1/4. Intravenous nitro-glycerine versus general anaesthesia for placental extraction--a sequential comparison.BACKGROUND: Postpartum haemorrhage due to retained placenta is one of the commonest life-threatening conditions during the third stage of labour. Uterine relaxation is usually required to facilitate placental removal. 'Full-stomach' obstetric patients (which includes those who delivered within 48 h), parturients with a history of antepartum or recurrent postpartum hemorrhage, grand multiparity, twin pregnancy, and those with cardiac abnormalities may benefit from an alternative to volatile-based general anaesthesia for uterine relaxation to avoid complications associated with the technique (e.g. aspiration pneumonitis and cardiovascular compromise). CASE REPORT: A 34-year-old gravida 4, para 3 parturient with rheumatic valvular heart disease presented with retained placenta and postpartum haemorrhage on two consecutive deliveries and had the placenta removed manually by the same surgeon under two different anaesthetic techniques. On the first occasion, general anaesthesia was administered whereas only i.v. fentanyl and nitro-glycerine were used on the second occasion. The postoperative course was uneventful on both occasions. CONCLUSIONS: The use of nitro-glycerine was found to be efficacious for manual removal of placenta with minimal haemodynamic perturbations, avoiding the use (and associated risks) of general anaesthesia for uterine relaxation. The ability of nitro-glycerine to reduce spontaneous uterine activity, induce uterine relaxation, coupled with its short duration of action and high efficacy, may render it a safe alternative to general anaesthesia for facilitating intrauterine manoeuvres. Nitro-glycerine may be useful especially in patients with associated co-morbid chronic cardiac conditions, e.g. rheumatic heart disease, which is characterised by impaired haemodynamics and cardiac reserves.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. Severe hypertension during postpartum haemorrhage after i.v. administration of prostaglandin E2.Severe hypertension with arterial spasm was observed after i.v. administration of prostaglandin E2 (PGE2) during uterine exploration under general anaesthesia for control of postpartum haemorrhage. This hypertension was exceptional because PGE2 is known to cause a decrease in systemic arterial pressure. Different hypotheses for this paradoxical hypertensive crisis after PGE2 administration are discussed.- - - - - - - - - - ranking = 0.125keywords = anaesthesia (Clic here for more details about this article) |
3/4. Cardiovascular collapse following an overdose of prostaglandin F2 alpha: a case report.A case report is presented of a parturient who suffered severe hypotension and pulmonary oedema following an overdose of intramyometrial prostaglandin F2 alpha. oxytocin induction of labour in this patient led to a rapid delivery, followed by a hypotonic uterus and postpartum haemorrhage. After resuscitation with blood and crystalloid fluids, the uterus was explored under general anaesthesia. The uterus was free of retained products but the lower uterine segment failed to contract despite bimanual uterine compression and intravenous oxytocin. Prostaglandin F2 alpha was injected into the lower uterine segment via a transvaginal approach. This was rapidly followed by cardiovascular collapse and later by pulmonary oedema. The differential diagnosis and subsequent management are discussed.- - - - - - - - - - ranking = 0.125keywords = anaesthesia (Clic here for more details about this article) |
4/4. Secondary post partum haemorrhage due to uterine wound dehiscence.BACKGROUND: Secondary post partum haemorrhage due to uterine scar dehiscence is a potentially life threatening complication of caesarean section. It is of special importance in any population with a high caesarean section rate. CASES: Two illustrative cases are described. Both presented with life threatening haemorrhage about four weeks after delivery by lower segment caesarean section. One was successfully managed with uterine wound debridement and resuture. The other required total abdominal hysterectomy. CONCLUSIONS: This cause of post partum haemorrhage must be considered in any patient who presents with heavy bleeding in the puerperium following caesarean section. These patients should always be admitted to hospital, and the uterine wound should be palpated after dilation of the cervix at examination under anaesthesia. laparotomy and repair or hysterectomy is essential if a defect can be felt in the wound. The choice of procedure is discussed in the text.- - - - - - - - - - ranking = 0.125keywords = anaesthesia (Clic here for more details about this article) |