{"title":"Enhanced recovery","authors":"","doi":"10.1017/9781108684729.043","DOIUrl":"https://doi.org/10.1017/9781108684729.043","url":null,"abstract":"EDUCATIONAL OBJECTIVES After completing this activity, the participant should be better able to: • Discuss strategies for overcoming barriers to implementation of enhanced recovery protocols • Evaluate the efficacy and safety of current strategies to reduce postoperative ileus • Identify evidence-based techniques for objectively monitoring depth of neuromuscular blockade • Apply clinical evidence supporting use of reversal agents for postoperative residual neuromuscular blockade","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123669803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Research on the labour ward","authors":"","doi":"10.1017/9781108684729.176","DOIUrl":"https://doi.org/10.1017/9781108684729.176","url":null,"abstract":"","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125221579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Connective tissue disorders","authors":"","doi":"10.1017/9781108684729.113","DOIUrl":"https://doi.org/10.1017/9781108684729.113","url":null,"abstract":"Connective tissues provide a framework and structural support for the body, protect organs, connect body tissues, and store energy. Connective tissue disorders are a heterogeneous group of more than 200 conditions that often involve the joints, muscles, and skin. Heritable connective tissue disorders include both soft tissue disorders, characterized by excessive skin laxity, joint hypermobility, and easy bruising, as well as skeletal dysplasias that affect bone development.","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125371320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cord prolapse","authors":"Cord Prolapse","doi":"10.1002/9781444314489.ch73","DOIUrl":"https://doi.org/10.1002/9781444314489.ch73","url":null,"abstract":"1. Purpose This document outlines the guideline details for the prevention, diagnosis and management of cord prolapse at the Women’s. 2. Definitions Cord Prolapse: the umbilical cord lies in front of or beside the presenting part in the presence of ruptured membranes. Cord presentation: the presence of the umbilical cord between the presenting part of the fetus and the cervix. In both conditions a loop of the cord is below the presenting part. The difference is in the condition of the membranes; if intact it is cord presentation and if ruptured it is cord prolapse. 3. Responsibilities Obstetric and midwifery staff are responsible for identifying and responding to this emergency situation. 4. Guideline 4.1 Incidence The incidence of cord prolapse/ presentation is said to occur in 0.1 0.6% of births1. The predisposition to cord prolapse is higher in a breech presentation and with multiple gestations. 4.2 Risk factors • High / ill fitting presenting part • High parity • Prematurity • Multiple pregnancy • Polyhydramnios • Malpresentations • Obstetric manipulation. 4.3 Prevention • Identification/ awareness of risk factors • Artificial rupture of membranes (ARM) should not be done when the station is high. If ARM is essential to manage a difficult obstetric situation and the head is not engaged and high consider a controlled ARM by senior medical staff in theatre The same procedure should take place in the situation of polyhydramnios. Consider need to identify a cord presentation on ultrasound. 4.4 Clinical recognition Diagnosis of cord prolapse is made by visual inspection or by palpation during vaginal examination where the umbilical cord is felt below or beside the presenting part. Cord prolapse should be suspected with an abnormal fetal heart rate pattern (bradycardia, severe variable decelerations) occurring soon after spontaneous or artificial rupture of membranes. Note: In the presence of predisposing risk factors a vaginal examination should always be performed after the membranes rupture spontaneously or if a fetal bradycardia occurs after rupture of membranes.","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126167248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Collapse on the labour ward","authors":"","doi":"10.1017/9781108684729.081","DOIUrl":"https://doi.org/10.1017/9781108684729.081","url":null,"abstract":"","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131191823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thrombocytopenia","authors":"J. Abeykoon, O. A. Abu Saleh, C. Rivera","doi":"10.1017/9781108684729.110","DOIUrl":"https://doi.org/10.1017/9781108684729.110","url":null,"abstract":"Drug-induced thrombocytopenia (DITP) is commonly attributed to antimicrobial agents; 153 drugs are believed to have a high probability of causing immune-mediated thrombocytopenia. Rifampin is categorized as a definite cause of DITP. Median time to presentation with thrombocytopenia