ABSTRACT: Purpose: The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an
epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural
catheterization performed in three different body positions. —
Methods: The study was conducted in 900 (three groups of 300) obstetric patients undergoing continuous epidural analgesia
during their labour and who were randomly allocated to three groups. Epidural catheterization was performed with patients
in the sitting, lateral recumbent horizontal, or lateral recumbent head-down position.
Results: There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down
position (2%) than in the lateral recumbent horizontal (6%) and in the sitting position (10.7%).
Conclusion: Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour
at term, reduces the incidence of lumbar epidural venous puncture.
Objectif: La canulation accidentelle et passée inaperçue d’une veine péridurale représente une complication potentiellement
dangereuse de l’anesthésie épidurale. La présente étude évalue l’incidence de ponction vasculaire reliée au cathétérisme péridural
réalisé selon trois positions corporelles différentes.
Méthode: L’étude a été menée auprès de 900 patientes en obstétrique, trois groupes de 300 réparties au hasard, qui recevaient
une analgésie épidurale pendant le travail. La mise en place d’un cathéter péridural a été réalisée en position assise, allongée
sur le côté ou allongée sur le côté et tête vers le bas.
Résultats: L’incidence de ponction vasculaire est plus faible, 2%, en position allongée avec la tête vers le bas, puis de
6% en position allongée sur le côté et de 10,7% en position assise.
Conclusion: Pendant le travail dans le cas d’une grossesse à terme, l’adoption de la position allongée sur le côté et tête
vers le bas, pour l’administration d’un bloc épidural, réduit l’incidence de ponction veineuse.
Canadian Journal of Anaesthesia 04/2012; 48(1):48-53. · 2.35 Impact Factor
ABSTRACT: Ureaplasma urealyticum is the most common pathogen cultured from the amniotic cavity of women with preterm labor and intact membranes. However, experience with antibiotic eradication of the pathogen in this setting is limited.
We report a case of U. urealyticum isolation from the amniotic cavity of a woman with preterm labor at 27 weeks gestation. The patient was treated with erythromycin base for 1 week, followed by fluoroquinolones and clindamycin for 10 days. A healthy neonate was delivered after spontaneous labor began at 33 weeks. The cultures obtained from the placenta and membranes were sterile, but the histopathology of the placenta revealed acute chorioamnionitis with acute funisitis.
We suggest that intra-amniotic colonization with Mycoplasma spp. remote from term may be managed expectantly, and that therapy with fluoroquinolones and/or clindamycin may be an appropriate choice.
Fetal Diagnosis and Therapy 02/2007; 22(2):90-3. · 1.05 Impact Factor
ABSTRACT: Fibrinogen abnormalities have been implicated in many adverse pregnancy outcomes, mainly spontaneous abortion, placental abruption, and postpartum hemorrhage. Two new cases of congenital hypofibrinogenemia in pregnancy are reported detailing their obstetric course and management. The relevant obstetric and hematologic literature is reviewed, including previous case reports and studies concerning the mechanisms of pregnancy complications. Suggestions for treatment guidelines and management strategies are detailed.
Obstetrical and Gynecological Survey 12/2004; 59(11):775-9. · 2.51 Impact Factor
ABSTRACT: The p53 tumor suppressor gene was found to play a role in the differentiation of several tissue types. We report here that p53-dependent apoptosis plays a role in the final stages of physiological differentiation of normoblasts, resulting in nuclear condensation and expulsion without cell death. Blood samples of healthy newborns, cord blood as well as bone marrow, were analysed for apoptosis by TUNEL and p53 expression by immunostaining. While some samples exhibited simultaneously several distinct patterns of apoptosis, such as perinuclear, diffused nuclear or nuclear apoptotic bodies, others presented a single defined pattern. Overexpression of p53 protein was detected in normoblasts exhibiting either perinuclear or diffused nuclear p53, corresponding to the nuclear apoptotic pattern in the same sample. Similar results were also evident with colonies cultivated for 12-14 days in culture. Differentiated erythroid colonies exhibited overexpression of p53 and positive TUNEL staining only in the normoblasts. We further examined the state of caspase 3/7 and observed a decrease of this activated enzyme during erythroid differentiation in culture. This study suggests a novel role for apoptosis in normoblast differentiation where nuclear degradation occurs with a delay in the actual cell death. A pivotal role for the p53-dependent apoptosis in the erythroid lineage development is implied. However, this apoptotic process is not fully executed because of the exhaustion in caspase 3/7 and thus cells are diverted towards final stages of differentiation.
