RESUMO
We present the anaesthetic management of a woman who, at 10 days post partum, suffered a series of convulsions in the context of two episodes of post partum haemorrhage. The probable aetiology of the convulsions is discussed.
Assuntos
Hipopituitarismo/diagnóstico , Placenta Prévia/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Convulsões/diagnóstico , Adulto , Cesárea , Procedimentos Cirúrgicos Eletivos , Feminino , Seguimentos , Idade Gestacional , Humanos , Hipopituitarismo/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Testes de Função Hipofisária , Placenta Prévia/diagnóstico , Hemorragia Pós-Operatória/etiologia , Gravidez , Medição de Risco , Convulsões/fisiopatologia , Índice de Gravidade de DoençaRESUMO
We report the anaesthetic management of a primiparous patient presenting in late pregnancy with rapidly progressive bitemporal hemianopia due to a pituitary mass caused by autoimmune hypophysitis. Caesarean section was complicated by post-partum haemorrhage. Anaesthesia is discussed together with a review of the literature on lymphocytic hypophysitis.
RESUMO
We report three cases of intracranial haemorrhage from arteriovenous malformations during pregnancy. The anaesthetic management of the pregnant patient undergoing a major neurosurgical procedure and the anaesthetic management of caesarean section in a patient at risk of recurrent intracranial haemorrhage are discussed.
RESUMO
The aim of this study was to determine the effect on the instrumental delivery rate of two different concentrations of bupivacaine combined with fentanyl in epidural infusions during labour. Only primiparous women in whom a spontaneous vaginal delivery was anticipated, were included in the study. Those women receiving a higher concentration of bupivacaine and therefore a greater amount of local anaesthetic agent during labour were significantly more likely to have an instrumental delivery with Kielland's rotational forceps (p < 0.01). Those women receiving a lower concentration and smaller amount of bupivacaine were significantly more likely to have an instrumental delivery with Neville-Barnes forceps (p < 0.05). This provides evidence to support the theory that epidural analgesia may contribute to inadequate rotation of the presenting fetal part due to weakened pelvic floor muscles and that this is more likely to occur when higher concentrations of bupivacaine are used and a greater degree of motor block occurs.