after rifampin exposure is 1 to 2 weeks. DITP in current medical practice largely remains a clinical diagnosis. The therapy for DITP is discontinuation of the offending agent. Although DITP is associated with a high incidence of morbidity and mortality, the possibility of completely reversing it by discontinuing the offending agent indicates that an accurate and timely diagnosis is vital.","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"152 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131758940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lymphoma and leukaemia","authors":"S. Milham","doi":"10.1017/9781108684729.111","DOIUrl":"https://doi.org/10.1017/9781108684729.111","url":null,"abstract":"Szmigielski, S., Cancer morbidity in subjects occupationally exposed to high frequency (radiofrequency and microwave) electromagnetic radiation, 1996 The cancer morbidity rate for RF/MW-exposed personnel for all age groups (20–59 years) reached 119.1 per 100 000 annually (57.6 in non-exposed) with an OER of 2.07, significant at P < 0.05. The difference between observed and expected values results from higher morbidity rates due to neoplasms of the alimentary tract (OER = 3.19–3.24), brain tumours (OER = 1.91) and malignancies of the haemopoietic system and lymphatic organs (OER = 6.31). Among malignancies of the haemopoietic/lymphatic","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125095434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Epidural analgesia for labour","authors":"J. Papalkar, D. Shrivastava, C. Hariharan","doi":"10.1017/9781108684729.027","DOIUrl":"https://doi.org/10.1017/9781108684729.027","url":null,"abstract":"Epidural analgesia in labour From Miss J Towler, Midwife, and Mr A H C Walker, Consultant Obstetrician & Gynaecologist, St Mary's Hospital, Manchester M13 OJH Dear Sir, Andrew Doughty's paper (December 1978 Journal, p 879) expresses a contemporary anaesthetist's view on this important subject and concludes that 'an epidural rate of 40O% might be considered as really necessary'.. A 40% epidural rate might be necessary for cases of induced and accelerated 'pharmacological' labour, because the hypoxia due to the sudden and increased amplitude of the Syntocinon (oxytocin) contractions certainly increases the pain felt by the mother. Dr Doughty writes of the 'severe pain' experienced in labour, but we suggest that a mother who does experience severe pain (requiring relief by an epidural), does so because she is in the cold, clinical, strange surroundings of a labour ward and consequently is suffering from loss of autonomy and identity; in addition to which, she may have been subjected to an amniotomy, to an oxytocic infusion, to the application of a fetal scalp electrode and tocograph belt attached to a monitor. She is, consequently, literally 'confined' to a wet bed and will be almost totally dependent on her attendants. All these factors increase anxiety and, therefore, perception of pain. Dr Doughty concedes that the epidural 'deprives the mother of the automatic desire to bear down', but suggests that a 'spontaneous delivery' can be anticipated 'despite the use of regional analgesia'. The manoeuvres for this include 'improving the strength of uterine contractions with oxytocin', 'digital assistance of the rotation of the fetal head', and 'judicious application of fundal pressure' (which could cause placental separation), which he calls 'active management of the second stage with a view to securing a normal delivery'. To our minds, nothing could be more abnormal, and it is certainly the very opposite of 'spontaneous'. It is no wonder that it has been said that 'childbirth is not now something women do, but something done unto them by doctors'. We do, of course, concede that an epidural is valuable in selected cases, but it is still very important to remember that pregnancy is a 'nine months physiological disease, with a spontaneous cure, nine times out of ten'. Unfortunately, modern obstetric thinking ignores this definition. If one allows spontaneous onset of labour and first-stage ambulation, thus facilitating descent of the head (conversely, the supine wedged position for an epidural prevents this), and physiological contractions throughout, the patient often will require only Entonox (nitrous oxide and oxygen), the oxygen content of which must be beneficial for the fetus, it must aid the uterus to work more efficiently and it will relieve discomfort by reducing hypoxia. Dignity is very important, but so is a sense of achievement, and there can be dignity in achievement. Yours sincerely","PeriodicalId":373558,"journal":{"name":"Analgesia, Anaesthesia and Pregnancy","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134045838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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