Background: There are few case reports describing maternal mortality and intensive care of the pregnant patient with COVID-19 infection. Case: A 27-year-old patient at 34 weeks of gestation was admitted for the evaluation of cough, fever, tachypnea, and oligohydramnios. The day of admission she underwent cesarean delivery for a non-reassuring fetal heart rate tracing. Over the next 6 days her clinical condition deteriorated, she developed multi organ system failure, and died despite aggressive supportive care. Conclusion: Although mortality related to COVID-19 in pregnancy has been rarely reported to date, we describe a case of progressive clinical deterioration postpartum despite aggressive supportive care. Management strategies specific for pregnant women have not been developed. In timing delivery, the obstetrician must consider the possibility that the inflammatory response associated with CD may increase the risk for multiorgan system failure in parturients with COVID-19 while recognizing that risks to the fetus may be higher in patients with COVID-19 than in other critically ill parturients. Vertical transmission of infection to the neonate did not occur in our case and has not been demonstrated in other pregnancies with COVID-19 disease.
Propofol (2,6-diisopropylphenol) is the most common intravenous anesthetic used in modern medicine. It is postulated that individual differences in genetic factors [polymorphism of single nucleotide polymorphisms (SNPs)] in the genes encoding metabolic enzymes, molecular targets and molecular binding sites of propofol can be responsible for susceptibility to propofol effects. The aim of our study was to investigate the influence of the cytochrome P450 2B6 isozyme CYP2B6 (rs3745274), γ-aminobutyric acid type A (GABAA) receptor α1 subunit GABRA1 (rs2279020) and ATP-binding cassette subfamily B member 1 ABCB1 (rs1045642) gene polymorphisms on propofol therapeutic outcomes in the patients undergoing abdominal hysterectomy. Ninety patients aged 29-74 years, with different ethnicities were included in this study. The presence of polymorphisms was analyzed using TaqMan SNP genotype analysis on Stratagene MxPro 3005P real-time polymerase chain reaction (qPCR). The distribution of all three genetic variants was within the Hardy-Weinberg equilibrium. There was no significant difference (p >0.05) in the allelic frequencies of polymorphic variants and genotype distributions between adult and older patients and between patients of different ethnicities. Our study did not detect a statistically significant influence of the CYP2B6 (c.516G>A), GABRA1 (c.1059+15G>A) and ABCB1 (c.3435T>C) variants on the variability of clinical parameters (doses for induction in anesthesia, additional doses, induction time and wake time after anesthesia and side effects of propofol). However, the observed trend on the possible influence of the CYP2B6 (c.516G>A) and GABRA1 (c.1059+15G>A) variants warrant an extension of these studies on a larger number of patients.
Introduction. The number of caesarean sections has drastically increased and thus arose the idea to examine the effect of the type of anesthesia on the neonates. The objective was to compare vital parameters in the neonates, born under general and spinal anesthesia.Method. A total of 120 patients with need for caesarean section have been divided in two groups of 60, of which the first was lead in general and the second one in spinal anesthesia. The first one was given propophol (2.0-2.5 mg/kg/tt) and succinil colin (1-1.5 mg/kg/tt). The anesthesia was lead with fentanil 0,005 mg/kg/tt and rocuronium bromide 0.4-0.6 mg/kg/tt. O2:N2O was 3:3 l/min. The second group was lead in spinal anesthesia. 2-3 ml Bupivacain 0.5% was spinally applied between L2-L3. Apgar score was defined in the neonates in the first and fifth minutes. The acido-basic status of the neonate was examined through pH values in the blood and the base excess.Results. In the first minute after birth giving with Apgar, 8 newborns 37(61,67%) were born to the group of patients with SA and 29 (48.33%) to the group of patients with GA. In 11 (18.33%) newborns born to the patients led with SA had Apgar score of 9-10, while only 3 (5%) of the newborns born to the patients led with GA had Apgar score of 9-10. Similar ratio was noted in the fifth minute after birth. Ph of the newborns’ blood as well as the base excess (BE) demonstrated significantly lower values in the group of patients led with SA than in the group of patients led with GA. Ph = 7.33 vs 7.37; BE=-4.57±1.8 vs -2.96±2.3.Conclusion. The newborns from the second group had significantly higher Apgar scores than those in the first group. The newborns’ relative acidose (lower SpO2and BE) did not affect the newborns’ Apgar score in the first and fifth minute.
The study describes a case of subdural hematoma developed after cesarean section in a 34-year-old patient with normal intra-operative course.During the first twelve hours after the operation, the patient had a headache considered as post-dural puncture headache (PDPH) and was treated in that direction.After the third operative day the headache was reduced, and on the fifth day the patient was discharged from the hospital in good condition. As soon as the patient was discharged, the headache appeared again with stronger and persisting intensity and at the end it was accompanied by epileptic seizure. MR scan showed subdural hematoma in absorption. After conservative therapy, the condition was improved and the patient was without neurologic consequences. The differences between PDPH and other types of headache, as well as the potential etiopathogenesis of subdural hematoma in obstetric patient, are discussed in this study. We have come to the conclusion that after the long persisting headache, if we take into consideration this complication as a possibility, the early diagnosis and adequate treatment could lead to complete recovery.
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