ABSTRACT
Recently, the external cephalic version procedure has attracted attention as an alternative for the operative or vaginal delivery of a breech-presenting fetus. Although this procedure has many benefits, including its comparative safety and economical efficiency, it is not free from complications. We report two cases of external versions attempted under epidural anesthesia. These cases demonstrate that the use of a neuraxial blockade during a version attempt can provide the appropriate conditions necessary for this procedure, as well as the ability to deal with complications in a timely and safe manner.
Subject(s)
Female , Pregnancy , Anesthesia, Epidural , Breech Presentation , Fetus , Version, FetalABSTRACT
A 33-yr old female patient with coagulation factor VII deficiency was scheduled for laparoscopic oophorectomy under the diagnosis of ovarian teratoma. Plasma concentration of factor VII of this patient was 9 IU/dl (normal range; 60-140 IU/dl) and the prothrombin time INR (International Normalization Ratio) was 1.79 (normal range; 0.8-1.2) on the day before the operation. Total 1,200microgram (30microgram/kg) of recombinant activated factor VII (rFVIIa) was administered just before the start of the laparoscopic procedure, which was accomplished safely without severe hemorrhage or other complications. Postoperative course was uneventful. In addition, this article provides the clinical implication of rFVIIa in terms of hemostasis management in hemophiliacs and surgical patients.
Subject(s)
Female , Humans , Blood Coagulation , Blood Coagulation Factors , Diagnosis , Factor VII , Factor VIIa , Hemorrhage , Hemostasis , International Normalized Ratio , Ovariectomy , Plasma , Prothrombin Time , TeratomaABSTRACT
Uterine rupture is usually associated with previous uterine scar. Although intrapartum rupture of unscarred uterus is very rare, it may cause catastrophic outcomes to both the mother and the newborn infant compared with that of a scarred uterus. The present case describes our experience of anesthesia for an emergency cesarean section due to the arrest of fetal descent in a 36-year-old parturient who had undergone external cephalic version for the breech presentation of her fetus. We detected the rupture of her unscarred uterus during the operation under epidural anesthesia, which was changed to general anesthesia. Despite the uterine rupture the newborn infant survived uneventfully. At the postoperative twelfth day she was discharged from hospital with her baby.