Academic literature on the topic 'Obstetric Haemorrhage'
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Journal articles on the topic "Obstetric Haemorrhage"
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Kilgert, K., and G. Pfanner. "Obstetric bleeding complications." Hämostaseologie 26, S 02 (2006): S56—S63. http://dx.doi.org/10.1055/s-0037-1617083.
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SummaryThe instability of the gestational and puerperal equilibrium of haemostasis is affected by a shift of primary and plasmatic haemostasis in a procoagulatory direction, whereas the regulation mechanism of the fibrinolytic system can easily cause disproportional peri- and postpartal reaction leading to massive haemorrhage. Peripartal injuries or an atonic uterus can lead to massive haemorrhage and cause a classic haemorrhagic coagulopathy. Complications like amniotic fluid embolism, puerperal sepsis, eclampsia or HELLP syndrom can lead through DIC to rapidly developing and possibly fulminant hyperfibrinolysis.This article depicts different forms of haemorrhage in the peripartal situation, their particular pathologies and specific possibilities for management. A case study demonstrates the diagnostic and therapeutic options in the case of eclampsia with early abruption of placenta.
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MacLean, A. B. "Obstetric Haemorrhage." Journal of Obstetrics and Gynaecology 32, no. 1 (December 20, 2011): 1. http://dx.doi.org/10.3109/01443615.2012.638554.
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McLintock, Claire. "Obstetric haemorrhage." Thrombosis Research 123 (January 2009): S30—S34. http://dx.doi.org/10.1016/s0049-3848(09)70006-4.
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Wise, Arlene, and Vicki Clark. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 8, no. 8 (August 2007): 326–30. http://dx.doi.org/10.1016/j.mpaic.2007.06.002.
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Wise, Arlene, and Vicki Clark. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 11, no. 8 (August 2010): 319–23. http://dx.doi.org/10.1016/j.mpaic.2010.05.004.
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Maclennan, Kirsty, and Rachael Croft. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 14, no. 8 (August 2013): 337–41. http://dx.doi.org/10.1016/j.mpaic.2013.05.009.
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Mount, Thomas, and Kirsty MacLennan. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 17, no. 8 (August 2016): 379–83. http://dx.doi.org/10.1016/j.mpaic.2016.05.009.
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Ching, Rosanne, Thomas Mount, and Kirsty MacLennan. "Obstetric haemorrhage." Anaesthesia & Intensive Care Medicine 20, no. 9 (September 2019): 484–88. http://dx.doi.org/10.1016/j.mpaic.2019.07.006.
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Higgins, Shane. "Obstetric haemorrhage." Emergency Medicine Australasia 15, no. 3 (June 2003): 227–31. http://dx.doi.org/10.1046/j.1442-2026.2003.00464.x.
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Reyes Espinoza, Ixchel Suyapa. "Obstetric Hemorrhage, its role in maternal morbidity and mortality and the importance of its diagnosis, prevention and timely management." Mexican Journal of Medical Research ICSA 8, no. 15 (January 5, 2020): 37–44. http://dx.doi.org/10.29057/mjmr.v8i15.3906.
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Background: In recent years, different international and national campaigns have been implemented to combat obstetric haemorrhage. Maternal mortality (MM) is one of the main concerns of public health and represents a good indicator to measure the quality of care, an indicator that also allows to establish the socioeconomic differences between countries. There are still many activities to be carried out and achieve the objective set by the World Health Organization (WHO) and the Latin American Federation of Societies in Obstetrics and Gynaecology (FLASOG) "Zero deaths due to haemorrhage". Objective: Based on the scientific evidence available, deepen the knowledge of the role of obstetric haemorrhage as the main avoidable cause of maternal morbidity and mortality. Methodology: retrospective study through the search of original articles and systematic reviews in: Elsevier, Lancet, Intramed, PubMed, EMBASE, ScienceDirect and Cochrane Library. The following keywords were used for all sites: "Obstetric haemorrhage", "Maternal mortality and obstetric haemorrhage", "Maternal morbidity and obstetric haemorrhage", "Postpartum, late, secondary haemorrhage". The items with the highest level of evidence were selected. Conclusions: Obstetric haemorrhage is still a potential cause of maternal and fetal morbidity and mortality. Its appearance at any time of pregnancy is a cause for concern and alarm. Despite advances in obstetric and anesthetic care, its treatment remains a challenge for the surgical team, anesthesiologist, gynaecologist and Pediatrician.
