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Labor anesthesia

B Carvalho, K M Seligman, C F Weiniger
BACKGROUND: The study aimed to compare the accuracy of epidural depth estimation of a handheld ultrasound device, with an integrated algorithm that estimates epidural depth (AU; Accuro, Rivanna Medical), to that of a console ultrasound machine (GU; GE LOGICTM S8). METHODS: Women requesting labor epidural analgesia consented to this prospective cohort study. The L2/3, L3/4, and L4/5 interspaces and the respective depths to the epidural space were identified, marked and measured using an AU and GU...
January 11, 2019: International Journal of Obstetric Anesthesia
Min Jang, Sooyoung Choi, In Lee, Inhyung Lee
OBJECTIVE: To describe computed tomographic (CT) features of intra-abdominal hypertension (IAH) in 3 dogs with abdominal distension. CASE SUMMARY: Three dogs with anorexia, distended abdomen, or labored breathing were presented for CT imaging. All 3 dogs were premedicated with IV butorphanol (0.2 mg/kg). A Foley urinary catheter was aseptically placed and the transvesical technique was used to obtain intra-abdominal pressure (IAP). The IAP measurements were obtained with the dogs in a standing position after a stabilization period of 5 minutes...
February 11, 2019: Journal of Veterinary Emergency and Critical Care
Alexander J Straughan, Pamela A Mudd, Allison L Silva, Susan S Callicott, Gina Krakovsky, Nancy M Bauman
OBJECTIVE: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution's VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist...
February 9, 2019: Annals of Otology, Rhinology, and Laryngology
Piya Chaemsaithong, Angel H W Kwan, Wing Ting Tse, Wen Teng Lim, Winnie W Y Chan, Ka Chun Chong, Tak Yeung Leung, Liona C Poon
BACKGROUND: The traditional approach to assessing labor progress is by digital vaginal examination, however, it is subjective and imprecise. Recent studies have investigated the role of transperineal ultrasonographic assessment of fetal head descent by measuring angle of progression and head-perineum distance. OBJECTIVE: The objective of this study was to evaluate factors that affected labor progress, defined by the transperineal ultrasonographic parameters, in women achieving vaginal delivery...
February 5, 2019: American Journal of Obstetrics and Gynecology
Safinaz Abdelrahman, Nooraldaem Yousif
BACKGROUND: Mitral stenosis is one of the most commonly encountered valvular heart diseases during pregnancy, the majority are rheumatic in origin and poorly tolerated due to cardio circulatory changes that occur during pregnancy, labor and postpartum. OBJECTIVE: The distinctive physiological events that arise during pregnancy and labor and the influence of mitral stenosis are tackled in this article. METHOD: Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade as well as the recommendations from guidelines of high-impact worldwide...
February 7, 2019: Reviews on Recent Clinical Trials
Jacob Davidson, Khrystyna Ioanidis, Vanessa Fantillo, Josee Paradis, Julie Strychowsky
OBJECTIVES: Minor pediatric surgeries performed in the minor procedure room (MPR) may be more time efficient and less costly compared to those performed in the operating room (OR). STUDY DESIGN: Retrospective review. METHODS: This was a retrospective study on cost and efficiency differences of bilateral myringotomy with tube insertions performed in the MPR versus the OR. Charts were reviewed from June 2015 to May 2017. Cost data was based on supply cost and case costing of medical personnel including nurses, aides, and anesthesia assistants...
February 5, 2019: Laryngoscope
Stacey E Iobst, Rachel B Breman, Debra Bingham, Carla L Storr, Shijun Zhu, Meg Johantgen
BACKGROUND: Admission in early labor is associated with increased likelihood of cesarean birth, but the context in which this occurs is unclear. Previous research has explored the relationship between dilatation at admission and the use of single intrapartum interventions; however, the majority of women in the United States receive multiple intrapartum interventions. The objective of this study was to examine the associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women with spontaneous onset of labor...
January 28, 2019: Birth
Gennadiy A Katsevman, Ryan C Turner, Cletus Cheyuo, Charles L Rosen, Matthew S Smith
Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis...
January 18, 2019: Acta Neurochirurgica
Chung Hun Lee, Sang Sik Choi, Mi Kyoung Lee, Jung Eun Kim, Dong Ik Chung, Mido Lee
BACKGROUND: The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%. OBJECTIVES: To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery. STUDY DESIGN: An open label randomized prospective study. METHODS: Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation...
2019: PloS One
Yaniv Zipori, Oren Grunwald, Yuval Ginsberg, Ron Beloosesky, Zeev Weiner
BACKGROUND: A low rate of primary cesarean delivery is expected to reduce some of the major complications that are associated with a repeat cesarean delivery such as uterine rupture, adhesive placental disorders, hysterectomy and even maternal death. Since 2014, and in alignment with the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, we changed our approach to labor dystocia, defined as abnormal progression of labor, by allowing a longer duration of the second stage of labor...
October 25, 2018: American Journal of Obstetrics and Gynecology
Yuki Hosokawa, Toshiyuki Okutomi, Shunsuke Hyuga, Rie Kato, Krzysztof M Kuczkowski
BACKGROUND: The accurate identification of an intervertebral lumbar level is essential to avoid neuraxial anesthesia and analgesia-related spinal cord injury. It has been shown that estimation of L3/4 intervertebral lumbar level based on the intercristal line determined by palpation (palpated L3/4) is often inaccurate. However; studies evaluating intervertebral lumbar level concordance based on palpation vs. ultrasonography were conducted in Western populations (i.e. in North America and/or Europe)...
