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Características da assistência ao trabalho de parto e parto em três modelos de atenção no SUS, no Município de Belo Horizonte, Minas Gerais, Brasil; Characteristics of labor and delivery care in three healthcare models within the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil

VOGT, Sibylle Emilie; DINIZ, Simone Grilo; TAVARES, Carlos Mendes; SANTOS, Nagela Cristine Pinheiros; SCHNECK, Camilla Alexsandra; ZORZAM, Bianca; VIEIRA, Débora de Andrade; SILVA, Kátia Silveira da; DIAS, Marcos Augusto Bastos
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica
POR
Relevância na Pesquisa
26.58%
Estudo transversal com 831 gestantes, de risco habitual, sobre o manejo do trabalho de parto num Centro de Parto Normal (CPN), num hospital vencedor do título "Galba de Araújo" (HG) e numa maternidade com modelo assistencial prevalente (HP). O uso da ocitocina no CPN foi de 27,9%, no HG 59,5% e no HP 40,1%, enquanto a amniotomia foi realizada em 67,6%, 73,6% e 82,2% das mulheres, respectivamente. A realização da episiotomia foi menor nas modalidades com incorporação de práticas humanizadas: 7,2% no CPN e 14,8% no HG versus 54,9% no HP. A prática de oferta liberal no HG resultou numa taxa de analgesia superior (54,4%) à do HP (7,7%). O percentual de internação dos recém-nascidos e o de parto a fórceps foram mais altas no HP, mas não houve diferenças para o índice de Apgar e para a taxa de cesárea. Os resultados sugerem resistência ao uso seletivo de intervenções em todos os modelos assistenciais, embora favoreçam o CPN como estratégia no controle das intervenções durante o trabalho de parto e parto nas gestantes de risco habitual sem prejuízos para as mulheres e os recém-nascidos.; This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care)...

Correlation between the Body Mass Index (BMI) of Pregnant Women and the Development of Hypotension after Spinal Anesthesia for Cesarean Section

NANI, Fernando Souza; TORRES, Marcelo Luis Abramides
Fonte: ELSEVIER SCIENCE INC Publicador: ELSEVIER SCIENCE INC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.48%
Nani FS, Torres MLA - Correlation between the Body Mass Index (BMI) of Pregnant Women and the Development of Hypotension after Spinal Anesthesia for Cesarean Section. Background and objectives: Very few publications correlate hypotension in obese pregnant women, and especially morbidly obese, after spinal anesthesia for cesarean section. The objective of the present study was to evaluate the incidence of hypotension according to the BMI. Methods: Forty-nine patients with pregestational BMI below 25 kg.m(-2) were included in the Eutrophia group, and 51 patients with BMI >= 25 kg.m(-2) were included in the Overweight group. After spinal anesthesia, blood pressure, volume of crystalloid infused, and dose of vasopressors used until delivery were recorded. A fall in systolic blood pressure below 100 mmHg or 10% reduction of the initial systolic blood pressure (SBP) was considered as hypotension and it was corrected by the administration of vasopressors. Results: Episodes of hypotension were fewer in the Eutrophia group (5.89 +/- 0.53 vs. 7.80 +/- 0.66, p = 0.027), as well as the amount of crystalloid administered (1,298 +/- 413.6 mL vs. 1,539 +/- 460.0 mL; p = 0.007), and use of vasopressors (5.87 +/- 3.45 bolus vs. 7.70 +/- 4.46 bolus; p = 0.023). As for associated diseases...

Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases

BLIACHERIENE, Fernando; CARMONA, Maria Jose Carvalho; BARRETTI, Cristina de Freitas Madeira; HADDAD, Cristiane Maria Federicci; MOUCHALWAT, Elaine Soubhi; BORTOLOTTO, Maria Rita de Figueiredo Lemos; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo
Fonte: ELSEVIER SCIENCE INC Publicador: ELSEVIER SCIENCE INC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.47%
Bliacheriene F, Carmona MJC, Barretti CFM, Haddad CMF, Mouchalwat ES, Bortlotto MRFL, Francisco RPV, Zugaib M - Use of a Minimally Invasive Uncalibrated Cardiac Output Monitor in Patients Undergoing Cesarean Section under Spinal Anesthesia: Report of Four Cases. Background and Objectives: Hemodynamic changes are observed during cesarean section under spinal anesthesia. Non-invasive blood pressure (BP) and heart rate (HR) measurements are performed to diagnose these changes, but they are delayed and inaccurate. Other monitors such as filling pressure and cardiac output (CO) catheters with external calibration are very invasive or inaccurate. The objective of the present study was to report the cardiac output measurements obtained with a minimally invasive uncalibrated monitor (LiDCO rapid) in patients undergoing cesarean section under spinal anesthesia. Case report: After approval by the Ethics Commission, four patients agreed to participate in this study. They underwent cesarean section under spinal anesthesia while at the same time being connected to the LiDCO rapid by a radial artery line. Cardiac output, HR, and BP were recorded at baseline, after spinal anesthesia, after fetal and placental extraction, and after the infusion of oxytocin and metaraminol. We observed a fall in BP with an increase of HR and CO after spinal anesthesia and oxytocin infusion; and an increase in BP with a fall in HR and CO after bolus of the vasopressor. Conclusions: Although this monitor had not been calibrated...

Intervenção fisioterapêutica na assistência ao trabalho de parto; Physiotherapy intervention during labor

Bio, Eliane Rodrigues
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 24/10/2007 PT
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26.61%
A assistência ao trabalho de parto envolve constante atualização sobre as intervenções obstétricas benéficas e necessárias para o nascimento seguro. Neste sentido, há uma redescoberta das posturas verticais e da liberdade de movimento da parturiente como prática eficiente para facilitar o trabalho de parto. Paralelamente, há uma tendência mundial à valorização do parto vaginal, a despeito das altas taxas de cesárea em nosso meio. Nesse contexto, se insere a proposta de intervenção fisioterapêutica na assistência ao trabalho de parto, com o objetivo de avaliar a influência da mobilidade da parturiente sobre a progressão da fase ativa, sobre a evolução da dilatação cervical e para facilitar o parto vaginal. Foi realizado um ensaio clínico controlado prospectivo, com análise comparativa entre um grupo de estudo e um grupo controle, no Centro Obstétrico do Hospital Universitário da Universidade de São Paulo. Os critérios de inclusão foram: primigestas em trabalho de parto espontâneo com pelo menos duas contrações a cada dez minutos e cérvico-dilatação de 3 a 4 cm; idade gestacional entre 37 e 42 semanas; feto único em apresentação cefálica fletida e concordância em assinar o termo de consentimento livre e esclarecido. Foram excluídas parturientes com patologias clínicas. As parturientes foram acompanhadas pela mesma fisioterapeuta durante toda a fase ativa e orientadas a manterem-se em posições verticais e em movimento coordenado...

Avaliação de dor crônica pós-cesariana. Influência da técnica anestésico-cirúrgica e da analgesia pós-operatória; Chronic pain after cesarean delivery. Influence of anesthetics, surgical techniques and postoperative analgesia

Cançado, Thais Orrico de Brito
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 11/03/2013 PT
Relevância na Pesquisa
26.5%
INTRODUÇÃO: O Brasil ocupa o primeiro lugar entre os países com maiores taxas de cesariana no mundo. Pouco se sabe a respeito das consequências futuras deste procedimento, sobre a saúde materna. Este estudo investigou a influência da técnica anestésico-cirúrgica e analgesia pós-operatória, no aparecimento de dor crônica após a cesariana. Procuramos também identificar os fatores de risco de dor crônica pós-cesariana. MÉTODO: Este estudo prospectivo com distribuição aleatória foi conduzido em 443 pacientes que foram submetidas à cesariana (eletivas e emergenciais), com diferentes doses de bupivacaína 0,5% hiperbárica e opioides na raquianestesia, bem como uso de anti-inflamatórios não esteroidais peri-operatório. Os grupos foram: G8SMA- 8 mg bupivacaína hiperbárica + 2,5 mcg sufentanil + 100 mcg morfina; G10SMA- 10 mg bupivacaína hiperbárica + 2,5 mcg sufentanil + 100 mcg morfina; G12,5MA- 12,5 mg bupivacaína hiperbárica + 100 mcg morfina; G15MA- 15 mg bupivacaína hiperbárica + 100 mcg morfina; G12,5M - 12,5 mg bupivacaína hiperbárica + 100 mcg morfina. Somente as pacientes do grupo G12,5M não receberam AINE no peri-operatório. Dor em repouso e em movimento foram avaliadas no pós-operatório imediato. Fatores peri-operatórios...

