1/112. Anaesthetic management of a woman who became paraplegic at 22 weeks' gestation after a spontaneous spinal cord haemorrhage secondary to a presumed arteriovenous malformation.A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.- - - - - - - - - - ranking = 1keywords = breech (Clic here for more details about this article) |
2/112. Strumpell's disease in a patient presenting for cesarean section.PURPOSE: The anesthetic management of a parturient with Strumpell's disease (hereditary or familial spastic paraparesis) who presented for cesarean section is described. This neurological disorder is briefly reviewed and anesthetic implications of the condition are discussed. CLINICAL FEATURES: A 30-yr-old woman in premature labour presented for cesarean section. She had bilateral lower limb spastic paresis which had resulted in her being confined to a wheelchair from the age of 13 yr. A diagnosis of Strumpell's disease had been made in childhood. She was currently receiving thromboprophylaxis, having suffered a deep venous thrombosis four weeks after a previous cesarean section. The patient was in mild respiratory distress. Despite a history of uneventful general anesthesia and the aforementioned complicating factors, epidural anesthesia was considered the most appropriate technique in these circumstances. An epidural catheter was sited at the L3-L4 interspace. Adequate anesthesia for the procedure was obtained after administration of 20 ml lidocaine 2% with 100 microg epinephrine and 100 microg fentanyl in saline. Postoperatively and at six month follow-up there were no neurological complications related to the use of epidural anesthesia. CONCLUSION: Strumpell's disease is an inherited progressive spastic paresis predominantly affecting the lower extremities. Epidural anesthesia appears to be an appropriate technique when administering anesthesia for cesarean section under similar circumstances.- - - - - - - - - - ranking = 0.033582250502234keywords = labour (Clic here for more details about this article) |
3/112. Funic presentation as a complication of external cephalic version. A case report.BACKGROUND: breech presentation is associated with increased risk. External cephalic version (ECV) has been successful in decreasing the incidence of intrapartum breech presentation. CASE: Funic presentation occurred as a complication of successful ECV. CONCLUSION: The wide-spread use of version calls for increased surveillance for adverse sequelae. At the completion of ECV, ultrasound analysis, pelvic examination and fetal heart rate monitoring are appropriate to exclude serious cord complications.- - - - - - - - - - ranking = 1.5469510918778keywords = breech, breech presentation (Clic here for more details about this article) |
4/112. Obstetrical anesthesia for a parturient with a ventriculoperitoneal shunt and third ventriculostomy.PURPOSE: To describe the anesthetic considerations for a primiparous woman whose history included four neurosurgeries: ventriculoperitoneal (VP) shunt insertion, evacuation of a subdural hematoma, shunt revision, and third ventriculostomy for hydrocephalus secondary to aqueductal stenosis. CLINICAL FEATURES: A 37-yr-old GI, P0 woman with a VP shunt and third ventriculostomy was assessed in the Obstetrical anesthesia Clinic at 36 wk. gestation to consider analgesic options for labour and delivery and review anesthetic management in the event that an operative delivery was required. A third ventriculostomy had been performed when increased intracranial pressure and neurological symptoms reappeared despite the previous VP shunt. pregnancy was uneventful and vaginal delivery was anticipated. She presented in spontaneous labour at 40 wk. gestation. She declined analgesia throughout her four and a half hour labour A mediolateral episiotomy was performed to facilitate spontaneous delivery of a 4,182 g female infant. Mother and baby were discharged home without incident after two days. She denied any problems, including headaches, on follow up at two and four weeks. CONCLUSION: A review of the literature concerning pregnant patients with shunts found that both regional and general anesthesia has been used with no reports of complications directly related to anesthesia. No published cases describing labour analgesia for patients with third ventriculostomy were found. Two neurosurgeons advised that regional anesthesia was not contraindicated in such patients and that analgesia should be based on obstetrical considerations and the neurological status of the patient.- - - - - - - - - - ranking = 0.13432900200894keywords = labour (Clic here for more details about this article) |
5/112. Combined spinal-epidural in the obstetric patient with Harrington rods assisted by ultrasonography.We describe a patient with severe scoliosis, which had been corrected partially with Harrington rods, who requested epidural analgesia for labour. With no palpable landmarks, the use of ultrasound enabled identification of the vertebral midline and allowed provision of regional anaesthesia.- - - - - - - - - - ranking = 0.033582250502234keywords = labour (Clic here for more details about this article) |
