Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005488.71910.8d
D.N. Bateman, T.W. Hale
(BMJ. 2023;380:p514) Both pain management for mothers following delivery and breastfeeding are things that health care professionals often encourage. Historically, codeine was a common opioid prescribed for postpartum pain. This decreased significantly after an infant death was seemingly caused by maternal codeine-paracetamol use while breastfeeding. While that case was debunked, there is again rising concern about how the use of opioids by mothers following delivery affects breastfeeding infants.
{"title":"Opioid Analgesia for Breastfeeding Mothers","authors":"D.N. Bateman, T.W. Hale","doi":"10.1097/01.aoa.0001005488.71910.8d","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005488.71910.8d","url":null,"abstract":"(BMJ. 2023;380:p514)\u0000 Both pain management for mothers following delivery and breastfeeding are things that health care professionals often encourage. Historically, codeine was a common opioid prescribed for postpartum pain. This decreased significantly after an infant death was seemingly caused by maternal codeine-paracetamol use while breastfeeding. While that case was debunked, there is again rising concern about how the use of opioids by mothers following delivery affects breastfeeding infants.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"2 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005264.48120.4d
A. Maeda, D. Villela-Franyutti, M. Lumbreras-Marquez, A. Murthy, K.G. Fields, S. Justice, L. Tsen
(Anesth Analg. 2023. doi: 10.1213/ANE.0000000000006691) Neuraxial labor analgesia includes the conventional epidural (EPL) technique as well as the combined spinal epidural and dural puncture epidural (DPE) techniques. Some advantages to the DPE technique have been discovered through research in comparison to the EPL technique. A study was conducted using a biased-coin up-down allocation method to determine the effective dose of bupivacaine needed to achieve initial analgesia in 90% of women in labor (ED90) using the DPE and EPL techniques. It was hypothesized that a lower bupivacaine dose would be needed with the DPE versus the EPL.
{"title":"Labor Analgesia Initiation With Dural Puncture Epidural Versus Conventional Epidural Techniques: A Randomized Biased-Coin Sequential Allocation Trial to Determine the Effective Dose for 90% of Patients of Bupivacaine","authors":"A. Maeda, D. Villela-Franyutti, M. Lumbreras-Marquez, A. Murthy, K.G. Fields, S. Justice, L. Tsen","doi":"10.1097/01.aoa.0001005264.48120.4d","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005264.48120.4d","url":null,"abstract":"(Anesth Analg. 2023. doi: 10.1213/ANE.0000000000006691)\u0000 Neuraxial labor analgesia includes the conventional epidural (EPL) technique as well as the combined spinal epidural and dural puncture epidural (DPE) techniques. Some advantages to the DPE technique have been discovered through research in comparison to the EPL technique. A study was conducted using a biased-coin up-down allocation method to determine the effective dose of bupivacaine needed to achieve initial analgesia in 90% of women in labor (ED90) using the DPE and EPL techniques. It was hypothesized that a lower bupivacaine dose would be needed with the DPE versus the EPL.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"79 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140440089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005344.68330.b3
T. Bleeser, D. Basurto, F. Russo, S. Vergote, I. Valenzuela, S. Van den Broucke, Y. Kunpalin, L. Joyeux, L. van der Veeken, J. Vally, D. Emam, J. van der Merwe, M. Van de Velde, S. Devroe, J. Deprest, S. Rex
(J Clin Anesth. 2023;85:111050) This study examines the impact of repeated and prolonged exposure to sevoflurane anesthesia on fetal neurodevelopment in pregnant sheep. The rationale behind this research lies in the concern over the possible negative effects of long or repeated exposure to anesthesia during pregnancy on fetal brain development, particularly based on findings in animal studies. The experiment involves exposing pregnant sheep to different anesthesia regimens and conducting neurobehavioral assessments of their offspring. It aims to determine whether repeated exposure results in neurodevelopmental impairments. The study follows ethical guidelines designed to align with principles promoting humane animal research.