Oncogene 08/2003; 22(30):4648-55. · 6.37 Impact Factor
ABSTRACT: To study the association between midtrimester triple-test levels and renal function in pregnant women with chronic hypertension.
Forty-three patients with chronic hypertension for whom renal function was evaluated by the creatinine clearance test between 14- and 20-weeks gestation were studied. Midtrimester triple-test values obtained as part of Down screening program were correlated with renal function.
hCG correlated inversely with creatinine clearance (r = -0.345; p = 0.002) and directly with alpha-fetoprotein (r = 0.499; p = 0.003).
In pregnant women with chronic hypertension, impaired renal function may alter midtrimester maternal serum hCG levels.
Prenatal Diagnosis 03/2003; 23(2):166-7. · 2.11 Impact Factor
ABSTRACT: To find patterns characteristic of maternal heart rates recorded by an electronic fetal monitor and compare them with concomitant fetal heart rate (FHR) patterns.
Maternal heart rates and FHRs during active labor and delivery were simultaneously recorded in 26 parturients with singleton pregnancies in vertex presentation. The FHRs were obtained by an external ultrasound transducer or via a spiral scalp electrode and maternal heart rates by a triple-wire cable with electrocardiographic electrodes attached to the chest. Representative tracings of 30-60 minutes duration were selected from all stages of labor and after delivery of the placenta. Quantitative assessments were carried out under guidelines from the National Institute of Child Health and Human Development after blinding the source of these tracings. Patterns were compared by appropriate statistical analyses.
Baseline maternal heart rates were significantly lower and their variability significantly higher than FHRs during all stages of labor. Maternal heart rates showed no decelerations; the proportion of tracings with accelerations increased as labor advanced, most of them coinciding with uterine contractions or bearing down efforts. The FHRs had both decelerations and accelerations. However, tracings with only accelerations (and no decelerations) were observed in decreasing frequency as labor advanced. Maternal accelerations had higher amplitudes and longer durations than fetal accelerations, especially in the second stage of labor.
Maternal heart rate patterns recorded by electronic fetal monitors closely resemble fetal patterns. Baseline "fetal bradycardia," the absence of decelerations in the second stage of labor, and marked accelerations coinciding with uterine contractions may suggest a maternal heart rate rather than an FHR recording.
Obstetrics and Gynecology 05/2002; 99(4):542-7. · 4.73 Impact Factor
ABSTRACT: The unintentional and unrecognized cannulation of an extradural vein is a potentially serious complication of an epidural anesthetic. The present study was undertaken to assess the incidence of blood vessel puncture related to epidural catheterization in three different body positions, in a cohort of morbidly obese parturients, following the completion of a similar study published in 2001 from which such parturients were excluded.
The study was conducted in 450 (three groups of 150) morbidly obese, obstetric patients undergoing continuous epidural analgesia during labour. Epidural catheterization was performed on patients randomized to the sitting, lateral recumbent horizontal, or lateral recumbent head-down position.
There was a lower incidence of vessel cannulation when this procedure was performed in the lateral recumbent head-down position [1.3%; body mass index (BMI): 37.0] than in the lateral recumbent horizontal [12.9%; BMI: 38.0] and in the sitting position [12.0%; BMI: 38.0]. The incidence of accidental subarachnoid puncture was 2%, 1.3% and 2% respectively, in these same positions.
Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture in these obese parturients.
Canadian Journal of Anaesthesia 51(6):577-80. · 2.35 Impact Factor