Dissertations / Theses on the topic "Obstetric Haemorrhage"
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Parsons, Janine, and janine parsons@svhm org au. "The Experiences of Men whose Partners have been Admitted to an Intensive Care Unit (ICU) Immediately after Childbirth." RMIT University. Health Sciences, 2008. http://adt.lib.rmit.edu.au/adt/public/adt-VIT20080805.141158.
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ABSTRACT Naturalistic Inquiry was used to explore, describe and discover the experiences and perceptions of men whose partners have been admitted to an Intensive Care Unit (ICU) immediately after childbirth. The sixteen men's experiences were explored using semi-structured open-ended questions. Data were analysed using thematic content analysis. The research questions driving this study were: What are men's experiences and perceptions of the incidence and impact of their partners being admitted to ICU following the complications of childbirth? What is the nature of the relationships and interactions that men have with healthcare professionals before, during and after their partner's ICU admission following the complications of childbirth? What impact did the experience of their partners being admitted to ICU, following the complications of childbirth, have on the men's relationships with their partners, newborn child, and other children? What impact did the experiences of their partners being admitted to ICU following the complications of childbirth have on their future life plans? During the time of their partners' obstetric crisis the men, in this study, were left isolated, alone and struggling. The current healthcare policy and practice for men with their partners in life-threatening situations intrapartum and immediately postpartum failed 16 families.
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Adams, Tracey. "A quality of care assessment of the management of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/3058.
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Includes bibliographical references (leaves 64-68).In South Africa obstetric haemorrhage is the third most common cause of maternal deaths. In addition to maternal mortality audits, quality of care audits using criterion based audit methodology provides useful information. The aim of this study was to audit the management of all women with severe obstetric haemorrhage in the Peninsula Maternal and Neonatal Services in order to improve management. A descriptive retrospective audit was conducted during the period August 2006 to August 2007 using a criterion based audit methodology. Cases of severe obstetric haemorrhage were identified prospectively. Folders were reviewed and data collection sheets utilized to: 1. Describe the demographics and causes of obstetric haemorrhage in the Peninsula Maternal and Neonatal Services, 2. Measure the case fatality ratio, 3. Describe the management of women with severe obstetric haemorrhage with reference to that prescribed in the South African National Guidelines (2002-2004), 4. Score the management provided by the Peninsula Maternal and Neonatal Services using a shorter checklist devised from the National Guidelines.
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Muavha, Dakalo Arnold. "The use of uterine compression sutures in the management of patients with severe postpartum haemorrhage in a regional obstetric hospital." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27017.
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Background: Postpartum haemorrhage (PPH) is a direct leading cause of maternal death in developing countries including South Africa, and atonic uterus is responsible for up to 80% of cases of postpartum haemorrhage. The introduction of the uterine compression suture (UCS) by C B-Lynch revolutionised the conservative surgical management of postpartum haemorrhage. Its use is simple, does not require special training and reduces the need for hysterectomy. Many small studies have been conducted in different parts of the world on its effectiveness but no published studies have been found from Africa. To understand the unique challenges in developing countries, especially those in Africa, it would be relevant to establish if uterine compression sutures are beneficial in a low resource setting for the management of PPH. Accordingly, the aim of the present study was to audit the use of uterine compression suture (UCS) in our regional hospital, with a focus on the circumstances in which it was used and its success rate in treating postpartum haemorrhage. Methods: This was a retrospective folder review study of all women who had a UCS inserted to treat obstetric haemorrhage in Mowbray Maternity Hospital during the period between January 2010 and June 2016, following ethical approval from the UCT HREC and Mowbray Maternity Hospital's management. Cases were identified from theatre registrars and a designated UCS book. Patients' records were retrieved and data collected and analyzed using the Excel spreadsheet software. Results: During the 6.5-year study period, there were 132, 612 deliveries in the population served by Mowbray maternity Hospital, of which 102,261 (78%) were by normal vaginal delivery and 30,351 (22%) by caesarean section. A total of 150 UCS cases were identified giving a rate of 0.87 UCS per 1000 deliveries (at MMH and its referral MOUs). Of the 150 cases, 115 (77%) patient files could be retrieved for further analysis. UCS was performed more commonly after ceasarean section (107; 93%) than after vaginal delivery (8; 7%) The majority were performed by obstetric registrars (73; 63.4%) compared to 21 (18.3%) performed by consultants and by medical officers. The UCS was successful in stopping haemorrhage without the need for hysterectomy in 107 (93%) of all analyzed cases. Among the 8 failures, all required a hysterectomy and one woman died. The majority of UCS (50%) were performed in cases with estimated blood loss over 1000 mls, with 20.9% having blood loss more than 2000mls. Of note, 13.9% had an estimated blood loss (EBL) less than 500 mls (the majority of which were performed by medical officers). Short term morbidity of UCS cases included blood transfusion (42%), admission to ICU (8.7%), post ceasarean section sepsis (9.6%), and prolonged hospital stay (46.1%). Discussion and conclusion: This study is one of the largest case series and the first done in an African setting. Our success rate of 93% is similar to other previously reported published studies with similar low rates of short term morbidity. Our study confirmed that the success of the UCS is achievable even in low-resource environments and that UCS can be safely performed by surgeons with different levels of surgical expertise (medical officers as well as registrars and consultants).