6/112. Familial hypokalemic periodic paralysis and wolff-parkinson-white syndrome in pregnancy.PURPOSE: To describe the anesthetic and obstetrical management of a pregnant patient with co-existing Familial hypokalemic periodic paralysis (FHPP) and wolff-parkinson-white syndrome (WPW). CLINICAL FEATURES: A 29 yr-old primigravida with FHPP and WPW presented to the antenatal clinic at 18 wk gestation, for consideration of her anesthetic and obstetrical management during labour and delivery. A plan was constructed to avoid the known precipitating factors of FHPP including carbohydrate loading, cold, mental stress and exercise, which could lead to acute attacks of weakness. She presented for induction of labour at 41 wk and three days. An epidural catheter was sited early in labour. The second stage was limited to less than one hour. She had a rotational forceps delivery for which the epidural was extended to provide anesthesia. A healthy male baby was delivered. The patient made an uncomplicated recovery and was discharged home on the second postnatal day. The peripartum potassium was kept within the normal range with intravenous as well as oral potassium supplementation. No arrhythmias were reported. CONCLUSION: Assessment of the patient at an early stage in her pregnancy allowed for a multidisciplinary approach to this patient and her medical problems. A plan was made to avoid known precipitating factors during labour, delivery and the postnatal period well in advance of her date of confinement, leading to a successful outcome for mother and child.- - - - - - - - - - ranking = 0.13432900200894keywords = labour (Clic here for more details about this article) |
7/112. zinc deficiency in malabsorption states: a cause of infertility?Thirteen patients with malabsorption, 7 women and 5 men, were investigated extensively. All showed low serum zinc concentrations irrespective of the duration of illness and degree of malabsorption. Eleven of the 13 had active coeliac disease. It was suspected that the low serum zinc concentrations reflected a state of zinc deficiency, and this theory was borne out by the fact that no inflammatory reaction, no clear-cut albumin deficiency, and no oestrogen or corticosteroid influence could be demonstrated. All 7 women suffered from infertility, in most of them of long standing. Two showed secondary infertility after pregnancy and abnormal labour resulting in infants with congenital malformations (one case of bilateral congenital dislocation of the hip and one of multiple cardiac anomalies). I have reported similar complications in pregnancies in which the serum zinc was low. One of the infertile women conceived after the institution of gluten-free diet and zinc therapy, but later aborted spontaneously. Investigations on zinc metabolism and intestinal absorption might well prove valuable in otherwise unexplained infertility and could open up a new therapeutic approach.- - - - - - - - - - ranking = 0.033582250502234keywords = labour (Clic here for more details about this article) |
8/112. Anaesthetic management of a parturient with a colloid cyst of the third ventricle.A colloid cyst in the third ventricle near the foramen of Monroe can obstruct cerebrospinal fluid (CSF) flow from the lateral ventricles. Any change in the CSF pressure on either side of the cyst can lead to displacement and thus precipitate acute hydrocephalus. Management of the confinement of a patient with a colloid cyst must therefore aim to minimize changes in CSF pressure. We describe our management of a patient with a small colloid cyst who was permitted to labour with the assistance of patient-controlled epidural analgesia. The available alternatives are discussed.- - - - - - - - - - ranking = 0.033582250502234keywords = labour (Clic here for more details about this article) |
9/112. Twin pregnancy following gonadotrophin therapy in a patient with Sheehan's syndrome.A case of Sheehan's syndrome presented with secondary amenorrhea and was put on L-thyroxine, prednisolone and cyclical estrogen and progestin. ovulation induction with gonadotrophins and intrauterine insemination with husband's semen resulted in a twin pregnancy. Antepartum course was complicated by bronchial asthma, gestational diabetes and pregnancy-induced hypertension. Cesarian section was done at 34 weeks gestation for preterm rupture of membranes and breech presentation. Both babies and their mother were doing well at 6 months of follow-up.- - - - - - - - - - ranking = 1.5469510918778keywords = breech, breech presentation (Clic here for more details about this article) |
10/112. Anaesthetic management of a pregnant patient in a persistent vegetative state.pregnancy in a patient in a persistent vegetative state presents challenging therapeutic questions about the level of supportive management required, the assessment of fetal well-being, the timing and mode of delivery and the anaesthetic management of labour and delivery. We report the case of a 29-yr-old woman who had a favourable fetal outcome despite suffering hypoxic brain damage after a suicide attempt by a drug overdose. She was managed until the onset of labour on an intensive care unit and had a spontaneous vaginal delivery assisted by epidural anaesthesia.- - - - - - - - - - ranking = 0.067164501004468keywords = labour (Clic here for more details about this article) |
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