Venous thromboembolism is recognized as a leading cause of maternal death in the United States. Thromboprophylaxis has been highlighted as a key preventive measure to reduce venous thromboembolism-related maternal deaths. However, the expanded use of thromboprophylaxis in obstetrics will have a major impact on the use and timing of neuraxial analgesia and anesthesia for women undergoing vaginal or cesarean delivery and other obstetric surgeries. Experts from the Society of Obstetric Anesthesia and Perinatology, the American Society of Regional Anesthesia, and hematology have collaborated to develop this comprehensive, pregnancy-specific consensus statement on neuraxial procedures in obstetric patients receiving thromboprophylaxis or higher dose anticoagulants. To date, none of the existing anesthesia societies' recommendations have weighed the potential risks of neuraxial procedures in the presence of thromboprophylaxis, with the competing risks of general anesthesia with a potentially difficult airway, or maternal or fetal harm from avoidance or delayed neuraxial anesthesia. Furthermore, existing guidelines have not integrated the pharmacokinetics and pharmacodynamics of anticoagulants in the obstetric population. The goal of this consensus statement is to provide a practical guide of how to appropriately identify, prepare, and manage pregnant women receiving thromboprophylaxis or higher dose anticoagulants during the ante-, intra-, and postpartum periods. The tactics to facilitate multidisciplinary communication, evidence-based pharmacokinetic and spinal epidural hematoma data, and Decision Aids should help inform risk-benefit discussions with patients and facilitate shared decision making.

We evaluated the efficacy of the Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) banding procedure in treating dialysis-associated steal syndrome or high-flow access problems. A retrospective analysis was conducted, evaluating banding of 183 patients of which 114 presented with hand ischemia (Steal) and 69 with clinical manifestations of pathologic high access flow such as congestive heart failure. Patients were assessed for technical success and symptomatic improvement, primary and secondary access patency, and primary band patency. Overall, 183 patients underwent a combined 229 bandings with technical success achieved in 225. Complete symptomatic relief (clinical success) was attained in 109 Steal patients and in all high-flow patients. The average follow-up time was 11 months with a 6-month primary band patency of 75 and 85% for Steal and high-flow patients, respectively. At 24 months the secondary access patency was 90% and the thrombotic event rates for upper-arm fistulas, forearm fistulas, and grafts were 0.21, 0.10, and 0.92 per access-year, respectively. Hence, the minimally invasive MILLER procedure appears to be an effective and durable option for treating dialysis access-related steal syndrome and high-flow-associated symptoms.

OBJECTIVE-To investigate whether magnesium sulfate (MgSO 4 ) prevents fetal brain injury in inflammation-associated preterm birth (PTB).STUDY DESIGN-Utilising a mouse model of PTB, LPS or normal saline (NS)-exposed mice via intrauterine injection, were randomized to intraperitoneal treatment with MgSO 4 or NS. From the 4 treatment groups, 1)NS+NS; 2)LPS+NS; 3)LPS+MgSO 4 ; and 4)NS+MgSO 4 , fetal brains were collected for QPCR studies and primary neuronal cultures. mRNA expression of cytokines, cell death, and markers of neuronal and glial differentiation were assessed.Immunocytochemistry and confocal microscopy were performed. RESULTS-There was no difference between LPS+NS and LPS+MgSO 4 groups in expression ofpro-inflammatory cytokines, cell death markers as well markers of pro-oligodendrocyte and astrocyte development (P>0.05 for all). Neuronal cultures from LPS+NS demonstrated morphological changes and this neuronal injury was prevented by MgSO 4 (P<0.001).CONCLUSION-Amelioration of neuronal injury in inflammation-associated PTB may be a key mechanism by which MgSO 4 prevents cerebral palsy.

Fistula salvage attempts should not be limited by factors such as a diffusely small diameter or an inaccessibly deep position.

Fetuses with an isolated single umbilical artery are at similar risk for SGA compared with fetuses with 3-vessel umbilical cords. It appears that antepartum serial ultrasound examination does not provide more information for interval fetal growth assessment in fetuses with an isolated single umbilical artery.

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