The preoperative assessment of obstetric patients

Hinova, A.; Fernando, Roshan

doi:10.1016/j.bpobgyn.2009.12.003

Cited by 18 publications

(18 citation statements)

References 75 publications

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“…Special attention must be paid for acid aspiration and compression of the inferior vena cava and aorta. Estrogen levels may lead to edema of the upper airway and hence warrants the use of smaller endotracheal tube, which may further lead to increased resistance to passive expiration [ 11 ]. The list of drugs that causes teratogenicity must be avoided during pregnancy.…”

Section: Discussionmentioning

confidence: 98%

Mechanical Ventilation in Critically Ill Obstetric Patient

Danish

2016

Principles of Critical Care in Obstetrics

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Section: Discussionmentioning

confidence: 98%

Mechanical Ventilation in Critically Ill Obstetric Patient

Danish

2016

Principles of Critical Care in Obstetrics

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“…It is particularly important to discuss the possibility of a regional anesthetic technique, accurately document any pre‐existing neurological deficit (Hinova & Fernando, 2010) and not refuse appropriate anesthetic management on the grounds of medico‐legal concerns (Warren & Fletcher, 1986). Recent data show that increased postnatal relapse rates seem to be the only real risk for these women (Finkelsztejn et al., 2011), irrespective of the type of anesthesia (Hinova & Fernando, 2010). Anesthetists should not automatically take all the responsibility in the case of progressive or new deficits after the procedure (Vercauteren & Heytens, 2007).…”

Section: Discussionmentioning

confidence: 99%

Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10‐year retrospective cohort study

et al. 2018

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ObjectivesMultiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6‐month postpartum period in MS parturients with and without obstetric anesthesia/analgesia.Materials and MethodsWe retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD‐10 code G35 (MS) recorded anytime in their medical history (n = 428). We included only deliveries of women with confirmed diagnosis at the time of labor (n = 70). Statistical analysis was performed using the Fischer Exact Test.ResultsThere were 70 deliveries of 65 women, including 45 vaginal deliveries and 25 Cesarean deliveries (16 under general anesthesia, 8 with epidural anesthesia and 1 with spinal anesthesia). Epidural obstetric analgesia was performed in 11 deliveries. There was no statistically significant difference in relapses between the vaginal delivery group (n = 15; 33%) and Cesarean section group (n = 10; 40%), p = 0.611.ConclusionNeither delivery mode (vaginal vs Caesarean) nor type of obstetric anesthesia/analgesia was found to have any impact on the course of MS at 6 months postpartum in women with this condition.

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“…Weiterhin muss gerade im Hinblick auf die Anlage eines PDK oder die Durchführung einer SPA in der Geburtshilfe der Subtyp des vWS bekannt sein, denn nur beim vWS-Typ I kann im Gegensatz zu den Typen II und III peripartal eine Normalisierung der Gerinnungsparameter erwartet werden [18].…”

Section: Fallberichte Und üBersichtsarbeitenunclassified

“…Aus Sicht der Autoren ist deshalb nach Sicherstellung einer normalen Gerinnungssituation (Normalwerte für aPTT, Quick, Thrombozyten, vWF:Ag, vWF:RCo und FVIII:C) bei diesen Patientinnen die Durchführung eines neuroaxialen Anästhesieverfahrens (PDK oder SPA) häufig ohne Substitutionstherapie gerechtfertigt. Jedoch sollte bei einer PDK-Anlage dieser so früh wie möglich wieder gezogen werden, da es nach Entbindung zu einem raschen Abfall von Faktor VIII kommen kann [18].…”

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Rückenmarknahe Regionalanästhesie bei Patienten mit hämorrhagischen Diathesen

2011

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Neuraxial anesthesia is an established and safe procedure in perioperative pain therapy which can help to minimize complications and to improve perioperative outcome. In patients with acquired bleeding disorders by comorbidities or concomitant antithrombotic medication an individual decision should be made based on risks and benefits. A large number of literature references and guidelines help making a decision, for example the recently updated evidence-based guidelines of the American Society of Regional Anesthesia and Pain Medicine for patients receiving antithrombotic or thrombolytic therapy. However, no explicit recommendations or guidelines exist for patients with hemorrhagic diatheses, such as von Willebrand disease (vWD), hemophilia A and B and idiopathic thrombocytopenic purpura (ITP). Published data regarding the safety of neuraxial techniques in these patients is scarce. Neuraxial anesthesia in patients with vWD is only acceptable when coagulation is optimized (substitution of factor concentrates or hemostatic agents depending on the type of vWD) and monitored frequently during the procedure. The only exception might be obstetric patients with vWD type I as coagulation frequently normalizes at the end of pregnancy. In these patients neuraxial anesthesia can often be performed without supplementation of clotting factors.Neuraxial techniques in patients with hemophilia A or B are usually contraindicated. The procedure may only be acceptable if serious reasons exist against general anesthesia. Supplementation of the missing factor to normal levels and monitoring during procedure is essential if neuraxial block is performed.Patients with ITP often present with low platelet counts. Normally, spinal or epidural anesthesia is considered safe if the platelet count is over 80,000/µl. However, the consistently low platelet counts in ITP seem to be less problematic than rapidly falling values due to other diseases, because this is often accompanied by platelet dysfunction or coagulopathy. In several studies neuraxial anesthesia was successfully performed with platelet counts between 50,000 and 80,000/µl. Nevertheless, the minimum safe platelet count for neuraxial blockade remains undefined in these patients.Evidence-based recommendations for neuraxial anaesthesia in patients with hemophilia, vWD or ITP cannot be offered. Each patient has to be treated individually with appropriate caution. This overview is intended to assist in the decision for or against neuraxial anesthesia in these patients, with emphasis on the pathophysiological background, blood investigations and case reports from the literature.

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The preoperative assessment of obstetric patients

Cited by 18 publications

References 75 publications

Mechanical Ventilation in Critically Ill Obstetric Patient

Mechanical Ventilation in Critically Ill Obstetric Patient

Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10‐year retrospective cohort study

Rückenmarknahe Regionalanästhesie bei Patienten mit hämorrhagischen Diathesen

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