{"title":"Effects of Cumulative Duration of Repeated Anesthesia Exposure on Fetal Brain Development in the Ovine Model","authors":"T. Bleeser, D. Basurto, F. Russo, S. Vergote, I. Valenzuela, S. Van den Broucke, Y. Kunpalin, L. Joyeux, L. van der Veeken, J. Vally, D. Emam, J. van der Merwe, M. Van de Velde, S. Devroe, J. Deprest, S. Rex","doi":"10.1097/01.aoa.0001005344.68330.b3","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005344.68330.b3","url":null,"abstract":"(J Clin Anesth. 2023;85:111050)\u0000 This study examines the impact of repeated and prolonged exposure to sevoflurane anesthesia on fetal neurodevelopment in pregnant sheep. The rationale behind this research lies in the concern over the possible negative effects of long or repeated exposure to anesthesia during pregnancy on fetal brain development, particularly based on findings in animal studies. The experiment involves exposing pregnant sheep to different anesthesia regimens and conducting neurobehavioral assessments of their offspring. It aims to determine whether repeated exposure results in neurodevelopmental impairments. The study follows ethical guidelines designed to align with principles promoting humane animal research.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"40 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140440243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005292.74993.be
T.B. Stein, A. Vasan
(N Engl J Med. 388;21. doi: 10.1056/NEJMp2301278) The US court case Dobbs v. Jackson Women’s Health Organization removed the constitutional right to abortion. Currently, 13 states ban abortion with few exceptions, while other states have enacted certain restrictions around abortion. This, coupled with new legislation frequently being introduced that further restricts access to abortions, has made it very difficult for people searching for abortion information or services.
{"title":"Public Health’s Role in a Post-Dobbs World—The New York City Abortion Access Hub","authors":"T.B. Stein, A. Vasan","doi":"10.1097/01.aoa.0001005292.74993.be","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005292.74993.be","url":null,"abstract":"(N Engl J Med. 388;21. doi: 10.1056/NEJMp2301278)\u0000 The US court case Dobbs v. Jackson Women’s Health Organization removed the constitutional right to abortion. Currently, 13 states ban abortion with few exceptions, while other states have enacted certain restrictions around abortion. This, coupled with new legislation frequently being introduced that further restricts access to abortions, has made it very difficult for people searching for abortion information or services.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"23 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005492.26516.a9
N. Singh, V. Anandan, S.R. Ahmad
(J Clin Anesth. 2022:81:110892) Pain must be managed properly in surgical patients, especially those undergoing cesarean delivery (CD). Regional nerve blocks are used to relieve pain in postoperative patients as a part of multimodal analgesia. Ultrasound-guided blocks employed for abdominal surgeries include the transverse abdominis plane block and the quadratus lumborum (QL) block.
{"title":"Effect of Dexmedetomidine as an Adjuvant in Quadratus Lumborum Block in Patient Undergoing Caesarean Section: A Randomized Controlled Study","authors":"N. Singh, V. Anandan, S.R. Ahmad","doi":"10.1097/01.aoa.0001005492.26516.a9","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005492.26516.a9","url":null,"abstract":"(J Clin Anesth. 2022:81:110892)\u0000 Pain must be managed properly in surgical patients, especially those undergoing cesarean delivery (CD). Regional nerve blocks are used to relieve pain in postoperative patients as a part of multimodal analgesia. Ultrasound-guided blocks employed for abdominal surgeries include the transverse abdominis plane block and the quadratus lumborum (QL) block.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"12 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140439180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005356.73313.18
G. Bitar, B. Sibai, H.Y. Chen, N. Neff, S. Blackwell, S.P. Chauhan, M. Fishel Bartal
(Obstet Gynecol. 2023;142:393–401) Pregnancy-associated stroke has been occurring with increasing frequency in recent years, both antepartum and postpartum. It is associated with a high rate of maternal mortality along with a short-term morbidity of seizures, infections, mechanical ventilation, and venous thromboembolism. There is also a recorded association of stroke during pregnancy with fetal morbidity. Research is lacking, however, in powerful statistics; most studies up to this point have been limited by a very small sample size or a focus on specific risk groups, age groups, or epidemiology. This study was designed to address these shortcomings by assessing the temporal trend of pregnancy-associated stroke between 2016 and 2019, the relationship between timing of stroke (antepartum or postpartum) and adverse outcomes, and the relationship between hypertensive disorders and adverse outcomes.