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Byrskog, Ulrica, Eva Eriksson, and Annica Sundell. "Kvinnlig Könsstympning : Litteraturstudie om praktisk handläggning och komplikationsrisker vid förlossning." Thesis, Högskolan Dalarna, Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:du-1636.
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Today around 28 000 women originally from countries where FGM is practised, are living in Sweden. Many of them are at childbearing age which means that knowledge about FGM and its consequences is of outmost importance during delivery. The aim of this study is to describe current research on how to manage the delivery, regarding deinfibulation and the following stitching as well as the risk of complications when the labouring woman is mutilated. This review of literature is based on 12 scientific articles published between years 1989 – 2005. Five different databases have been searched with use of a large number of keywords.The review found that no scientific research has been carried out that describes how deinfibulation and following stitching should be managed when the woman is mutilated. All available articles within this area are referring to best practice only. The review also found that the conclusions of the studies are contradictory. The majority, however, show an increased frequency for prolonged labour that could be related to FGM. The three largest studies also show an increased rate of caesarean section among mutilated women. In the few studies that examine haemorrhage, the majorities show an increased tendency to bleed, that could be related to FGM. Several articles emphasize the importance of good routines for deinfibulation to reduce the risk for complications.In summary it can be established that due to methodological problems in many studies, no reliable conclusion can be made that the researched complications exists to a greater extent when the woman is mutilated
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Abdul-Kadir, Rezan Ahmed. "Inherited bleeding disorders in obstetrics and gynaecology." Thesis, University of London, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391628.
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Aflaifel, Nasreen. "Postpartum haemorrhage : new insights from published trials and the development of novel management options." Thesis, University of Liverpool, 2015. http://livrepository.liverpool.ac.uk/2015019/.
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Postpartum haemorrhage (PPH) is the most common cause of maternal mortality leading to an estimated 86, 000 deaths/year. The most common cause of PPH is failure of the uterus to contract properly (uterine atony). Several measures have been introduced to prevent and treat atonic PPH, but in spite of active management of the third stage of labour (AMTSL), maternal deaths from PPH still occur. PPH can kill rapidly within two hours or less. PPH has long been recognised as a dangerous complication for mothers. In order to optimise the prevention and treatment of PPH, different approaches have been introduced and modified over the last century. We reviewed the regimes used in the management of the third stage of labour between 1917 and 2011 as described in the successive editions of the ‘Ten Teachers’ books. Throughout the Ten Teachers series, uterotonic drugs have always been taught as being the best initial measure to manage PPH. However, the importance of bimanual uterine compression (BMC) has increased gradually, moving from third to first treatment option over the editions (Aflaifel and Weeks, 2012a). The components of the AMTSL package for PPH prophylaxis have recently been extensively examined in clinical trials. Its effectiveness in reducing blood loss is now known to be almost all due to the uterotonics (Aflaifel and Weeks, 2012b). However, clinical trials evaluating the efficacy of uterotonics in treating PPH are comparatively rare. Where present they usually compare two uterotonics with an absence of control group, as it is unethical to leave a bleeding woman untreated. A recent innovation is to model the likely outcomes in the absence of uterotonic therapy through histograms. This also allows an assessment of the efficiency of treatment by measuring the number of women who stop bleeding shortly after administering treatments. This model has never previously been applied to databases in which uterotonics were used for prophylaxis. In a secondary analysis of 4 large randomised trials, small secondary histogram peaks (primarily attributed to a treatment effect) were still present even if uterotonic therapy had not been used. Furthermore, the study revealed that women were commonly treated at low levels of blood loss (< 500 mls). It was also seen that, of those diagnosed with PPH (≥ 500 mls), most stopped bleeding at blood losses of around 700 mls even if they did not receive any uterotonic therapy. This should warn against ascribing all the effect to uterotonic therapy. As well as stopping spontaneously, other physical therapies may also have been used concurrently and may have had an effect. The evidence from the histogram study suggested that use of additional uterotonic is not a good surrogate for PPH in the research context. Chapter 4 reports on evaluations of the outcomes that are used by researchers in PPH trials. In the 121 studies evaluated, there was a huge diversity in choosing the outcomes (PPH prevention). The most common was ‘Incidence of PPH ≥ 500 mls’, which was mentioned in 21% (25/121) of trials. The study interestingly showed that use of additional uterotonic was used for sample size calculation in 6% (7/121) of studies as a surrogate for PPH. The above findings emphasise the importance of physical measures in the early treatment of PPH. BMC is thought to help in treating PPH, although there are no clinical trials on its effectiveness. A survey was therefore conducted amongst obstetric care providers in the UK to look at the frequency of BMC use in clinical practice and the attitudes