January 6, 2019: Journal of Maternal-fetal & Neonatal Medicine
Hongying Wu, Jiayi Yue
BACKGROUND: We examined the influence of pre-pregnancy body weight on the rates of attempted and successfully assisted-vaginal delivery. METHODS: We used 2008-2016 inpatient records including 3408 women who had singleton gestations and needed operative delivery assistance to conduct a retrospective cohort study. Patients were categorized based on pre-pregnancy BMI (normal weight = 18.5 to less than 25 or obese = 30 or greater). We used logistic regression to estimate odds ratios and 95% confidence intervals of attempted and successful forceps or vacuum-assisted vaginal delivery by body weight adjusted for marital status, age, gestational age, induction of labor, episiotomy, diabetes, and birth weight...
December 27, 2018: BMC Pregnancy and Childbirth
Pierre Descargues, Catherine Battie, Cyril Huissoud, Nathalie Hoen, Yesim Dargaud, Muriel Doret, Pascal Gaucherand
OBJECTIVES: Adrenal vein thrombosis during pregnancy is a rare thromboembolic event but is not exceptional. The objective of this study was to described the symptoms, diagnosis, treatment and follow-up of patients with this condition. STUDY DESIGN: This was a retrospective descriptive study of 14 cases (13 patients, one recurrence) that occurred in the three university maternity hospitals in Lyon (France) from 2008 to 2016. RESULTS: Adrenal vein thrombosis occurred exclusively in the third trimester (gestational age > 28 weeks), with most patients presenting unilateral lumbar pain (13/14 cases, 93%) and vomiting (8 cases, 57%), mimicking renal colic...
February 2019: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Laurence Ring, Ruth Landau
As major stakeholders in the labor and delivery suite, obstetric anesthesiologists are frequently called upon to provide their unique skill sets and expertise to the management of postpartum hemorrhage, whether anticipated or not. Essential contributions of the anesthesia team ideally begin in the antenatal period with referral of women at high risk of postpartum hemorrhage to an outpatient obstetric anesthesia clinic where a tailored plan for both urgent or scheduled delivery for women with an anticipated complex delivery can be formulated...
November 14, 2018: Seminars in Perinatology
Misgav Rottenstreich, Hen Y Sela, Ori Shen, Rachel Michaelson-Cohen, Arnon Samueloff, Orna Reichman
BACKGROUND: Repeat cesarean delivery (CD) accounts for approximately 15% of all annual deliveries in the US with an estimated 656,250 operations per year. We aimed to study whether prolonged operative time (OT; skin incision to closure) is a risk marker for post-operative maternal complications among women undergoing repeat CD. METHODS: We conducted a cross-sectional retrospective study in a single tertiary center including all women who underwent repeat CD but excluding those with cesarean hysterectomy...
December 4, 2018: BMC Pregnancy and Childbirth
Sara L Zettervall, Andrew Amata, Jeffery S Berger, Paul Dangerfield, Ruth Derkenne, Ramon Go, Deborah Jeon, Kiera Murphy, Molly Phillips, Marian Sherman, Khashayar Vaziri
Background: The use of epidural analgesia for laboring women is generally unavailable at public hospitals in Guyana despite favorable utilization rates in private institutions. In 2014, a healthcare team completed a targeted mission aimed at neuraxial analgesia training of providers at the preeminent public hospital in Georgetown, Guyana. This study evaluates the impact of the training, including provider attitudes, use, and barriers. Methods: A prospective, mixed methods study of all obstetric, nursing, and anesthesiology providers at Georgetown Public Hospital Corporation was completed...
July 2018: Journal of Education in Perioperative Medicine: JEPM
D Shatalin, C F Weiniger, I Buchman, Y Ginosar, S Orbach-Zinger, A Ioscovich
BACKGROUND: This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016. METHODS: Prospective survey questionnaire was emailed to obstetric anesthesia unit directors/chairperson of all 25 labor and delivery services units within the jurisdiction of the Israeli Ministry of Health. RESULTS: The response rate was 100%. Nineteen (76%) units have dedicated anesthesiologist cover...
November 2, 2018: International Journal of Obstetric Anesthesia
Ramsis F Ghaly, Tatiana Tverdohleb, Kenneth D Candido, Nebojsa Nick Knezevic
Background: Ependymomas represent 50-60% of all brain and central nervous system tumors. Previous lumbar spine surgery for resection of an ependymoma should not be considered a relative contraindication for the administration of epidural/subarachnoid anesthesia to patients in labor. Case Description: A 34-year-old G1P0, who underwent resection of an L1-L3 intramedullary ependymoma 8 years previously, presented in active labor with residual left leg numbness and tingling...
2018: Surgical Neurology International
Michal Lipschuetz, Sarah M Cohen, Aya A Lewkowicz, Hagai Amsalem, Rani Haj Yahya, Lorinne Levitt, Simcha Yagel
INTRODUCTION: Professional bodies have published guidelines defining the length of the second stage of labor and when it is "prolonged", according to parity and epidural anesthesia administration. Recently these guidelines have been extended, aiming to reduce rates of unplanned cesarean deliveries. AIMS: To examine the risk factors and outcomes of a prolonged second stage of labor, in order to understand its causes and implications for mothers and neonates, including the delivery mode...
November 2018: Harefuah
K W Arendt, K J Lindley
Cardiovascular disease is the leading cause of maternal mortality in much of the developed world. Risk stratification models can predict which patients are at greatest risk for maternal or fetal morbidity or mortality. Particular cardiac diseases hold significant risk of mortality during pregnancy including pulmonary hypertension, aortic aneurysm, left-ventricular outflow tract obstruction, and severe cardiomyopathy. High-risk patients should deliver at high-resource hospitals under the care of experts in cardiology, obstetrics, perinatology, neonatology and anesthesiology...
September 27, 2018: International Journal of Obstetric Anesthesia
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