Bupivacaína, Ropivacaína e Levobupivacaína em Analgesia e Anestesia de Parto. Repercussões Materno-Fetais

Nakamura, G.; Castiglia, Y. M M; Do Nascimento, P.; Rugollo, L. M S S
Fonte: Universidade Estadual Paulista Publicador: Universidade Estadual Paulista
Tipo: Artigo de Revista Científica Formato: 105-111
POR
Relevância na Pesquisa
26.8%
Background and Objectives - Bupivacaine has been a very useful local anesthetic in Obstetrics in spite of its potential cardiotoxicity. In obstetric analgesia, ropivacaine is preferred to bupivacaine, and levobupivacaine is less cardiotoxic than the racemic mixture. The aim of this study was to compare the maternal-fetal effects of bupivacaine, ropivacaine and levobupivacaine in obstetric analgesia and anesthesia. Methods - Participated in this study 33 term pregnant women, physical status ASA I and II submitted to epidural anesthesia who received 18.75 mg (in 15 ml completed with 9% saline) of: GI - bupivacaine, GII - ropivacaine, and GIII - levobupivacaine. Pain intensity, sensory block level, onset time, quality of analgesia, motor block intensity, analgesia duration and time for labor resolution were evaluated. For vaginal delivery, 40 mg (in 8 ml of saline) of the same local anesthetic were used; for cesarean delivery, the dose has been mg in 20 ml solution. Newborns of these mothers were evaluated through the Apgar score in minutes 1, 5 and 10, and through the Amiel-Tison method (neurologic and adaptative capacity score - NACS) at 30 min, 2 h, and 24 h. Results - There were no significant statistical differences among groups as to sensory block level...

Meeting the challenge: providing anesthesia services in rural hospitals.

Barry, A W
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 15/11/1995 EN
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Although the volume and intensity of surgery done in rural hospitals are not sufficient to support a fully trained staff anesthetist, it is not practicable for all surgical, anesthesia and obstetric services to be provided by specialists in referral centres. As the study reported by Chiasson and Roy in this issue shows (see pages 1447 to 1452), general practitioners (GPs) with limited additional training in anesthesia already play an important role in the provision of these services in rural areas. To ensure that there is a continued supply of physicians prepared to meet the needs of small communities, funding and opportunities for supplemental training in surgery, anesthesia and obstetrics must be made available to GPs.

Trends in small hospital obstetric services in Ontario.

Rourke, J. T.
Fonte: College of Family Physicians of Canada Publicador: College of Family Physicians of Canada
Tipo: Artigo de Revista Científica
Publicado em /10/1998 EN
Relevância na Pesquisa
26.47%
OBJECTIVE: To compare obstetric services provided in small Ontario hospitals in 1995 with those provided in 1988. DESIGN: Mailed survey questionnaire. SETTING: Small hospitals in Ontario. PARTICIPANTS: Chiefs of Staff of the hospitals. MAIN OUTCOME MEASURES: Hospital size and location; numbers of physicians; availability of obstetric, anesthesia, and general surgery services; and other medical services. The 1995 questionnaire was identical to the 1988 one, except for addition of questions on midwives and deletion of the detailed emergency medicine section. RESULTS: A study group of 35 hospitals that provided active obstetric care in both years had significantly fewer births, fewer family physicians attending births, and fewer GP anesthetists in 1995 than in 1988. There were fewer cesarean births, but a similar number of epidural anesthetics. Availability of anesthetic, epidural, and cesarean services was significantly lower in 1995 than in 1988 in these 35 hospitals. Also, 11 other hospitals that had provided active obstetric care (defined as more than 25 births yearly) in 1988 no longer did so in 1995. CONCLUSION: By almost all measures, obstetric services in these rural Ontario hospitals were less available in 1995 than they had been in 1988.

