Biomedical subjects
Publications and source records attributed to M L Flanagan.
A case is presented of a morbidly obese parturient who had multiple medical problems. She had angina and was receiving nitrate therapy, had insulin-dependent diabetes mellitus, hypertension, asthma and benign intracranial hypertension (pseudotumour cerebri). Lumbar epidural analgesia was chosen for labour and delivery and resulted in an uneventful outcome.
The management of a 28-year-old primigravida with placenta accreta diagnosed during Caesarean section is described. A hysterectomy was required to control massive haemorrhage, and the patient made a full recovery. The increased incidence of placenta accreta over the last three decades is thought to be associated with the concomitant increased frequency of Caesarean section, resulting in an increased incidence of placenta praevia (1.9 per cent to 3.9 per cent). Patients with placenta praevia who have had a previous Caesarean section have a remarkably increased risk of placenta accreta. Management of placenta accreta is primarily by control of haemorrhage on delivery of the placenta. Control can be assisted by infrarenal cross-clamping of the aorta and/or intra-myometrial injection of prostaglandin F2 alpha which produces myometrial and vascular contraction. Identification of patients at increased risk, preparation for treatment and effective treatment of placenta accreta will minimize maternal morbidity and mortality.
This paper describes the anaesthetic management of a 29-year-old woman for an elective repeat Caesarean section. A diagnosis of peripartum cardiomyopathy (PPCM) had been made after her first delivery by Caesarean section three years earlier. Although the patient was currently asymptomatic, recent echocardiography demonstrated persistent left ventricular dilatation. The choice of haemodynamic monitors and the clinical significance of PPCM in this situation are discussed.
The relative sensitivities of the prothrombin time, Russell's viper venom time and activated partial thromboplastin time were determined in one-stage quantitative assays for factor V and factor X. Sensitivity was defined as the slope of the reference curve. The prothrombin time was the most sensitive test for factor X and the least sensitive for factor V. The Russell's viper venom time was the most sensitive test for factor V and least sensitive for factor X. The activated partial thromboplastin time approximated the sensitivity of Russell's viper venom for factor V and had intermediate sensitivity for factor X. The data indicate that factor V is best quantitated by the Russell's viper venom time and factor X by the prothrombin time, exactly the opposite of what is customarily done.