towards its use. The survey found that, although clinicians find BMC effective, it is rarely used as the procedure is considered to be too tiring and too invasive. If, however, BMC could be performed in a less invasive manner, then it could act as an effective low-cost treatment for those PPHs arising from atony. The thesis concludes with an investigation into a new low cost intervention that might contribute to the early physical management of PPH. The ‘PPH Butterfly’ is a new device that is designed to make uterine compression simpler, less tiring and less invasive. It was compared to the standard BMC in a mannequin model. The main objective was to compare the efficacy of the PPH Butterfly to standard BMC in producing sustained uterine compression. The study revealed that the PPH Butterfly is simple to use on a mannequin model, even among obstetric care providers with little experience. It produces an equivalent amount of pressure to BMC, but neither method produced sustained compression over the 5 minutes of use. It also demonstrates the feasibility of using a mannequin model for teaching and performing BMC.
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Pheto, Peloentle. "An audit of uterotonic use for the prophylaxis and treatment of haemorrhage at caesarean delivery at Mowbray Maternity Hospital, Cape Town, South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29673.
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Obstetric Haemorrhage is the leading cause of maternal death globally (1) and the third leading cause of death in South Africa (2). Concern has been expressed in South Africa that bleeding associated with caesarean delivery (CD) accounts for one-third of haemorrhage deaths and this has increased over the last ten years (3). The underlying cause of bleeding at CD is commonly uterine atony, and the majority of the CDs were performed at district hospitals (2,3,4). The Saving Mothers Reports describe inadequate use and documentation of uterotonics to prevent or treat bleeding at CD and have promoted the development of a standardised national protocol. While there is international agreement on the dosage and administration route for oxytocin to prevent OH after vaginal delivery, there is lack of consensus or standardisation of protocols for its prophylactic use at CD, with marked differences between country and facility protocols. Anaesthetists are concerned about the hypotensive effect of high dose intravenous boluses of oxytocin, particularly in women under spinal anaesthesia, and some maternal mortalities in the United Kingdom have been partially attributed to this (5). Hence it is important to balance safety with efficacy by promoting the lowest effective doses to minimise side effects but enable uterine contraction. Aim: The aim of this study was to perform a clinical audit of the documented use of uterotonics at CD at MMH to see how it adheres to the national protocol; and as a secondary outcome to measure the rate of haemorrhage at CD. Methods: This was a retrospective folder review of women who delivered by CD at MMH during the months of June and July 2017, including both elective and emergency operations. Information was obtained from women’s folders kept in the medical records department, using especially designed data extraction sheets. Data analysis was by simple descriptive statistics. Results: Three hundred and nineteen (319) folders from the study period were interrogated. This included 239 emergency CDs (75%) and 80 elective CDs (25%). They were all performed by obstetric registrars or medical officers with 89% being done under spinal anesthesia. Prophylactic oxytocin boluses at CD were given in 302 (94.7%) women but there was no documentation of its use in 17 (5.3%). One of the 302 women had a high dose IV bolus (7.5 IU) but the remainder had boluses below 5 IU. There were 75 women (23.5%) patients who received the national recommended dose of 2.5 IU IVI while 227 (71.1%) received alternative low dose boluses which were all less than 5 IU. The dose most commonly given was 3 IU; to 169 patients (53%) as a single or divided dose. There was wide variation in the dosage of prophylactic infusions with only 18 (5.6%) patients receiving the recommended intraoperative 7.5 IU infusion, while 221 (66.5%) received alternate infusion doses. Only 49 (15%) were discharged from theatre recovery to the postnatal ward with a prophylactic infusion running. In total 65 (20.4%) of the women received a 20 IU oxytocin infusion but it was unclear whether this was for prophylaxis or treatment. No intramuscular doses of oxytocin or syntometrine were given for prophylaxis. Among the 319 CDs, 13 (4.1%) had documented blood loss over 1000 ml and 24 (7.5%) had uterine atony reported by the surgeon. The most common treatment was 20 IU infusion followed by misoprostol (13 women), syntometrine (three women) and tranexamic acid (one woman). Additional surgical measures required were B-Lynch compression suture for one, and haemostatic sutures for two. There were no re-look laparotomies or hysterectomies during the study period and there were no major morbidity or mortalities from either CD or from anaesthetic complications. Discussion: Low dose bolus oxytocin and infusion is widely used at CD post fetal delivery at MMH, although the dose of 3 IU was most commonly used in contrast to the recommended 2.5 IU in the national protocol. There was variation in the usage and dosage of prophylactic oxytocin infusion. The rate of PPH in the subjects was low (4.1%) with the low dose prophylactic regimens used, suggesting that they were effective, although this may also have been contributed to by the skill of the surgeons. Consensus is needed among anaesthetists and standardisation of protocols on oxytocin prophylaxis at CD, particularly for training doctors working in district hospitals. Repeating this audit in district hospitals where there are higher CD case fatality rates would be important to shed light on practice in such facilities and improve healthcare delivery.