Neurological adverse events following regional anesthesia administration

Kent, Christopher D; Bollag, Laurent
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
Publicado em 27/10/2010 EN
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26.36%
Regional anesthesia and analgesia have been associated with improved analgesia, decreased postoperative nausea and vomiting, and increased patient satisfaction for many types of surgical procedures. In obstetric anesthesia care, it has also been associated with improved maternal mortality and major morbidity. The majority of neurological adverse events following regional anesthesia administration result in temporary sensory symptoms; long-term or permanent disabling motor and sensory problems are very rare. Infection and hemorrhagic complications, particularly with neuraxial blocks, can cause neurological adverse events. More commonly, however, there are no associated secondary factors and some combination of needle trauma, intraneural injection, and/or local anesthetic toxicity may be associated, but their individual contributions to any event are difficult to define.

A first step in determining appropriate amounts of obstetric anesthesia work

Varaday, Swarup S; Leighton, Barbara L
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 14/12/2012 EN
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Ginosar, et al. describe a new performance indicator, the Obstetric Anesthesia Activity Index, to represent the current amount of obstetric anesthesia work done daily at each of 25 Israeli hospitals. The authors claim, correctly, that this index is a closer reflection of the anesthetic workload than simply looking at the number of deliveries at each hospital. However, the Obstetric Anesthesia Activity Index could easily be refined to reflect more closely the actual obstetric anesthesia workload by using the average cesarean delivery time for each hospital rather than one value for all hospitals. Although the authors state that they developed the Obstetric Anesthesia Activity Index out of concern for inadequate obstetric anesthesia manpower in Israel, they have not compared the Obstetric Anesthesia Activity Index with the size of the patient population or any measure of patient satisfaction or patient safety. In its current form, the Obstetric Anesthesia Activity Index describes the current work situation but does not evaluate the extent of the unmet need for additional anesthesia providers. Despite these shortcomings, the Obstetric Anesthesia Activity Index is an important first step in developing a tool to assess unmet obstetric anesthesia needs.

Intracranial Subdural Hematoma after Spinal Anesthesia for Cesarean Section

Schweiger, Vittorio; Zanconato, Giovanni; Lonati, Gisella; Baggio, Silvia; Gottin, Leonardo; Polati, Enrico
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.36%
Intracranial subdural hematoma following spinal anesthesia is an infrequent occurrence in the obstetric population. Nevertheless, it is a potentially life-threatening complication. In the majority of the cases, the first clinical symptom associated with intracranial subdural bleeding is severe headache, but the clinical course may have different presentations. In this report, we describe the case of a 38-year-old woman with an acute intracranial subdural hematoma shortly after spinal anesthesia for cesarean section. Early recognition of symptoms of neurologic impairment led to an emergency craniotomy for hematoma evacuation with good recovery of neurologic functions. The possibility of subdural hematoma should be considered in any patient complaining of severe persistent headache following regional anesthesia, unrelieved by conservative measures. Only early diagnosis and an appropriate treatment may avoid death or irreversible neurologic damage.

Obstetric anesthesia considerations in Kearns-Sayre syndrome: a case report

Faris, Ali S; Tawfic, Qutaiba A; Jeyaraj, Leo
Fonte: The Korean Society of Anesthesiologists Publicador: The Korean Society of Anesthesiologists
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.41%
Kearns-Sayre syndrome (KSS) is a rare mitochondrial myopathy that usually develops before 20 years of age. It demonstrates multisystemic involvement with a triad of cardinal features: progressive ophthalmoplegia, pigmentary retinopathy, and cardiac conduction abnormalities. In addition, patients might have cerebellar ataxia, a high content of protein in the cerebrospinal fluid, proximal myopathy, multiple endocrinopathies, and renal tubular acidosis. We herein report the successful obstetric analgesic and anesthetic management of a 28-year-old parturient patient with KSS who required labor analgesia and proceeded to deliver by cesarean section. We extrapolate that regional analgesia/anesthesia might be beneficial for reducing the metabolic demands associated with the stress and pain of labor in patients with KSS. Efficient postoperative analgesia should be provided to decrease oxygen requirements.

