Deputy of Chief Obstetric Anaesthesiologist, Dept. of Anaesthesiology & Intensive Care, 1st Faculty of Medicine, Charles University in Prague; General University Hospital, Prague, Czech Republic
Member of Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine
Post-dural puncture headache is one of the most feared complications of anesthetists performing obstetric anesthesia and analgesia. Even in the hands of experienced colleagues, its incidence varies between 0.16 to 1.3%. Due to the necessary to mobilize the patient and the care of newborn is appropriate to solve effectively this complication. Referred algorithm is a logical therapeutic procedure and clearly brings anesthesiologist over the initial conservative therapy also to conventional invasive solution. The topic for discussion may be required laboratory tests needed to neuraxial puncture in obstetrics, which nowadays accords with practices in any workplace. The literature shows that in case of monitored physiological pregnancy is sufficient blood count value during the first and third trimester while there are no signs of mucosal and cutaneous bleeding manifestations.
Preeclampsia is common pregnancy-complicating state that comes to anesthesiologist´s and obstetrician´s practice every day. Worldwide incidence is around 7,5% of all pregnancies. If not being diagnosed and treated correctly, it can develope into a critical preeclampsia or eclampsia with the risk of increased maternal and neonatal mortality. This algorithm presents basic clinical signs and guide the doctor through the particular treating steps. It points out the necessity to administer magnesium and compares it with benzodiazepine therapy during seizure and the necessity of continuing administering magnesium after delivery. Unfortunately, as is well known, in practice this continuing magnesium therapy is not often kept.
The most frequent cause of maternal morbidity and mortality is postpartum haemorrhage (PPH). A background of PPH is in 70-80 % hypotony or atony of the uterus. This is followed by delivery trauma in 10-15 % and in 1-5 % by placenta adherens or placenta accreta. Disseminated intravascular coagulopathy (DIC) participates in only 1-3 % and mostly it is connected with emboly of foetal water or during abruption of placenta. This practical and well arranged algorithm is led by the anesthesiologist in cooperation with the obstetrician and it leads to a solution of this critical condition in gynecology. The materials are based on the newest czechoslovakian interdisciplinary recommended techniques and guidelines from the year 2018. This brings us to a new and rational view on this problem.
The target of medical effort is to stop PPH and to protect and preserve uterus by using all contemporary accessible methods and medical guidelines.
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of stimulated ovulation within modern procedures of assisted reproductive technology, which is nowadays still on the rise. In predisposed women, this process may get out of control and the activation of many neurohumoral systems results in OHSS. The incidence moves between 0,5-11% of all IVF(in vitro fertilization) patients, severe life-threatening form occurs in 0,1-2% of stimulated cycles. The state is characterized by significant cystic ovarian enlargement, high capillary permeability with fluid leakage to the third space, hypovolemia and hypercoagulation. Next complications are dysfunction or final organs failure as the consequence of hypoperfusion and thromboembolic event. The algorithm illustrates the issue very practically and leads the investigator logically step by step to the right therapy in clinical practice.