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Bailey, Elizabeth Helen. "An investigation into the combination of nifedipine with potassium channel openers as potential tocolytic therapy for preterm labour, and a novel potassium channel blocker as potential therapy for post-partum haemorrhage." Thesis, University of Warwick, 2015. http://wrap.warwick.ac.uk/78668/.
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Background Preterm labour and post-partum haemorrhage are leading causes of pregnancy morbidity and mortality. Previous work identified potassium channels expressed in myometrium and hypothesized modulation of channels with greater expression in MSMC than VSMC will influence contractility and avoid cardiovascular effects. By combining calcium channel blockers with potassium channel openers an enhanced tocolytic effect is anticipated. VU590 inhibits Kir 7.1 and it was hypothesised would elicit a contractile effect with therapeutic potential for post-partum haemorrhage. Aim To determine the effect of select potassium channel openers and a specific potassium channel blocker in myometrial contractility. Methods Human and murine myometrial strips were used in contractility organ bath experiments. Select combined doses were tested in myometrial small arteries using wire myography. Western blotting was carried out to determine the gestational and labour-state expression of potassium channels in human myometrium and myometrial small arteries. Results Pinacidil demonstrated a relaxatory effect on both myometrial and vascular smooth muscle. Riluzole reduced contractility alone and greater inhibition in combination with nifedipine than nifedipine alone. Riluzole appeared to have a mild effect on myometrial arteries. Kir 7.1 showed a trend of diminished expression by gestation and was downregulated in term and preterm labour states. VU590 elicited a significant increase contractility characterised by a prolonged contraction phase of up to 6.7±1.9 hrs (VU590 10 µM). A gestational-dependent effect was seen on murine myometrium. Conclusion The combination of nifedipine with potassium channel openers has a more potent effect on reducing contractility than either compound alone. Riluzole combined with nifedipine warrants further investigation for potential tocolytic therapy. VU590 augments spontaneous contractions profoundly in human myometrium in vitro and could have potential therapeutic benefits in the treatment of postpartum haemorrhage.
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Antwi, Kwadwo Atobra. "Obstetric haemorrhage-related severe maternal outcomes in HIV-infected women." Thesis, 2018. https://hdl.handle.net/10539/25436.
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There is paucity of data on the contribution of HIV infection to obstetric haemorrhage-related severe maternal outcomes (SMO) with some literature suggesting an increased risk in HIV-infected women. Since the leading causes of maternal mortality in South Africa are non-pregnancy related infections, mainly HIV-related, and obstetric haemorrhage, there is a possible relationship between HIV infection and obstetric haemorrhage-related SMO. Hence the aim of this study was to determine whether obstetric haemorrhage-related SMO are increased in HIV-infected women.
A retrospective study of cases of obstetric haemorrhage-related SMO at Chris Hani Baragwanath Academic Hospital, from January to December 2015 was conducted. A total of 73 women had obstetric haemorrhage-related SMO. Of these, 18 (24.7%) women were HIV-infected and 50 (68.5%) uninfected. All the HIV-infected women were on antiretroviral therapy, 50% initiated pre-pregnancy, and the median CD4 count was 409 cells/mm3. There were 65 near-misses, 49 (72.1%) in HIV-infected women, and there were three maternal deaths, two in HIV-infected women.
