Parturient

BACKGROUND: The effect of bariatric surgery (BS) on twin pregnancy outcomes is unclear. OBJECTIVES: We examined associations of BS with maternal and perinatal outcomes among women with twin gestation. SETTING: A university hospital. METHODS: A retrospective case-control study of twin deliveries during 2006 through 2017. The study group comprised all women with twin pregnancy who had undergone BS and delivered during the study period...

Clinical reports of Zika Virus (ZIKV) RNA detection in breast milk have been described, but evidence conflicts as to whether this RNA represents infectious virus. We infected post-parturient AG129 murine dams deficient in type I and II interferon receptors with ZIKV. ZIKV RNA was detected in pup stomach milk clots (SMC) as early as 1 day post maternal infection (dpi) and persisted as late as 7 dpi. In mammary tissues, ZIKV replication was demonstrated by immunohistochemistry in multiple cell types including cells morphologically consistent with myoepithelial cells...

BACKGROUND This study aimed to compare the efficacy and safety of bolus norepinephrine, phenylephrine, and ephedrine in parturient with preeclampsia who had hypotension during cesarean delivery under spinal anesthesia. MATERIAL AND METHODS One hundred and sixty-six parturient women with preeclampsia who had a baseline systolic blood pressure (SBP) <80% during spinal anesthesia for cesarean section were divided into three treatment groups; bolus norepinephrine 4 μg (group N) (n=56), phenylephrine 50 μg (group P) (n=55), and ephedrine 4 mg (group E) (n=55)...

BACKGROUND: Preprocedural ultrasound examination of vertebral column guides to locate desired intervertebral space and provides a prevision of needle trajectory and estimated needle depth in parturients. The objective of this study was to assess the correlation between ultrasound-estimated epidural depth (ED) with abdominal girth (AG), body mass index (BMI), weight, height, and age. METHODS: In this prospective, observational study, ultrasound imaging was done at L3-4 interspace in transverse median plane (TP) and paramedian sagittal oblique plane (PSO) to obtain ultrasound estimates of skin to epidural space depth...

BACKGROUND: Phenylephrine is the current "gold standard' vasopressor used to treat maternal hypotension in women undergoing cesarean delivery with spinal anesthesia. Since 2015, various studies have explored the use of norepinephrine to manage maternal hypotension. We conducted this systematic review and meta-analysis of available randomized controlled trials (RCTs) to compare the efficacy and safety of norepinephrine and phenylephrine for the prevention and treatment of maternal hypotension...

OBJECTIVE: To develop and analysis of measurement properties an instrument to assess maternal perception of fatigue during childbirth. METHODS: The study was developed in three steps: elaboration of the initial version of the questionnaire from literature review and semi-structured interviews of the health professionals and the women during labor; consultation of Brazilian specialists through a Delphi Study, to define the items that should compose the final version of the document; validation and factor analysis...

BACKGROUND: The effect of accidental dural puncture during labor epidural analgesia on obstetric outcomes remains unexplored. In this retrospective cohort study, we tested the hypothesis that accidental dural puncture is associated with prolonged second stage of labor. METHODS: Anesthetic and obstetric data from nulliparous parturients who suffered an accidental dural puncture at term labor (n=89) during the years 2006-2012 were compared with randomly selected parturients with uncomplicated epidural analgesia (n=232)...

OBJECTIVE: To compare the prevalence of postpartum retained products of conception (RPOC) among parturients with a history of third stage of labor placental complications and parturients without those complications. STUDY DESIGN: All women operated for postpartum RPOC following vaginal delivery by hysteroscopy or suction curettage between January 2013 and December 2017 were included in the study. Their medical records were reviewed for the occurrence of third stage of labor placental complications (including early postpartum hemorrhage treated with uterotonics, manual separation of the placenta, and revision of the uterine cavity for removal of cotyledons)...

High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min-1 oxygen flow) via nasal prongs with standard 15 l.min-1 oxygen breathing via a tight-fitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths...

Background: Transversus abdominis plane (TAP) block in cesarean section is carried out by local anesthetics such as bupivacaine or ropivacaine with a limited duration of analgesia. The addition of adjuvants such as clonidine and dexmedetomidine has increased the duration of postoperative analgesia. Aims Settings and Design: The aim of this study was to compare the duration of postoperative analgesia between clonidine and levobupivacaine (0.25%) versus levobupivacaine (0...

