ABSTRACT
Forty-six of 64 high risk labours were managed with continuous lumbar extradural analgesia. Fetal heart rate (FHR) and continuous transcutaneous PO2 (tcPO2) measurements were made in the 64 patients. Abnormal fetal heart rate patterns and low tcPO2 values associated with the onset of the extradural block were noted in 9% of these cases. A decrease in maternal arterial pressure and uterine hypertonus appeared to be responsible, singly or in combination, for the changes. These effects and the changes in FHR were not seen in the 18 mothers not receiving extradural analgesia. The supine position was associated with slightly smaller fetal tcPO2 values than the preferred lateral positions, with a significant worsening of the fetal tcPO2 values after induction of the extradural block although, overall, extradural analgesia neither improved nor impaired the fetal tcPO2.
Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Fetus/physiology , Labor, Obstetric , Oxygen/physiology , Female , Fetal Heart/physiology , Heart Rate , Humans , Partial Pressure , Posture , Pregnancy , Uterine ContractionABSTRACT
The fourth case of fetal and maternal survival following rupture of a splenic artery aneurysm is presented among 90 reported cases occurring during pregnancy. The previously reported cases are reviewed. A high level of awareness and careful review of history and physical findings in the absence of evidence of the more common causes of concealed hemorrhage may lead to the diagnosis. Ligation of the aneurysm and splenectomy is the indicated therapy.