Previous caesarean section was the commonest identifiable factor associated with obstetric haemorrhage, 6/18 (33.3%) in HIV-infected women and 9/50 (18.0%) in uninfected women. The commonest cause of haemorrhage was postpartum haemorrhage, diagnosed in 65/68 (95.6%) women, and there was no significant difference between HIV-infected and uninfected women. There were no significant differences in the medical and surgical interventions the patients needed.
Obstetric haemorrhage-related SMO were not increased in HIV-infected women in this study likely because it was a relatively healthy population of HIV-infected women. Larger studies are needed to elucidate these findings.LG2018
Books on the topic "Obstetric Haemorrhage"
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Norman, Jane E., and Vicki Clark. Obstetric haemorrhage. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0035.
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Major obstetric haemorrhage affects around 0.4% of pregnant women, accounts for around 50% of intensive care unit admissions amongst pregnant women, and is a significant cause of maternal death. Optimal obstetric and anaesthetic management plays an important role in reducing mortality. Such management includes antenatal optimization (ensuring that pre-delivery haemoglobin is normal, and identifying risk factors such as placenta praevia), prompt recognition of bleeding and senior involvement, and debriefing for staff and patients after the event. This chapter focuses on the causes of, and treatments for, antenatal, intrapartum, and postpartum haemorrhage. Resuscitation and therapeutic (pharmacological and surgical) strategies are described and the use of blood products and cell salvage discussed from the point of view of both the anaesthetist and the obstetrician. Lastly, current controversies, including the use of recombinant factor VII and tranexamic acid are mentioned.
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Waldmann, Carl, Neil Soni, and Andrew Rhodes. Obstetric emergencies. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0031.
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Pre-eclampsia 518Eclampsia 520HELLP syndrome 522Postpartum haemorrhage 524Amniotic fluid embolism 526Pre-eclampsia is a common complication of pregnancy, UK incidence is 3–5%, with a complex hereditary, immunological and environmental aetiology.Abnormal placentation is characterized by impaired myometrial spiral artery relaxation, failure of trophoblastic invasion of these arterial walls and blockage of some vessels with fibrin, platelets and lipid-laden macrophages. There is a 30–40%, reduction in placental perfusion by the uterine arcuate arteries as seen by Doppler studies at 18–24 weeks gestation. Ultimately the shrunken, calcified, and microembolized placenta typical of the disease is seen. The placental lesion is responsible for fetal growth retardation and increased risks of premature labour, abruption and fetal demise. Maternal systemic features of this condition are characterized by widespread endothelial damage, affecting the peripheral, renal, hepatic, cerebral, and pulmonary vasculatures. These manifest clinically as hypertension, proteinuria and peripheral oedema, and in severe cases as eclamptic convulsions, cerebral haemorrhage (the most common cause of death due to pre-eclampsia in the UK), pulmonary oedema, hepatic infarcts and haemorrhage, coagulopathy and renal dysfunction....
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Prout, Jeremy, Tanya Jones, and Daniel Martin. Obstetric anaesthesia. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199609956.003.0024.
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This chapter covers the knowledge required for higher training in obstetric anaesthesia. Physiological changes of pregnancy, along with their relevance to anaesthetic management are highlighted. Common maternal comorbidity and the impact on antenatal course, delivery and anaesthesia are summarized. Modern labour analgesia techniques are compared. Anaesthetic management of common obstetric emergencies e.g. fetal distress, preeclampsia, massive haemorrhage, abnormal placentation, amniotic fluid embolus and uterine inversion are described. Finally, the recent Confidential Enquiry into Maternal Death is summarized along with the role of early warning scores to improve future care.
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Beed, Martin, Richard Sherman, and Ravi Mahajan. Obstetric and fertility patients. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199696277.003.0013.
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Critical illness in pregnancySevere pre-eclampsia/eclampsiaHELLP syndromeAnaphylactoid syndrome of pregnancyMassive obstetric haemorrhageOvarian hyperstimulation syndromeAny critical illness may complicate pregnancy, or the postpartum period; especially sepsis and thromboembolic disease. Pregnancy-related illnesses may also require critical care intervention, including: pre-eclampsia and eclampsia, the HELLP syndrome, major haemorrhage, and anaphylactoid syndrome of pregnancy (amniotic fluid embolism). As with any critical illness, life-threatening problems are identified and treated first....
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Collis, Rachel, Sarah Harries, and Abrie Theron, eds. Obstetric Anaesthesia. 2nd ed. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780199688524.001.0001.