Background: Optimal labor analgesia can be provided with epidural by addition of opioid to the local anesthetic. Aims: The aim of this study is to compare the efficacy of labor epidural bolus regimes 20 mL of 0.1% ropivacaine with 40 μg fentanyl versus 15 mL of 0.1% ropivacaine with 15 μg fentanyl as epidural bolus dose. Settings and Design: This was prospective double-blinded randomized study. Materials and Methods: After approval from the Institutional Ethical Committee, 50 consenting parturients in active labor were allotted into two groups by closed envelope technique...

Epidural hematoma is a very uncommon complication of spinal anesthesia. Its incidence has been reported to be between 1:200 000-250 000 in the obstetric population following neuraxial anesthesia (D'Angelo et al., 2014). Cesarean delivery increases the risk of maternal venous thromboembolism significantly and recommendations to decrease its incidence and morbidity have been developed. Strategies to decrease venous thromboembolism include pharmacologic prophylaxis with unfractionated or low molecular weight heparin...

OBJECTIVE: To investigate the expression of micro ribonucleic acid miR-518b and its regulatory role in the pathogenesis of placenta accreta. PATIENTS AND METHODS: A total of 50 parturient women in the Obstetric Department were collected and divided into observation group (placenta accreta, n=23) and control group (normal placenta, n=27). After the placental tissues were removed via surgery, the expressions of osteopontin (OPN) and vascular endothelial growth factor (VEGF) were detected using the immunohistochemical method...

OBJECTIVE: To measure the prevalence of smoking cessation during pregnancy and to identify factors associated with its occurrence. METHODS: The present survey included all puerperal women living in the municipality of Rio Grande, RS, whose birth occurred between January 1 and December 31, 2013. A single standardized questionnaire was applied, in the hospital, within 48 hours of delivery. Multivariate analysis was performed using Poisson regression with robust variance...

Evaluating acid-base status is important for monitoring dairy herd health. In a field study, we aimed to compare the acid-base status measured by net acid-base excretion (NABE) in urine with results of venous blood analysis in clinically healthy, but possibly metabolically burdened cows in their transition period. For this, we sampled blood from the jugular vein and urine from 145 German Holstein cows within 1 to 76 days post-partum. In blood, the metabolic parameters non-esterified fatty acids (NEFA) and β-hydroxybutyrate (BHB), as well as numerous parameters of the acid-base status were measured...

A lumboperitoneal shunt facilitates dynamic flow of cerebrospinal fluid into the peritoneum. Consequently, neuraxial technique placement in the parturient with a lumboperitoneal shunt can result in unexpected levels of blockade. We present the case of a parturient with a lumboperitoneal shunt who experienced symptoms consistent with high blockade after epidural administration of 450 mg chloroprocaine. This report emphasizes potential mechanisms for high neuraxial blockade and strategies to decrease risks in this unique patient population...

BACKGROUND: Phenylephrine is the first-line vasoactive drug in the cesarean section under spinal anesthesia. The rate of hypotension remains high after intravenous preventive use of phenylephrine. However, few studies have investigated the effect of preventive intramuscular phenylephrine via a longer period of usage on fetal and maternal outcomes. METHODS: A total of 99 healthy parturients undergoing elective cesarean delivery were randomly allocated into three groups: M group (preventive intramuscular use of 5 mg phenylephrine), V group (preventive intravenous use of 100 μg phenylephrine), and P group (0...

Background and Aims: Post-dural puncture headache (PDPH) is a consequence of spinal and epidural anaesthesia in approximately 1% of obstetric patients. The gold standard for its treatment is epidural blood patch. Sphenopalatine ganglion block (SPGB) has been proposed as a non-invasive intervention with minimal adverse effect. The primary objective of this study was to assess the efficacy of SPGB for treatment of PDPH. Secondary objectives were to assess onset of analgesia, duration of block and adverse effects...

BACKGROUND: Anticoagulant therapy during pregnancy is widely used due to the increasing awareness of maternal hypercoagulability. Few studies have reported the use of minimally invasive spinal anesthesia in these parturients. The objective of this study was to evaluate the safety and feasibility of minimally invasive spinal anesthesia in parturients with anticoagulation therapy undergoing cesarean section. METHODS: This was a randomized, controlled study conducted in 239 parturients using anticoagulants and undergoing selective cesarean section...

Background: The results of previous studies have shown that using sequential intrathecal injection of fentanyl and hyperbaric bupivacaine for cesarean section (CS) anesthesia provides better quality anesthesia and prolongs postoperative analgesia. The aim of this study was to determine whether rapid intrathecal injection of fentanyl followed by slow injection of hyperbaric bupivacaine affects the duration of postoperative analgesia, the quality of anesthesia and hemodynamic status. Methods: Fifty-six American Society of Anesthesiologists physical status I and II parturients aged 18-40 years old who underwent elective CS were randomly assigned to two groups of 28 patients each...