1/17. Acute complete puerperal inversion of the uterus following twin birth: case report.A twenty-year old multiparous woman was admitted to our obstetric unit on February 13th 1998, with features of acute complete puerperal uterine inversion, two hours after twin birth at home. She was resuscitated and the inverted uterus repositioned using Johnson's method under general anaesthesia. The potential of twin birth as an important aetiological factor in acute/sub-acute puerperal inversion is discussed. Formal training of traditional birth attendants (TBAs) in developing countries where trained medical personnel are scarce, is emphasised.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/17. Management of respiratory deterioration in a pregnant patient with severe kyphoscoliosis by non-invasive positive pressure ventilation.The problem of kyphoscoliosis in combination with pregnancy is uncommon and published cases are rare. Until now, little and controversial information on the outcome, optimal management and course of pregnancy in patients with kyphoscoliosis has been available. The majority of maternal deaths seem to be attributed to cardiorespiratory failure, while obstetric complications account for relatively few complications. We present the case of a 34-year old pregnant woman with congenital kyphoscoliosis and a forced vital capacity (FVC) of about one liter. A further deterioration of lung function was expected. In fact, severe limitations in exercise capacity (bed rest), fatigue and hypersomnolence, as well as a severe increase in pulmonary hypertension occurred during the second and third trimester. Nasal intermittent positive pressure ventilation (NIP-PV) with bilevel positive airway pressure (BiPAP) was started in the 20th week of gestation and adapted throughout pregnancy. Nasal BiPAP was well-tolerated and corrected exercise tolerance, fatigue and nocturnal oxygen desaturations. At 32 weeks of gestation, the patient was admitted for an elective Caesarean section under combined spinal-epidural anaesthesia with ongoing NIPPV, and delivered a healthy baby. Home nocturnal ventilatory support was continued as nocturnal episodic desaturations were also assessed during the postpartum period. At time of discharge, the patient's exercise capacity and lung function were nearly equal to levels before pregnancy. We conclude that pregnancy in selected kyphoscoliotic patients with severe limitations in lung function is relatively safe for both the mother and the child when NIPPV is used for overcoming respiratory deterioration and for preventing further cardiorespiratory failure.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/17. Recurrent post-partum seizures after epidural blood patch.There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/17. Fatal pulmonary embolism following spinal anaesthesia for caesarean section.pulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo-embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be the first time this has been reported.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
5/17. Backache after extradural anaesthesia in the postpartum period: dissection of thoracic aneurysm.We describe a case of postpartum ruptured dissecting aneurysm of the thoracic aorta, unrelated to the anaesthetic management with extradural anaesthesia. This complication is discussed in detail, as the anaesthetist may be the specialist required to respond to the common presenting symptom of severe back pain.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
6/17. Caesarean section in undiagnosed Eisenmenger's syndrome. Report of a patient with a fatal outcome.An obstetric patient is described in whom the first sign of cardiac disease was unexplained hypoxaemia during emergency anaesthesia for antepartum haemorrhage, with an eventual fatal outcome. The case highlights the importance of patient information at the booking clinic, and the implications of a raised haemaglobin in early pregnancy.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/17. Chronic urinary retention postpartum.Three cases of chronic urinary retention postpartum are reported. All patients were primigravidas. Unrecognized urinary retention following epidural anaesthesia in labour was the likely cause. Abdominal ultrasound may have a place in early recognition of this complication. The early use of a suprapubic catheter hastens bladder recovery.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
8/17. Pulmonary oedema in two parturients with hypertrophic obstructive cardiomyopathy (HOCM).Two patients with hypertrophic obstructive cardiomyopathy (HOCM) presented for delivery. The first had a repeat Caesarean section with general anaesthesia and the second gave birth vaginally with epidural analgesia. Both patients developed pulmonary oedema in the peripartum period. These cases highlight the delicate fluid requirements of the pregnant patient with HOCM. The fluid management of the parturient is discussed with particular emphasis on the pathophysiology of HOCM. The indications for invasive monitoring are presented.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
9/17. Grand mal seizure after extradural morphine analgesia.Following an elective Caesarean section under extradural anaesthesia, a 30-yr-old known epileptic woman (gravida 4, para 3) developed a tonic-clonic seizure, 6 h after the administration of morphine 3 mg into the extradural space. Possible aetiological factors are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
10/17. Inversion of the uterus. Replacement without general anaesthesia.Three cases of acute inversion of the uterus were managed by immediate manual replacement without general anesthesia. They are recorded to emphasize that recognition and prompt action prevent the onset of serious complications and the problems with reduction usually reported with this condition.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
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