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Starting work on the labour ward is very challenging for all junior anaesthetists. This handbook is an easily navigated practical reference guide for anaesthetists new to this environment, as well as other members of the labour ward multi-disciplinary team; midwives, obstetricians, and Consultant Anaesthetists who visit labour ward less frequently or only when on-call. It covers all aspects of obstetric anaesthesia that the trainee anaesthetist will encounter during their obstetric training module, and is essential reading for FRCA exam preparation. Since the first edition, there is no doubt that the pregnant population has become more complex, with increasing maternal age and BMI, and challenging co-morbidities presenting more frequently. As well as providing updates from recent MBRRACE reports and national guidelines, new techniques, drugs, and technology, such as point of care testing have been included. New chapters covering the application of ultrasound in obstetric anaesthesia, recognition of the sick and septic patient, maternal obesity and neonatal resuscitation have been introduced. Previous chapters, e.g. haemorrhage, have been extensively updated, with the latest management protocols and algorithms based on recent published research in obstetric bleeding. We have retained our practical guides to performing, managing, and trouble-shooting regional techniques that are more problematic on labour ward, and our extensive A–Z of rarer conditions has updated references. More conventional chapters on maternal physiology and pathophysiology provide readers with essential examination material. The importance of anticipating risk in the antenatal period through high risk anaesthetic assessment clinics and postpartum management of tricky neurological complications is also well covered.
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Eldridge, James, and Maq Jaffer. Obstetric anaesthesia and analgesia. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198719410.003.0033.
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This chapter discusses the anaesthetic management of the pregnant patient, for labour analgesia as well as surgical intervention. It begins with a description of the physiological and pharmacological changes of pregnancy. It describes methods of labour analgesia, including remifentanil, and epidural analgesia and its complications such as post-dural puncture headache. It describes anaesthesia for Caesarean section (both regional and general), failed intubation, antacid prophylaxis, post-operative analgesia, retained placenta, in utero fetal death, hypertensive disease of pregnancy (pre-eclampsia, eclampsia, and the hypertension, elevated liver enzymes, and low platelets (HELLP) syndrome), massive obstetric haemorrhage, placenta praevia and morbidly adherent placenta (placenta accreta, increta, and percreta), amniotic fluid embolism, maternal sepsis, and maternal resuscitation. It discusses co-morbidity in pregnancy, such as obesity and cardiac disease, and the patient who requires non-obstetric surgery while pregnant. It provides information on safe prescribing in pregnancy and breastfeeding.
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Levinson, Andrew, and Ghada Bourjeily. Obstetric Disorders in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0367.
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Critical illness in pregnancy is a rare, but potentially catastrophic event for the mother and foetus. A thorough understanding of the effective management practices for the most common obstetrical reasons for ICU admission is essential for providing effective critical care to women in the ante-partum and immediate post-partum period. Some of the most common reasons for the need for critical care in the peripartum and post-partum period include venous thromboembolism, post-partum haemorrhage, amniotic fluid embolism, ovarian hyperstimulation syndrome, and obstetric sepsis. Management of these conditions should focus on choosing the most effective diagnostic and therapeutic measures for the mother, while focusing on minimizing foetal harm, accounting for physiological changes that may affect diagnostic strategies and pharmacokinetics.
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Adam, Sheila, Sue Osborne, and John Welch. Endocrine, obstetric, and drug overdose emergencies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199696260.003.0014.
Full textAbstract:
This chapter discusses specific endocrine, obstetric, and drug overdose emergencies that necessitate admission to the critical care unit. First, the underlying physiology and management of endocrine disorders such as phaeocromocytoma, Addisonian crisis, diabetic emergencies (such as diabetic ketoacidosis), thyroid disorders, and calcium abnormalities are discussed. Secondly, the physiology and management of pregnancy-related problems are discussed including hypertensive disorders of pregnancy (such as pre-eclampsia), acute fatty liver of pregnancy, peri-partum cardiomyopathy, massive obstetric haemorrhage and amniotic fluid embolism. Finally, the management of drug overdose and toxic substance ingestion from the intial assessment and immediate resuscitation to specific antidotes and supportive therapies is described.
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McKenzie, Alistair G. Historic timeline of obstetric anaesthesia. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0001.