Vasopressors in obstetric anesthesia: A current perspective

Nag, Deb Sanjay; Samaddar, Devi Prasad; Chatterjee, Abhishek; Kumar, Himanshu; Dembla, Ankur
Fonte: Baishideng Publishing Group Inc Publicador: Baishideng Publishing Group Inc
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
26.5%
Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetal acid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.

Medication error report: Intrathecal administration of labetalol during obstetric anesthesia

Laha, Baisakhi; Hazra, Avijit
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
Relevância na Pesquisa
26.5%
Labetalol, a combined alfa and beta-adrenergic receptor antagonist, is used as an antihypertensive drug. We report a case of an acute rise in blood pressure and lower limb pain due to the inadvertent intrathecal administration of labetalol, mistaking it for bupivacaine, during obstetric anesthesia. The situation was rescued by converting to general anesthesia. The cesarean delivery was uneventful, and mother as well as newborn child showed no ill-effect. This particular medication error was attributable to a failure on the part of the doctors administering the injection to read and cross-check medication labels and the practice of keeping multiple injections together. In the absence of an organized medication error reporting system and action on that basis, such events may recur in future.

Maternal and Child Mortality Development Goals : What Can the Transport Sector Do?

Babinard, Julie; Roberts, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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26.33%
The reduction of child mortality and the improvement of maternal health are two of the Millennium Development Goals. Child and maternal mortalities continue to represent severe burdens in many developing countries. Every year, 527,000 women in developing countries die of pregnancy-related complications and nearly 4 million children die during their first month (accounting for 40 percent of all deaths under 5 years of age) with nearly all (98 percent) of them in developing countries. The risks of dying from pregnancy-related complications and a child dying under the age of five are highest in Sub-Saharan Africa. The risk of a mother or an infant dying can be significantly reduced by a continuum of basic care, which should include preventive measures and a skilled attendant during childbirth with access to the necessary equipment, drugs, and other supplies for effective management of any pregnancy-related complications. Yet, many women spend excessive time trying to reach a health facility with the capacity to treat obstetric or infant complications. It is estimated that 75 percent of maternal deaths might be prevented through timely access to essential emergency childbirth-related care. This paper focuses on the ways in which transport and road infrastructure play key roles in the overall delivery of and access to health services...

Clinical update: obstetric anaesthesia

Cyna, A.; Dodd, J.
Fonte: Lancet Ltd Publicador: Lancet Ltd
Tipo: Artigo de Revista Científica
Publicado em //2007 EN
Relevância na Pesquisa
26.5%
http://www.elsevier.com/wps/find/journaldescription.cws_home/31066/description#description; Allan M Cyna and Jodie Dodd; Copyright © 2007 Elsevier Ltd All rights reserved.

Comparación de la anestesia espinal con anestesia general endovenosa para legrado uterino obstétrico

Viloria Diaz, Lorenzo Alberto
Fonte: Facultad de Medicina Publicador: Facultad de Medicina
Tipo: info:eu-repo/semantics/bachelorThesis; info:eu-repo/semantics/acceptedVersion Formato: application/pdf
Publicado em 11/02/2015 SPA
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Introducción: La elección de la técnica anestésica para cualquier procedimiento quirúrgico debe estar basada en su seguridad, la rapidez para su aplicación, la recuperación óptima para el paciente y minimización de los efectos secundarios, la anestesia raquídea es una técnica anestésica que puede ser utilizada con buenos resultados clínicos y minimas complicaciones . Materiales y métodos: Se realizó un estudio observacional con recolección prospectiva en mujeres clasificadas como ASA I - II y que posteriormente fueron llevadas a la realización de legrado uterino obstétrico por embarazo no viable durante las primeras 12 semanas de gestación, las técnicas anestésicas fueron anestesia espinal o anestesia general endovenosa dependiendo de la elección hecha por el anestesiólogo previo al procedimiento. Se midieron variables hemodinámicas, control del dolor postoperatorio, tiempo de recuperación y complicaciones perioperatorias con el fin de determinar si se presentaban diferencias significativas entre estas dos técnicas anestésicas. Resultados: Se incluyeron un total de 110 pacientes, 63.6% (n=70) con anestesia general y 36.4% (n40) con anestesia espinal. Ambas poblaciones fueron comparables. Se presentaron menos efectos secundarios con la técnica espinal...