{"title":"Pregnancy-Associated Stroke and Outcomes Related to Timing and Hypertensive Disorders","authors":"G. Bitar, B. Sibai, H.Y. Chen, N. Neff, S. Blackwell, S.P. Chauhan, M. Fishel Bartal","doi":"10.1097/01.aoa.0001005356.73313.18","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005356.73313.18","url":null,"abstract":"(Obstet Gynecol. 2023;142:393–401)\u0000 Pregnancy-associated stroke has been occurring with increasing frequency in recent years, both antepartum and postpartum. It is associated with a high rate of maternal mortality along with a short-term morbidity of seizures, infections, mechanical ventilation, and venous thromboembolism. There is also a recorded association of stroke during pregnancy with fetal morbidity. Research is lacking, however, in powerful statistics; most studies up to this point have been limited by a very small sample size or a focus on specific risk groups, age groups, or epidemiology. This study was designed to address these shortcomings by assessing the temporal trend of pregnancy-associated stroke between 2016 and 2019, the relationship between timing of stroke (antepartum or postpartum) and adverse outcomes, and the relationship between hypertensive disorders and adverse outcomes.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"30 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005332.25930.e8
S. Patel
(Eur J Anaesthesiol. 2023; 40:334–342) Although most drug administration errors in the operating room setting are intravenous, cases of inappropriate neuraxial medication administration have been recorded and can be particularly catastrophic. The use of tranexamic acid (TXA) during surgery is increasing for certain surgical procedures where it has been shown to be effective at reducing blood loss and the need for transfusion. It is therefore often readily available in operating rooms during cesarean section and orthopedic procedures where neuraxial blocks are frequently utilized. This study aimed to assess the effects of neuraxial TXA administration based on published cases.
{"title":"Tranexamic Acid-Associated Intrathecal Toxicity During Spinal Anaesthesia","authors":"S. Patel","doi":"10.1097/01.aoa.0001005332.25930.e8","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005332.25930.e8","url":null,"abstract":"(Eur J Anaesthesiol. 2023; 40:334–342)\u0000 Although most drug administration errors in the operating room setting are intravenous, cases of inappropriate neuraxial medication administration have been recorded and can be particularly catastrophic. The use of tranexamic acid (TXA) during surgery is increasing for certain surgical procedures where it has been shown to be effective at reducing blood loss and the need for transfusion. It is therefore often readily available in operating rooms during cesarean section and orthopedic procedures where neuraxial blocks are frequently utilized. This study aimed to assess the effects of neuraxial TXA administration based on published cases.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140440863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005360.05742.f8
J.A. DiPietro, J. Bai, F.P. Sgambati, J.L. Henderson, H. Watson, R.S. Raghunathan, G. Pien
(Am J Obstet Gynecol. 2023;228(4):459.e1–459.e8) The physical changes inherent in pregnancy can amplify underlying comorbidities. One common problem worsened in pregnancy is sleep-disordered breathing. Sleep-disordered breathing has been investigated in relation to pregnancy and found to have a host of negative outcomes associated with it, including gestational diabetes, preeclampsia, preterm delivery, and stillbirth. Risk factors for sleep-disordered breathing often overlap with risk factors for other pregnancy complications, and thus relationships can be difficult to characterize. One area needing investigation is the effect of sleep-disordered breathing on fetal heart rate (FHR), which is an indicator of wellbeing during pregnancy. This study was designed to examine the FHR response to sleep-disordered breathing in pregnant women with obesity. The authors hypothesized that apnea or hypopnea would elicit a detectable response in FHR that would be potentiated in women with more severe symptoms.
