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At least 667 records · Page 37Linked to original sources
PubMed1976

Role of the anaesthetist in the prevention of maternal deaths in Caesarian Section.

The obstetric anaesthetist should not only be skilled in the administration of anaesthesia, but should also have a thorough knowledge of the pharmacology and physiology of pregnancy, labour and delivery and the full implications of the complications that may arise in late pregnancy and during labour. The diagnosis and treatment of these complications are as much his concern as the choice and administration of anaesthetic agents. Such complications which may arise before, during and after Ceasarian Section include prolonged and obstructed labour, inhalation of gastric contents, pre-eclamptic toxaemia and eclampsia, haemorrhage and coagulation disorders, supine hypotensive syndrome and amniotic fluid embolism. Close co-operation between obstetrician and anaesthetist, careful overall management and the judicious choice of drugs in pre-medication, anaesthetic agents and techniques, on the lines outlined and discussed should aid the reduction of meternal mortality in elective and emergency caesarian section to the barest minimum.

Anesthesia, Conduction↗
PubMed2006

[Haemorrhagic complications in obstetrics].

The instability of the gestational and puerperal equilibrium of haemostasis is affected by a shift of primary and plasmatic haemostasis in a procoagulatory direction, whereas the regulation mechanism of the fibrinolytic system can easily cause disproportional peri- and postpartal reaction leading to massive haemorrhage. Peripartal injuries or an atonic uterus can lead to massive haemorrhage and cause a classic haemorrhagic coagulopathy. Complications like amniotic fluid embolism, puerperal sepsis, eclampsia or HELLP syndrome can lead through DIC to rapidly developing and possibly fulminant hyperfibrinolysis. This article depicts different forms of haemorrhage in the peripartal situation, their particular pathologies and specific possibilities for management. A case study demonstrates the diagnostic and therapeutic options in the case of eclampsia with early abruption of placenta.

Abruptio Placentae↗
PubMed1991

[Analysis of maternal death rates and causes in 21 provinces, municipalities and autonomous regions].

An analysis of maternal mortality in 287 cities, districts and counties of 21 provinces, municipalities and autonomous regions covering a population of 177,550,000 in China in 1984-1985 was reported. Total number of live births was 15,466,368 in the areas investigated, with 4 669078 in the urban areas and 10,797,290 in rural areas. The number of maternal deaths was 7,485 882 were in urban areas and 6,603 in rural areas, giving a maternal mortality of 18.9/100,000 in urban areas and 61.2/100,000 in rural areas. Deaths due to direct obstetric causes constituted 71% of the total deaths. The sequences of the main causes were: obstetric hemorrhage, cardiac diseases, pregnancy induced hypertension, amniotic fluid embolism and puerperal infection. Obstetric hemorrhage caused nearly half of the total deaths. The maternal care for these cases was unsatisfactory. The average number of antenatal examination was only 2. In the rural areas half of the cases were delivered not in hospital but at home, and 1/6 of the cases died on the way to hospital. A discussion was made on the investigated material.

Cause of Death↗
PubMed1989

[A comprehensive laboratory evaluation of changes in the fibrinogen molecule in the diagnosis of acquired coagulopathy conditions].

A scheme of physicochemical determination of fibrinogen and the major molecular derivatives in a single sample of plasma is suggested, available for the majority of clinical laboratories. Such determination gives valuable information for a clinician. Among other things, the level of rapidly thrombin clotted fibrinogen portion is determined, as is the content of high-molecular fibrin monomer complexes, not clotted with thrombin, and the level of fibrinogen and fibrin proteolytic degradation products. Clinical (in 42 patients with various conditions) and experimental (coagulopathy in amniotic fluid embolism) application of this scheme has confirmed its clinico-diagnostic value.

Blood Coagulation Disorders↗
PubMed1989

Intravascular coagulation in relation to pregnancy and delivery.

Incidence, risk factors and morphological features of the intravascular coagulation (IC) in 160 women who had died during pregnancy, after abortion and delivery were studied. IC was established in 118 (73.8%) of them. The main risk factors leading to IC were shock (59.3%), sepsis (28.8%), toxemia of pregnancy (incl. eclampsia) (25.4%), Caesarean section (19.5%), fetal death in utero (12.7%), amniotic fluid embolism (9.3%), and abruptio placentae (7.6%). Disseminated intravascular coagulation (DIC) was established in 66% of the cases, and local intravascular coagulation (univisceral localisation of microthrombi) in 28%. In the resting 6% of the cases there was consumptive coagulopathy without microthrombi. Lungs, pituitary gland, uterus, kidneys and adrenals were the most frequently affected organs. Necrosis in the parenchymal organs, hyaline membrane formation in the lungs and consumptive coagulopathy were particularly frequent in the cases with DIC. The leading causes of death were acute renal failure and ARDS. It was established that prolonged intensive care including artificial ventilation, massive blood transfusion, as well as surgical treatment, aggravate the course and morphological features of IC.

