Thromboelastography (TEG) using disposable plastic cups and pins was performed with native whole blood (native group) in 17 nonpregnant volunteers, 134 healthy term pregnant women (>36 wk gestation), and 69 postpartum women. Thromboelastography was also performed with celite-activated whole blood (celite group) in 15 nonpregnant female volunteers, 38 healthy term pregnant women, and 34 postpartum women. The thromboelastographic parameters r and K were significantly decreased in pregnant and postpartum women compared with nonpregnant women in both groups (P < 0.05). The maximum amplitude MA, elastic shear modulus, and alpha angles were significantly increased in pregnant and postpartum women compared with nonpregnant women in both groups (P < 0.05). The TEG coagulation index was significantly greater in pregnant and postpartum women compared with nonpregnant women in both groups. In this study, TEG showed that pregnancy is a hypercoagulable state and that postpartum women remain hypercoagulable through the first 24 h postdelivery. The use of celite in TEG accelerated the speed of TEG analysis.

Epidural analgesia is associated with maternal fever. However, nulliparity and dysfunctional labor are also significant cofactors in the fever attributed to epidural analgesia.

SUMMARY During myelography we observed the contrast material in the spinal subarachnoid space while we changed: (1) the intracranial blood volume by CO2 inhalation, hyperventilation, and jugular vein compression; (2) the intra-abdominal and intrathoracic pressure by forced expiration with glottis closed; and (3) the CSF volume by withdrawals and reinjections of fluid. The spinal dural sac enlarges with increases in volume of both intracranial blood and CSF. It partially collapses with reductions in volume of both intracranial blood and CSF. With increases in intra-abdominal and intrathoracic pressure, the thoracolumbar sac partially collapses, while the cervical sac enlarges. From these observations we conclude that the spinal dural sac is a dynamic structure, readily changing its capacity in response to prevailing pressure gradients across its walls. It acts as a reservoir for CSF, which moves to and fro through the foramen magnum in response to changes in cerebral blood flow. By its bladder-like ability to alter its capacity, the spinal dural sac provides the 'elasticity' of the covering of the central nervous system.

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