Biomedical subjects
Publications and source records attributed to P Popham.
Massive postpartum haemorrhage is a major cause of maternal and fetal morbidity and mortality. Management mainstays include transfusion therapy, uterotonic agents and surgery. The "off label" use of recombinant activated factor VII appears to have an evolving role in the management of massive postpartum haemorrhage refractory to conventional treatments. The current literature is reviewed.
BACKGROUND: Collection of audit data about epidural blood patches has traditionally relied on voluntary reporting, which is notoriously incomplete. The records of Medicare-funded Australian private obstetric practice, which represents 30% of all deliveries, allow a novel method of central data collection and retrieval. METHOD: Data relating to all deliveries, epidurals and blood patches in private practice in Australia over a two-year period were retrieved from the Health Insurance Commission. RESULTS: The overall rate of epidural analgesia in labour was estimated at 30% and the proportion of epidurals that progressed to blood patching was 0.35%. The rate of epidural blood patching varied between states from 0.18% to 0.56%. CONCLUSION: Despite certain limitations of our data interpretation, we regard this technique as a useful audit tool capable of generating accurate and robust audit data that might otherwise be unobtainable.
Explore the source record for details and available documents.
Rupture of an aneurysm of the renal or splenic arteries remains a rare but catastrophic complication of pregnancy with a generally dismal prognosis for both mother and fetus. Improvements in abdominal imaging for incidental conditions are unlikely to lead to earlier diagnosis of such abnormalities antenatally, hence cardiovascular collapse during pregnancy is likely to continue to be their usual presentation. Two cases are described, both of splenic artery rupture. The literature of these rare events is reviewed.
Explore the source record for details and available documents.
We report the case of a 34-year-old woman who presented to the delivery unit at 36 weeks' gestation with spontaneous rupture of membranes. She had a triplet pregnancy following in vitro fertilisation. An elective caesarean section was performed under spinal anaesthesia 4h after admission. The patient had a massive postpartum haemorrhage in the recovery area at which time she mentioned that she was known to have 'low fibrinogen'. Further investigation showed that she suffered from dysfibrinogenaemia, as did several members of her family. We can find no reported cases of the use of central neural blockade in a patient with untreated dysfibrinogenaemia. Central neural blockade is often considered contraindicated in patients with disorders of fibrinogen; there were fortunately no neurological sequelae following spinal anaesthesia in this patient.
Explore the source record for details and available documents.
This study was designed to determine whether the introduction of epidural infusions containing fentanyl and bupivacaine has affected the mode of delivery in primiparous women attending our maternity department. We reviewed retrospectively the computerized records of 4362 consecutive primiparous women in labour. All the women were admitted with the expectation of a vaginal delivery. The results were analysed using logistic regression analysis adjusted for age, weight, gestation, cervical dilatation at epidural insertion, use of oxytocin, the year of entry into the study and the type of epidural block received. In women receiving an epidural block at 3-6 cm cervical dilatation (n = 1534), those who received an infusion were significantly less likely to have an emergency Caesarean section than those having intermittent 'topups' (P = 0.0019). In the same subgroup of women, the Caesarean section rate specifically for failure to progress followed the same trend, but just failed to reach statistical significance (P = 0.058). This provides evidence to support the theory that epidural infusions containing a low dose bupivacaine/fentanyl combination may reduce the risk of Caesarean section in primiparous women.
1. It has been reported that, during incremental exercise testing, the patterns of change in ventilation (VE) and arterial K+ (Ka+) are similar, suggesting that changing Ka+ may lead to the phenomenon of the ventilatory threshold through its action on the peripheral chemoreceptors. 2. Expiratory ventilation, oxygen consumption, CO2 production (VE, VO2, VCO2), arterialized venous PCO2 (Pav, CO2; see Methods), pH (pHav), K+ (Kav+) and lactate were measured during incremental exercise tests undertaken by six normal male subjects under control conditions and during lactic acidosis following severe exercise (experimental trial). 3. A ventilatory threshold, associated with a period of isocapnic buffering, was observed under both control and experimental conditions. During the control trial, plots of Kav+ against VO2 showed an inflexion close to the ventilatory threshold. Throughout the experimental trial Kav+ rose linearly relative to VO2. In both control and experimental trials Kav+ concentrations were similar at the ventilatory threshold. 4. These results suggest that the pattern of change of Ka+ cannot account for the phenomenon of the ventilatory threshold. The possibility that the peripheral chemoreceptor response is non-linear above a critical value of Ka+ requires further investigation.
Explore the source record for details and available documents.
Close agreement between arterialized venous and arterial pH, PCO2, and lactate has previously been demonstrated during steady-state exercise. The purpose of the present study was to compare arterialized venous and arterial pH, PCO2, K+, lactate, pyruvate, and epinephrine during the constantly changing circumstances of an incremental exercise test. Eight normal subjects undertook an incremental exercise test (increasing by 20 W/min) to exhaustion on a cycle ergometer during which simultaneous arterial and arterialized venous samples were drawn over the last 20 s of each work load. Linear regression of arterialized venous on arterial values showed that r varied from 0.97 to 0.99 for the variables examined and, therefore, showed that accurate estimates of arterial values could be made from the arterialized venous results during incremental testing. For many purposes it could be assumed that arterialized venous values equaled arterial values without serious error.