{"title":"Fetal Heart Rate Responses to Maternal Sleep-Disordered Breathing","authors":"J.A. DiPietro, J. Bai, F.P. Sgambati, J.L. Henderson, H. Watson, R.S. Raghunathan, G. Pien","doi":"10.1097/01.aoa.0001005360.05742.f8","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005360.05742.f8","url":null,"abstract":"(Am J Obstet Gynecol. 2023;228(4):459.e1–459.e8)\u0000 The physical changes inherent in pregnancy can amplify underlying comorbidities. One common problem worsened in pregnancy is sleep-disordered breathing. Sleep-disordered breathing has been investigated in relation to pregnancy and found to have a host of negative outcomes associated with it, including gestational diabetes, preeclampsia, preterm delivery, and stillbirth. Risk factors for sleep-disordered breathing often overlap with risk factors for other pregnancy complications, and thus relationships can be difficult to characterize. One area needing investigation is the effect of sleep-disordered breathing on fetal heart rate (FHR), which is an indicator of wellbeing during pregnancy. This study was designed to examine the FHR response to sleep-disordered breathing in pregnant women with obesity. The authors hypothesized that apnea or hypopnea would elicit a detectable response in FHR that would be potentiated in women with more severe symptoms.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"7 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005444.66064.b2
D.G. Bishop, N.L. Fernandes, R.A. Dyer, H. Sumikura, H. Okada, Y. Suga, F. Shen, Z. Xu, Z. Liu, M. Vasco, R.B. George, E. Guasch
(Int J Obstet Anesth. 2023:54:103648) Anesthesia provision varies worldwide, and obstetric anesthesia in particular is highly variable. The first country discussed in this article is South Africa, which is classified as a low-income to middle-income country. South Africa has high patient mortality related to cesarean delivery. The epidural rates for labor in South Africa are <5%, which is considered extremely low. Approximately one-third of maternal deaths investigated occurred following the administration of spinal anesthesia. In South Africa, it is 3 times more likely for maternal mortality to occur following cesarean delivery than vaginal birth. The mortality rates following a cesarean delivery in South Africa are also 50 times higher than in other regions of the world. Training has been implemented to reduce these statistics, although the level of preparedness following this training has been questioned.
{"title":"Global Issues in Obstetric Anesthesia: Perspectives From South Africa, Japan, China, Latin America, and North America","authors":"D.G. Bishop, N.L. Fernandes, R.A. Dyer, H. Sumikura, H. Okada, Y. Suga, F. Shen, Z. Xu, Z. Liu, M. Vasco, R.B. George, E. Guasch","doi":"10.1097/01.aoa.0001005444.66064.b2","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005444.66064.b2","url":null,"abstract":"(Int J Obstet Anesth. 2023:54:103648)\u0000 Anesthesia provision varies worldwide, and obstetric anesthesia in particular is highly variable. The first country discussed in this article is South Africa, which is classified as a low-income to middle-income country. South Africa has high patient mortality related to cesarean delivery. The epidural rates for labor in South Africa are <5%, which is considered extremely low. Approximately one-third of maternal deaths investigated occurred following the administration of spinal anesthesia. In South Africa, it is 3 times more likely for maternal mortality to occur following cesarean delivery than vaginal birth. The mortality rates following a cesarean delivery in South Africa are also 50 times higher than in other regions of the world. Training has been implemented to reduce these statistics, although the level of preparedness following this training has been questioned.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"34 S3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-22DOI: 10.1097/01.aoa.0001005456.46508.bf
M.R. Siegel, G.K. Mahowald, S.N. Uljon, K. James, L. Leffert, M.W. Sullivan, S. J. Hernandez, J.R. Gray, D.M. Schiff, S.N. Bernstein
(Am J Obstet Gynecol. 2023;228(6):741.e1–741.e7) In obstetrics, toxicology testing is often used to gather data about maternal substance use. A positive maternal or neonatal toxicology test can result in significant consequences, including referrals to child protective services, dismissal from substance use treatment programs, and possibly incarceration. The aim of this study was to evaluate the impact of administering neuraxial fentanyl during labor on toxicology test outcomes for mothers and neonates.
{"title":"Fentanyl in the Labor Epidural Impacts the Results of Intrapartum and Postpartum Maternal and Neonatal Toxicology Tests","authors":"M.R. Siegel, G.K. Mahowald, S.N. Uljon, K. James, L. Leffert, M.W. Sullivan, S. J. Hernandez, J.R. Gray, D.M. Schiff, S.N. Bernstein","doi":"10.1097/01.aoa.0001005456.46508.bf","DOIUrl":"https://doi.org/10.1097/01.aoa.0001005456.46508.bf","url":null,"abstract":"(Am J Obstet Gynecol. 2023;228(6):741.e1–741.e7)\u0000 In obstetrics, toxicology testing is often used to gather data about maternal substance use. A positive maternal or neonatal toxicology test can result in significant consequences, including referrals to child protective services, dismissal from substance use treatment programs, and possibly incarceration. The aim of this study was to evaluate the impact of administering neuraxial fentanyl during labor on toxicology test outcomes for mothers and neonates.","PeriodicalId":19432,"journal":{"name":"Obstetric Anesthesia Digest","volume":"22 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140442103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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