Full textAbstract:
Foremost in the history of obstetric anaesthesia was the introduction of inhalational analgesia by James Simpson in 1847, first with ether and then chloroform. Nitrous oxide was first used in obstetrics in 1880. Neuraxial anaesthesia in obstetrics began with spinal block by Oskar Kreis in 1900, and within 25 years included pudendal, caudal, and paracervical blocks. From 1902 there was a vogue for ‘twilight sleep’, which remained in use until the 1950s. Spinal anaesthesia only became popular with the advent of procaine in 1905; favour declined in the United Kingdom from 1948 and did not return until 40 years later. In 1930, Aburel described the pain pathways of labour. Continuous caudal analgesia for labour was popularized from 1942; it was superseded by the lumbar epidural approach in the 1960s. The arrival of lidocaine in 1950 was a major advance. Another important event in the 1960s was the elucidation of the supine hypotensive syndrome of late pregnancy. In the 1940s, intravenous barbiturates became popular. Mendelson published on the acid aspiration syndrome in 1946. It took 40 years to establish a reliable system of prevention, including fasting, antacids, and rapid sequence induction. This developed piecemeal, aided by recommendations from the British Confidential Enquiries into Maternal Deaths reports beginning in 1957. Neuraxial anaesthesia advanced: 24-hour epidural services (1960s), bupivacaine (1970s), epidural opioids (1980s), use of low-concentration bupivacaine with fentanyl mixtures, patient-controlled epidural and combined spinal–epidural analgesia (1990s), and pencil-point spinal needles (1990s). From the 1980s obstetric anaesthetists have assumed key roles in management of labour, preeclampsia/eclampsia, major haemorrhage, and perioperative care.
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Griffiths, James, and Kate Drummond. Neurological disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0045.
Full textAbstract:
This chapter predominantly focuses on the provision of obstetric anaesthesia and analgesia for the parturient with neurological disease. Diseases of the central nervous system are an important cause of maternal morbidity and mortality. Maternal deaths may occur from such conditions as subarachnoid haemorrhage, intracerebral haemorrhage, thrombosis, and epilepsy. Neurological disease may impact on maternal well-being during pregnancy and pregnancy has the potential to exacerbate many neurological diseases. Many neurological conditions also have important implications for the safe conduct of neuraxial anaesthesia and analgesia, such as spina bifida and hydrocephalus. Management of these conditions may require care to be coordinated by a multidisciplinary team including the obstetrician, neurologist, neurosurgeon, and anaesthetist.
Book chapters on the topic "Obstetric Haemorrhage"
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Bailey, Hannah. "Obstetric haemorrhage." In The Midwife's Labour and Birth Handbook, 297–314. Chichester, UK: John Wiley & Sons, Ltd, 2017. http://dx.doi.org/10.1002/9781119235064.ch16.
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Levy, David. "Obstetric Haemorrhage." In AAGBI Core Topics in Anaesthesia, 105–23. Oxford, UK: Wiley-Blackwell, 2011. http://dx.doi.org/10.1002/9781118227978.ch8.
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Ayres-de-Campos, Diogo. "Postpartum Haemorrhage." In Obstetric Emergencies, 63–80. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-41656-4_6.
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Padumadasa, Sanjeewa. "Antepartum Haemorrhage." In Obstetric Emergencies, 148–71. Boca Raton: CRC Press, 2021. http://dx.doi.org/10.1201/9781003088967-13-13.
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Padumadasa, Sanjeewa, and Malik Goonewardene. "Primary Postpartum Haemorrhage." In Obstetric Emergencies, 172–93. Boca Raton: CRC Press, 2021. http://dx.doi.org/10.1201/9781003088967-14-14.
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Padumadasa, Sanjeewa. "Secondary Postpartum Haemorrhage." In Obstetric Emergencies, 194–99. Boca Raton: CRC Press, 2021. http://dx.doi.org/10.1201/9781003088967-15-15.
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Nwandison, Millicent, and Susan Bewley. "Obstetric Management of Postpartum Haemorrhage." In Radiological Interventions in Obstetrics and Gynaecology, 181–88. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/174_2013_852.
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Lyons, G. "Perioperative obstetric anaesthesia — haemorrhage and coagulation." In Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E., 1053–57. Milano: Springer Milan, 2004. http://dx.doi.org/10.1007/978-88-470-2189-1_31.
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Ogu, Rosemary N., and Joseph Ifeanyi Brian-D. Adinma. "Aetiology and Management of Obstetric Haemorrhage." In Contemporary Obstetrics and Gynecology for Developing Countries, 235–47. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-75385-6_20.
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Stabile, Isabel, Tim Chard, and Gedis Grudzinskas. "Antepartum Haemorrhage." In Clinical Obstetrics and Gynaecology, 53–55. Berlin, Heidelberg: Springer Berlin Heidelberg, 2000. http://dx.doi.org/10.1007/978-3-642-85919-9_10.
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