Background: Cardiac disease complicating pregnancy is an indirect cause of maternal mortality. The incidence of cardiac disease during pregnancy has remained stable for many years even with significant decrease in the occurrence of rheumatic heart disease (RHD) as this decrease is being compensated by significant increase of pregnancy in women with congenital heart disease (CHD). Therefore, in this study we aim to analyse the incidence of cardiac disease in pregnancy and to assess the obstetrical outcome.Methods: A retrospective study carried out in 32 women with cardiac disorders at a tertiary care centre during the period of 5 years.Results: In the present study the incidence of cardiac disease in pregnancy was observed to be 0.21%. With 62.6% rheumatic, 21.8% congenital being and 15.6% peripartum cardiomyopathy. Among rheumatic valvular heart disease, mitral valve stenosis was most common followed by mitral regurgitation and tricuspid regurgitation. Non-cardiac complications like pre-eclampsia and anaemia were also noted. No of vaginal delivery were higher compared to caesarean (26 versus 6). Adverse perinatal outcomes in form of preterm, NICU admission and perinatal death were also noted.Conclusions: A cardiac disease has a major impact on pregnancy. It is a multidisciplinary teamwork to have optimal maternal and foetal outcome in women with cardiac disease. Hence, constant vigilance is required throughout antenatal, intrapartum and postpartum period to avoid adverse outcomes.
Abstractscausative agent, the mean body surface area affected was 42%. Mechanical ventilation of 40% of patients and hemodynamic support with vasoactive 80%, the mean sedation was 192 hours and the mean of beginning the diet was 43.2 hours, and is the most used jejunal (60%). Three patients made use of hyperbaric therapy, with good resolution. Conclusions The burns are an important public health problem, efforts are needed to reduce accidents and the large number of victims, because the main form of "treatment" for the burn is still prevention through the application of epidemiological principles awareness campaigns and legislative measures. HOSPITAL@HOME -AN INNOVATIVE COST EFFECTIVE APPROACH TO PAEDIATRIC CARE IN COMMUNITY
AIMOur primary aim is to analyze of maternal and fetal outcome in spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia. MATERIALS AND METHODSSixty parturients (60) with severe pre-eclampsia posted for cesarean section were randomized into two groups of thirty (30) each for either spinal anesthesia that is group S or epidural anesthesia that is group E. Spinal group (group S, n=30) received 10mg (2ml) of 0.5% of hyperbaric bupivacaine solution intrathecally in left lateral decubitus or sitting position at L3-4 lumbar space with 25G quincke-babcock spinal needle. Patients received 6l/min of oxygen through Hudson's face mask throughout the surgery. In Epidural group (group E, n=30), after thorough aseptic precautions, an 18G Tuohy's epidural needle inserted at the L3-4 lumbar space with the patient in lateral decubitus or sitting position. Three ml of 1.5% lidocaine with was given as a test dose. After ruling out any intrathecal injection of the drug, initially 8ml of 0.5% isobaric bupivacaine given and the vitals monitored. Then 3ml top-ups of the same bupivacaine solution is given in a graded manner slowly, simultaneously checking the height of block. A blockade upto T4 to T6 is required. Vitals are carefully monitored and oxygen is provided 6l/min throughout the procedure and surgery. Blood pressure (systolic, mean, diastolic), pulse rate, oxygen saturation are recorded immediately after giving anesthesia, every minute for first 10mins, then every 3mins for the rest of the surgery. Then vitals are also noted post-operatively for the first 24hrs. Apgar score after 1 and 5 minutes, of the newborn baby is also recorded. Other parameters noted were incidence and duration of hypotension or hypertension both intra-operatively and post-operatively, any usage of vasopressors (ephedrine) and its dose, convulsions, renal failure, pulmonary edema, requirement for ICU stay and the number of days in the mother, and the incidence of fetal demise. CONCLUSIONIn conclusion, although the incidence of hypotension and ephedrine requirement was slightly more frequent in the spinal group than in the epidural group, we found evidence that supports the use of spinal anesthesia in severely pre-eclamptic patients.HOW TO CITE THIS ARTICLE: Jyothi S, Ravisankar V. Analysis of maternal and fetal outcome in spinal versus epidural anesthesia for cesarean delivery in severe pre-eclampsia.
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