Abortion, Spontaneous↗
PubMed1988

Analysis of the causes of maternal death in China.

Data were analysed on maternal mortality for 1984 in 287 cities, districts, and counties in 21 provinces, municipalities, and autonomous regions of China. The total population covered was 177.55 million, and during the study period there were 2 483 269 live births and 1211 maternal deaths, corresponding to a maternal mortality rate of 48.8 per 100 000. The main cause of maternal death was obstetric haemorrhage, followed, in order, by cardiac diseases, toxaemia of pregnancy, hepatic disease, puerperal infection, and amniotic fluid embolism. The health care measures received by the mothers who died are analysed, and methods of reducing the maternal mortality rate are proposed.

Cause of Death↗
PubMed1982

Review on coagulation in trophoblastic disease.

Problems of haemostasis associated with abnormal pregnancy states such as eclampsia, prolonged intrauterine death and amniotic fluid embolism causing maternal death are well recognised. Coagulation problems have been suspected in hydatidiform molar pregnancies previously but because of the rare occurrence, the importance of defective haemostasis in this trophoblastic disorder has not been emphasised. Evidence from clinical course of the disease, from haematological studies and from postmortem findings provide evidence that enhanced coagulation occurs in all hydatidiform molar pregnancies. Secondary fibrinolysis in the intact mole increases during evacuation and could aggravate the coagulation state. If there should already be a moderate degree of intravascular coagulation, it could progress to an irreversible state with evacuation if the coagulation defect are not corrected before the procedure as illustrated by reported maternal deaths. Since the degree of vaginal bleeding does not definitely indicate the degree of coagulopathy, coagulation screening tests are necessary to detect the condition in all hydatidiform moles. The placental proteins with coagulation and fibrinolytic activity found in trophoblastic disease, may be associated with the aetiology of coagulation disorder and may have a prognostic value in detecting subsequent malignancy.

Disseminated Intravascular Coagulation↗
PubMed1983

[Focal nodular hyperplasia of the liver].

Report about 19 cases of focal nodular hyperplasia of the liver observed from 1971 to June 1981. The autopsy cases are 7 women between 19 and 62 years of age. The intake of oral contraceptives over a long time period was known in 4 cases; once a node was detected in a 19-year-old woman after a normal pregnancy (death from amniotic fluid embolism), once in a 62-year-old woman who had a longterm diabetes, and once in a 47-year-old woman who died from acute alcoholic intoxication; probably contraceptives had not been taken. The biopsy cases are 11 women between 27 and 50 years of age and a man 25 years of age. Ten times the nodes were found on occasion of cholecystectomy, once during gastric resection, and once during vagotomy. 4 women took oral contraceptives for 5 to 101/2, 2 others for about 2 years. A 34-year-old woman had 7 pregnancies one shortly after the other. 4 women did not use oral contraceptives. In 12 of 18 women a hormonal induction seems possible, in 10 cases by oral contraceptives and in 2 cases by pregnancies. Complications such as bleedings we did not find.

Adult↗
PubMed1994

[Analysis of national maternal death surveillance: 1989-1991].

An analysis of maternal mortality in 247 cities, districts and countries of 30 provinces, municipalities and autonomous regionscovering a population of 100,000,000 in China in 1989-1991 was reported. The total number of live births was 4,201,457 in the pilot area, and the number of maternal deaths was 3,274 giving an average maternal mortality rate (MMR) of 80.0/100,000. After correction, the average MMR was 87.8/100,000. The MMR per annum was in decreasing trends and in different regions were different from one another. The first 6 leading causes of maternal deaths in 3,274 cases, in decreasing order of importance, were: obstetric hemorrhage, pregnancy induced hypertension, cardiac diseases, puerperal infection, amniotic fluid embolism, and hepatic diseases. The result of audit on maternal deaths was as follow: 89.0% of the maternal deaths were avoidable, and 11.0% were unavoidable. Three aspects of the maternal deaths in China were formulated form this study.

Adult↗
PubMed1993

Ripening of the unfavorable cervix with prostaglandin E2: intracervical versus intravaginal route.

Forty-eight term primiparae women with unripe cervix (Bishop score of 4 or less) were randomly given either 1.5 mg of prostaglandin E2 in 3 ml of gel intracervically or 3 mg prostaglandin E2 tablet intravaginally to ripen the cervix. Intracervical administration caused favorable cervix in 36 per cent compared with 12 per cent in the intravaginal group, and induced spontaneous labor in 41 per cent compared with 69 per cent in the intravaginal group. Oxytocin augmentation was required in 88 per cent in the intracervical group compared to 62 per cent in the intravaginal group. The only significant difference statistically was the mean duration of the insertion of PGE2 to delivery being 16 hours and 23.5 hours in the intracervical and intravaginal routes respectively (P = 0.02). There was one case of hyperstimulation and one case of maternal death from amniotic fluid embolism in this study.

Administration, Intravaginal↗