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Pregnant Women and the Ebola Crisis
(N Engl J Med. 2018;379:2492–2493) Knowledge of the effects of Ebola virus disease (EVD) in pregnant women remains severely limited, despite recent occurence of some of the largest Ebola outbreaks to date—the West Africa Ebola outbreak of 2014-2016 included 28,000 cases and claimed 11,000 lives, and in 2018, the 10th EVD outbreak since 1976 was reported in the Democratic Republic of Congo. Surveillance systems in place at those times did not record pregnancy status, which in turn complicated case-investigation and contact-tracing efforts. In fact, monitoring outcomes of pregnant women and newborns was complete...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Nocturnal Desaturation Early After Delivery: Impact of Delivery Type and the Beneficial Effects of Fowler’s Position
(Br J Anaesth. 2019;122:e64–e66) The authors of the present study previously reported that 20% of women experience obstructive sleep apnea episodes in the immediate postpartum period. They have also found that women sleeping in a 45-degree elevated upper body position, rather than supine, may have significantly reduced apnea-hypopnea indices. Subsequently, in this article, the authors reported on their continuing investigation, which evaluates the impact of delivery type on nocturnal oxygenation and the potential influence of elevated upper body position. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Neuroinflammation in the Developing Brain: Risk Factors, Involvement of Microglial Cells, and Implication for Early Anesthesia
This article reviewed the most common situations associated with neuroinflammation and exacerbated systemic inflammation in infants along with the dual role of microglia in the resulting brain damage. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Assessing Long-Term Neurodevelopmental Outcome Following General Anesthesia in Early Childhood: Challenges and Opportunities
This study aimed to better inform design of future clinical studies on this topic by reviewing 76 clinical studies of long-term neurodevelopmental outcome after general anesthesia exposure in early childhood or before birth. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

The Frequency of Intrapartum Cesarean Section Use With the WHO Partograph Versus Zhang’s Guidelines in the Labor Progression Study (LAPS): A Multicenter, Cluster-randomized Controlled Trial
This study aimed to compare the rate of ICS when the WHO partograph versus Zhang’s contemporary guideline was used to assess labor progression and diagnose labor dystocia. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mother, Fetus, Neonate Source Type: research

Diagnostic Point-of-Care Ultrasound: Applications in Obstetric Anaesthetic Management
This report reviewed the use of ultrasound in assessing patients’ gastric contents and airways, managing breathless patients, diagnosing shock, and predicting fluid responsiveness. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Is Ultrasound Measured Fetal Biometry Predictive of Intrapartum Cesarean Section for Failure to Progress?
This study aimed to determine whether ultrasound biometry measurements were associated with intrapartum cesarean section for FTG. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Ocular Ultrasonography for Diagnosing Increased Intracranial Pressure in Patients With Severe Preeclampsia
This study aimed to determine whether patients with preeclampsia with severe features have greater ONSD or ODH when compared with healthy pregnant women. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review
(Reg Anesth Pain Med. 2018;43(8):880–884) Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population. Approximately 80% of patients suffer from this type of headache after an accidental dural puncture. A PDPH can limit postpartum mother-baby interactions, extend hospital stays, and raise health care costs. The gold standard treatment for postpartum PDPH is an epidural blood patch (EBP). This retrospective study aimed to compare the effectiveness of treatment with EBP to treatment with a sphenopalatine ganglion block (SPGB). (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Screening Extremely Obese Pregnant Women for Obstructive Sleep Apnea
This study evaluated the validity of existing OSA screening tools in a cohort of extremely obese pregnant women [body mass index (BMI) ≥40 kg/m2] and determined what screening factors were most strongly associated with OSA in this cohort. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist
(Reg Anesth Pain Med. 2018;43:689–698) A significant cause of patient morbidity in the perioperative setting is pulmonary aspiration of gastric contents. Despite patients following the American Society of Anesthesiologists recommendations for fasting before a procedure, there is substantial variability in gastric-emptying time among patients. This may lead to a small percentage of patients that still have solid gastric contents at the time of operation. Gastric ultrasound has the potential to play an important role in the perioperative setting to provide reliable information regarding gastric content and assessment ...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Term Pregnant Patients have Similar Gastric Volume to Nonpregnant Females: A Single-Center Cohort Study
(Br J Anaesth. 2019;122(1):79–85. Doi: 10.1016/j.bja.2018.07.025) Current studies suggest that gastric emptying time is not prolonged in pregnancy. However, these data come from small samples. Pulmonary aspiration of gastric contents during obstetric anesthesia remains a concern. In the present study, authors assessed the range of gastric fluid volume in fasted nonlaboring term pregnant patients and fasted nonpregnant female patients scheduled for surgery. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
This study aimed to evaluate a pregnancy-adapted version of the YEARS algorithm for the management of suspected pulmonary embolism during pregnancy. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-induced Contractility of Human Myometrium In Vitro
This study aimed to compare intermittent oxytocin pretreatment with continuous oxytocin for effect on subsequent oxytocin-induced myometrial contractility. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Clearsight Use for Hemodynamic Monitoring During the Third Trimester of Pregnancy: A Validation Study
This study aimed to evaluate the Clearsight, a noninvasive hemodynamic monitoring system that uses “volume clamp” technology to produce a continuous arterial BP wave, as a valid monitor of CO and stroke volume (SV) in parturients compared with TTE. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Experimental Validation of the CompuFlo Epidural Controlled System to Identify the Epidural Space and Its Clinical Use in Difficult Obstetric Cases
This study aimed to determine whether the CompuFlo is suitable for difficult epidural placement as well as examined the utility of CompuFlo during epidural placement. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Severe Maternal Morbidity Due to Sepsis: The Burden and Preventability of Disease in New Zealand
This article aimed to describe the degree of severe morbidity caused by obstetric sepsis in New Zealand, with special attention focused on possible methods of prevention. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research

