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At least 1,567 records · Page 87Linked to original sources
PubMed2003

Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient.

PURPOSE: To describe the anesthetic management and clinical course of a patient with peripartum cardiomyopathy. We highlight the frequent occurrence of thromboembolic morbidity in this group of parturients, emphasizing the need for early consideration of prophylactic anticoagulation. CLINICAL FEATURES: A 38-yr-old, diabetic, obese parturient was admitted with pulmonary edema and severe orthopnea at 31 weeks gestation. The respiratory rate was 44 breaths x min(-1), blood pressure 110/70 mmHg, pulse 120 beats x min(-1) and rales were heard in both lung fields. The diagnosis of peripartum cardiomyopathy was made based on sinus tachycardia with no evidence of ischemia on the electrocardiogram, and global left ventricular hypokinesis with an ejection fraction of 40-45% noted on transthoracic echocardiography. Cesarean delivery was planned to improve maternal respiratory status and hemodynamics. General anesthesia with invasive monitoring was planned, and surgery and anesthesia proceeded uneventfully. Less than 24 hr postoperatively, she sustained a thrombotic cerebral infarct leaving her hemiparetic and dysarthric. Subsequent investigations revealed a thrombophilic state due to elevated anticardiolipin antibody. CONCLUSION: General anesthesia is an acceptable option in parturients with heart failure secondary to cardiomyopathy. Thromboembolic complications are common, and early consideration should be given to prophylactic anticoagulation.

Adult↗
PubMed2004

Evidence-based intrapartum care.

Routine care in normal labour may range from supportive care at home to intensive monitoring and multiple interventions in hospital. Good evidence of effectiveness is necessary to justify interventions in the normal process of labour. Inadequate evidence is available to support perineal shaving, routine enemas, starvation in labour and excluding the choice for home births. Evidence supports continuity of care led by midwives, companionship in labour, restricting the use of episiotomy, and active management of the third stage of labour, including routine use of 10 units of oxytocin. Both benefits and risks are associated with routine amniotomy, continuous electronic fetal heart rate monitoring, epidural analgesia, and oxytocin-ergometrine to prevent postpartum haemorrhage. More evidence is needed regarding the emotional consequences of labour interventions, home births, vaginal cleansing, opioid use, the partograph, second-stage labour techniques, misoprostol for primary prevention of postpartum haemorrhage, and strategies to promote evidence-based care in labour.

Delivery, Obstetric↗
PubMed2001

Cost-effectiveness of a trial of labor after previous cesarean.

OBJECTIVE: To determine the cost-effective method of delivery, from society's perspective, in patients who have had a previous cesarean. METHODS: We completed an incremental cost-effectiveness analysis of a trial of labor relative to cesarean using a computerized model for a hypothetical 30-year old parturient. The model incorporated data from peer-reviewed studies, actual hospital costs, and utilities to quantify health-related quality of life. A threshold of $50,000 per quality-adjusted life-years was used to define cost-effective. RESULTS: The model was most sensitive to the probability of successful vaginal delivery. If the probability of successful vaginal birth after cesarean (VBAC) was less than 0.65, elective repeat cesarean was both less costly and more effective than a trial of labor. Between 0.65 and 0.74, elective repeat cesarean was cost-effective (the cost-effectiveness ratio was less than $50,000 per quality-adjusted life-years), because, although it cost more than VBAC, it was offset by improved outcomes. Between 0.74 and 0.76, trial of labor was cost-effective. If the probability of successful vaginal delivery exceeded 0.76, trial of labor became less costly and more effective. Costs associated with a moderately morbid neonatal outcome, as well as the probabilities of infant morbidity occurring, heavily impacted our results. CONCLUSION: The cost-effectiveness of VBAC depends on the likelihood of successful trial of labor. Our modeling suggests that a trial of labor is cost-effective if the probability of successful vaginal delivery is greater than 0.74. Improved algorithms are needed to more precisely estimate the likelihood that a patient with a previous cesarean will have a successful vaginal delivery.

Adult↗
PubMed2000

[Delivery after previous cesarean sections].

UNLABELLED: The author studies the method of delivery among 450 impregnant women after one or more cesarean section (c.s.) in First Obstetric gynecologic hospital in Sofia. He finds a high incidence of secondary c.s.--about 80%, and elective c.s.--70%. Vaginally were delivered 97 = 21.5%. Trial of labor was accomplished in 29.5% (133,450). The incidence of scar dehiscence of the uterus was 1.1%--5/450. CONCLUSION: It is necessary to be done more frequently a trial of labor in pregnant women after c.s.

Adult↗
PubMed1989

[Outcome of delivery following previous cesarean section].

Of 249 women whose last pregnancy was terminated by a caesarean section, 57 (22.9%) were delivered again by a primary caesarean section. The other 192 (77.1%) were allowed to attempt vaginal birth. Of these, 151 (60.6%) were successful, and 41 (16.5%) underwent a repeat caesarean section. The percentage of successful vaginal births was strongly correlated with the indication for the previous caesarean section. There was one case of incomplete uterine rupture. The maternal morbidity was lowest in the group who had a vaginal delivery. One child developed an Erb-Duchenne paralysis in addition to a mechanical birth trauma. In the secondary caesarean section group there were more children with a low one minute Apgar score than in the group delivered vaginally or by a primary caesarean section. It is concluded that there are sufficient arguments against routinely performing a repeat caesarean section after a previous one. The indication for the previous caesarean section can be an important aid in the selection of women to be allowed to try a vaginal delivery.

Adult↗
PubMedDate not supplied

Spontaneous uterine rupture with placenta percreta: a case report.

A case of spontaneous uterine rupture resulting from placenta percreta is described. The patient was treated by cesarean section and abdominal hysterectomy. The etiology, clinical features and management of this rare complication of pregnancy are briefly discussed.

Adult↗
PubMed1989

Obstetric epidural anaesthesia in patients with Harrington instrumentation.

This five-year retrospective study reviews our experience with epidural obstetric analgesia in patients with previous Harrington rod instrumentation (HRI) for correction of idiopathic scoliosis. Patients were identified by the presence of an antepartum anaesthetic consultation for HRI. The anaesthetic record was examined to determine the frequency of epidural catheter insertion and any problems related to this procedure. Nine epidural insertions were attempted in the 16 patients identified. Five were uncomplicated but four were complicated by one or more of: failure to identify the epidural space, blood vessel trauma, dural puncture, failure to obtain analgesia or the need for multiple attempts before successful insertion. There were no sequelae related to epidural insertion. There were no sequelae related to epidural insertion. We conclude that patients with HRI may be offered epidural anaesthesia for labour and delivery provided that they are informed of the increased risk of complications.

Adult↗
PubMed1979

Neonatal spinal cord injury.

In this review of the prognosis of patients having neonatal spinal cord injury, findings in 3 patients and 11 case histories from the literature are evaluated as to obstetric complications, clinical and pathologic examinations, and follow-up data from 2 to 12 years, or until death of the child. Eight of the 14 patients died: 4 at less than 3 months of age, 3 between 3 months and 1 year of age, and 1 at 3 1/2 years of age. Six children survived for more than 2 years for follow-up examination. Survival is dependent on the level of the lesion, with cervical lesions being almost incompatible with life. The quality of survival for those with levels of C8-T1 and below depends on the child's multiple medical complications.

Adolescent↗