Combined spinal-epidural anesthesia and non-pharmacological methods of pain relief during normal childbirth and maternal satisfaction: a randomized clinical trial

Orange,Flavia Augusta de; Passini-Jr,Renato; Melo,Adriana S.O.; Katz,Leila; Coutinho,Isabela Cristina; Amorim,Melania M.R.
Fonte: Associação Médica Brasileira Publicador: Associação Médica Brasileira
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2012 EN
Relevância na Pesquisa
36.3%
OBJECTIVE: The objective of this study was to compare maternal satisfaction with childbirth according to whether or not combined spinal-epidural anesthesia (CSE) of pain relief was used during labor. METHODS: A randomized, open clinical trial was performed with 70 pregnant women, 35 of whom received CSE anesthesia while 35 received only non-pharmacological forms of pain relief during labor. The variables evaluated were visual analogue scale (VAS) pain score, maternal satisfaction with the technique of pain relief used during childbirth and with delivery, the patient's intention to request the same technique in a subsequent delivery, and loss of control during delivery. RESULTS: VAS pain score decreased significantly in patients receiving CSE during vaginal delivery. Furthermore, maternal satisfaction with the technique of pain relief and with delivery was higher in the CSE group, and around 97% of the patients would repeat the same technique at future deliveries compared to 82.4% of the women in the group using only non-pharmacological methods. With respect to the women's impressions of their control during delivery, approximately half the women in both groups felt that they had lost control at some point during the process. CONCLUSION: The use of CSE was associated with a significant reduction in VAS pain scores during delivery and with greater maternal satisfaction with the pain relief method and with the childbirth process.

Anesthesia for Ex Utero Intrapartum Treatment: Renewed Insight on a Rare Procedure

Vieira Marques, M; Carneiro, J; Adriano, M; Lança, F
Fonte: Elsevier Publicador: Elsevier
Tipo: Artigo de Revista Científica
Publicado em //2015 ENG
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46.36%
The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise. Modifications to the classic ex utero intrapartum treatment management strategies were successfully adopted and will be discussed in the following report.

GESTATIONAL OBESITY AS A DETERMINANT OF GENERAL ANESTHESIA TECHNIQUE FOR CAESAREAN DELIVERY: A CASE REPORT

Navarro-Vargas,José Ricardo; Aldana-Díaz,José Luis; Eslava-Schamalbach,Javier H.
Fonte: Revista de la Facultad de Medicina Publicador: Revista de la Facultad de Medicina
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2009 EN
Relevância na Pesquisa
36.63%
Background. The incidence of obesity has undergone a dramatic increase around the world during the last few years. Such epidemic behavior has been associated with obstetric patient’s frequent presentation of different stages of obesity when undergoing anesthetic procedure. Obesity in pregnant women involves the risk of adverse maternal and fetal outcomes. Hypertension and preeclampsia, diabetes, fetal macrosomia, caesarean delivery, difficult airway management and neuroaxial techniques are more likely to be performed in this group of patients. Materials and methods. This is a case report of a morbid obese patient scheduled for caesarean delivery and tubal ligation. Regional, spinal and epidural techniques were attempted for surgery with unsuccessful results; this entails general anesthesia for surgery. The literature on complications due to obesity during pregnancy was reviewed, emphasising relevance for the anesthesiologist. Conclusion.Obesity, especially morbid obesity in pregnant women, represents a challenge for anesthesia management. Updated knowledge of physiology and the conditions related to obesity in pregnancy is necessary; medical services must be prepared to provide optimum and safe obstetric anesthesia, analgesia and post-operation care.