Helping Pregnant Women and Clinicians Understand the Risk of Ondansetron for Nausea and Vomiting During Pregnancy
(JAMA. 2018;320 (23):2425–2426) Nausea and vomiting during the first trimester of pregnancy is often unresponsive to conservative treatment and commonly requires antiemetic pharmacotherapy. First line agents, as per the American College of Obstetricians and Gynecologists’ treatment algorithm, are pyridoxine, alone or in combination with doxylamine. However, while the safety of pyridoxine has been well established, there remain concerns regarding potential effects of other antiemetic drugs on fetal development. In particular, the study by Huybrechts et al addressed concerns about potential associations between ...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Association of Maternal First-trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring
(JAMA. 2018;320(23):2429–2437) Ondansetron, a 5-HT3 receptor antagonist, has become the most frequently prescribed drug for nausea and vomiting during pregnancy. However, this medication is not formally approved for this use, and available evidence regarding ondansetron and fetal safety is limited or conflicting. The American College of Obstetricians and Gynecologists has concluded that further studies are warranted. Therefore, the authors of the present study investigated potential associations between ondansetron exposure during the first trimester of pregnancy and the risk of cardiac malformations and/or oral cle...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Alcohol, Cigarette, and Cannabis Use Between 2002 and 2016 in Pregnant Women From a Nationally Representative Sample
(JAMA Pediatr. 2019;173(1):95–96) In the National Survey of Drug Use and Health, the prevalence of cannabis use in pregnant women aged 18 to 44 years rose from 2.37% in 2002 to 3.85% in 2014. Corresponding rates of alcohol use (eg, 11.2% from 2001 to 2005 vs. 10.2% from 2011 to 2013) and cigarette smoking (eg, 13.3% in 2002 vs 12.3% in 2010) during pregnancy have declined. The purpose of this study was to provide more detailed characterization of patterns of substance use during pregnancy. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

A Conceptual Framework for the Impact of Obesity on Risk of Cesarean Delivery
This study presented a conceptual framework that hypothesized how obesity may impact factors that would lead to a CD. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Preeclampsia and Risk of Dementia Later in Life: A Nationwide Cohort Study
(BMJ. 2018;363:k4109) Vascular dysfunction plays an important role in the pathophysiology of preeclampsia, and women with a history of preeclampsia face an increased risk of other cardiovascular disorders after pregnancy, including hypertension and stroke. Given these associations, women with preeclampsia might also be at increased risk of developing dementia. Previous studies that have investigated the association between hypertensive disorders of pregnancy and dementia later in life have had limitations such as being underpowered and dependent on self-reported information. This current study used a large register-based ...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Perinatal Outcome in Births After a Previous Cesarean Section at High Trial of Labor Rates
(Acta Obstet Gynecol Scand. 2019;98:117–126) National guidelines in Norway state that all cesarean deliveries should be medically indicated, with the final decision regarding delivery mode being made by the obstetrician after discussion with the patient. Trial of labor after cesarean (TOLAC) has been associated with a higher risk of adverse perinatal outcomes when compared to a planned repeat cesarean delivery (CD). Previous studies regarding TOLAC outcomes have used populations with relatively low TOLAC rates or have taken place at centers with a policy that allows repeat CD by maternal request. Norway, however, ha...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Maternal Mortality Ratios in 2852 Chinese Counties, 1996-2015, and Achievement of Millennium Development Goal 5 in China: A Subnational Analysis of the Global Burden of Disease Study in 2016
This study aimed to estimate the maternal mortality ratio in 2852 counties in China between 1996 and 2015 and determine the effects of key factors such as economic development and maternal education on maternal mortality. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Maternal Age and Risk for Adverse Outcomes
The objective of this study was to characterize the risk for severe maternal morbidity and other pregnancy complications by maternal age during delivery hospitalizations. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Acute Myocardial Infarction During Pregnancy and the Puerperium in the United States
This study analyzed hospital admissions from a large national database to evaluate trends in the incidence, in-hospital management, and outcomes of AMI complicating pregnancy and the puerperium in the United States. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Epidemiologic Reports Surveys Source Type: research

Horner’s Syndrome Following Obstetric Neuraxial Blockade: A Systematic Review of the Literature
(Int J Obstet Anesth. 2018;35:75–87) Horner syndrome (HS), characterized by ipsilateral miosis, ptosis and anhydrosis, has been reported following regional anesthetic techniques such as cervical and brachial plexus blocks and epidural anesthetics. Although rare, HS has been reported in women who underwent obstetric neuraxial blockade (NB). The current authors undertook a systematic review of the literature that reported HS after obstetric NB in order to better inform anesthesiologists regarding the course and management of this condition. (Source: Obstetric Anesthesia Digest)
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Editorials and Reviews Source Type: research

Increasing the Participation of Pregnant Women in Clinical Trials
(JAMA. 2018;320:Number 20) Pregnant women are considered a “vulnerable” population in research and are often excluded from trials by institutional review boards and study investigators even when they may benefit from study interventions. This has led to>80% of pregnant patients routinely prescribed medications that have not been studied in pregnancy. It is mostly unknown which medications could cause harm, which interventions are effective, or whether treatment can safely be delayed until after pregnancy. The authors argue to improve the health of pregnant women and their fetuses, they need to be appropriat...
Source: Obstetric Anesthesia Digest - August 27, 2019 Category: Anesthesiology Tags: Editorials and Reviews Source Type: research