Can anesthesiologic strategies for caesarean section influence newborn jaundice? A retrospective and prospective study.

RATIONALE AND OBJECTIVES: Neonatal jaundice is a frequent problem in neonatology and can be influenced by many factors. Our study arose from the clinical observation that among all newborns delivered by caesarean section in our center, some had a more intense physiological jaundice. We began by reviewing clinical anesthesiological case-sheets to ascertain whether this difference was linked to the use of different anesthesiologic strategies. We then performed a prospective study on healthy preterm and term newborns to verify this hypothesis. STUDY DESIGN: We retrospectively considered all healthy term newborns with weight > 2,400 g delivered by caesarean section from January 1998 to May 1999. In the prospective studies we included healthy term and preterm newborns consecutively delivered by caesarean section from May 1999 to December 1999. We excluded preterm newborns with gestational age < 31 weeks and with weight < 1,400 g. RESULTS: Both in retrospective and in prospective studies anesthetic agents employed were isoflurane (A), sevoflurane (B), or bupivacaine (C). The statistical comparison of the three groups in retrospective study confirmed the clinical observation: the total bilirubin levels were significantly higher in the isoflurane group than in the sevoflurane group (p = 0.0000) and bupivacaine group (p = 0.0002). Analysis of data from the prospective study on term newborns confirmed our previous results. In preterm infants total bilirubin is statistically higher in group A starting from 96 h postdelivery. CONCLUSIONS: It is likely that anesthetic technique can be included among factors with possible influence on neonatal jaundice.

[Electric cardioversion in pregnant patients with obstructive hypertrophic cardiomyopathy. A clinical case]. / Cardioversione elettrica in paziente gravida affetta da miocardiopatia ipertrofica ostruttiva. Caso clinico.

A case of atrial fibrillation during pregnancy in a woman at 30 weeks of gestation is described. She was affected by obstructive hypertrophic myocardiopathy, a rare disease usually non interfering with the normal course of pregnancy. The mortality rate is of 2-4% per year. The most frequent cause is "cardiac sudden death". High frequency atrial fibrillation can lead to right and left cardiac failure. The treatment of atrial fibrillation is to be chosen between a pharmacological or electrical therapy. However, during pregnancy, pharmacological cardioversion, although not excluded, could cause damaging side effects to the fetus. Conversely, according to literature, electrical cardioversion is effective on the mother and safer for the fetus. At admission the patient showed dyspnea, palpitations, tachycardia and hypotensions; ECG showed an atrial fibrillation at high frequency that required an immediate therapeutic decision. In the case we studied, we reported the recovery of cardiac rhythm with a single synchronized electric shock. Non alteration of fetal cardiac rhythm or uterine contractility was observed. Pregnancy went on without accidents until the 36th week, when a cesarean section was performed under general anaesthesia. We described our experience reviewing previous literature on the account of the rareness of the disease, its association to a pregnancy and the serious alterations of cardiac rhythm at the admission, which led us to take an immediate decision, safeguarding both the mother and the fetus.