Abstract
A parturient is designated as “high risk” because of the various problems that might arise in the antenatal or peripartum periods. Anesthetic management – both in choice and technique – should be based on a thorough understanding of the physiology of pregnancy and also on the pathophysiology of the problems that made the parturients “high risk.” Any high-risk parturient can be a potential candidate for an obstetric emergency. Hence, continuous vigilance and constant communication with the obstetric team is mandatory.
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References
Wali A, Suresh M, Gregg AR. Antepartum hemorrhage. In: Datta S, ed. Anesthetic and Obstetric Management of High-Risk Pregnancy. 3rd ed. New York: Springer; 2003:87–110.
Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol. 1985;66(1):89–92.
Arcario T, Greene M, Ostheimer GW. Risk of placenta previa/accreta in patients with previous cesarean deliveries (abstract). Anesthesiology. 1988;69:659.
Chestnut DH, Dewan DM, Redick LF, Caton D, Spielman FJ. Anesthetic management for obstetric hysterectomy: a multi-institutional study. Anesthesiology. 1989;70(4):607–610.
Grange CS, Douglas MJ, Adams TJ, Wadsworth LD. The use of acute hemodilution in parturients undergoing cesarean section. Am J Obstet Gynecol. 1998;178(1 Pt 1):156–160.
Rebarber A, Lonser R, Jackson S, Copel JA, Sipes S. The safety of intraoperative autologous blood collection and autotransfusion during cesarean section. Am J Obstet Gynecol. 1998;179(3 Pt 1):715–720.
Bernstein HH, Rosenblatt MA, Gettes M, Lockwood C. The ability of the Haemonetics 4 Cell Saver System to remove tissue factor from blood contaminated with amniotic fluid. Anesth Analg. 1997;85(4):831–833.
Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake MD, Razavi MK. Pelvic arterial embolization for control of obstetric hemorrhage: a five-year experience. Am J Obstet Gynecol. 1999;180(6 Pt 1):1454–1460.
O'Rourke N, McElrath T, Baum R, et al. Cesarean delivery in the interventional radiology suite: a novel approach to obstetric hemostasis. Anesth Analg. 2007;104(5):1193–1194, tables of contents.
Peng AT, Gorman RS, Shulman SM, DeMarchis E, Nyunt K, Blancato LS. Intravenous nitroglycerin for uterine relaxation in the postpartum patient with retained placenta. Anesthesiology. 1989;71(1):172–173.
Shah-Hosseini R, Evrard JR. Puerperal uterine inversion. Obstet Gynecol. 1989;73(4):567–570.
Vaginal Birth After Previous Cesarean Delivery. ACOG Practice Bulletin NTACoOaG. Vaginal Birth After Previous Cesarean Delivery. ACOG Practice Bulletin, Number 54. The American College of Obstetricians and Gynecologists.
Brudenell M, Chakravarti S. Uterine rupture in labour. Br Med J. 1975;2(5963):122–123.
Uppington J. Epidural analgesia and previous Caesarean section. Anaesthesia. 1983;38(4):336–341.
Carlsson C, Nybell-Lindahl G, Ingemarsson I. Extradural block in patients who have previously undergone caesarean section. Br J Anaesth. 1980;52(8):827–830.
Crawford JS. The epidural sieve and MBC (minimal blocking concentration): an hypothesis. Anaesthesia. 1976;31(9):1277–1280.
Golan A, Sandbank O, Rubin A. Rupture of the pregnant uterus. Obstet Gynecol. 1980;56(5):549–554.
Demianczuk NN, Hunter DJ, Taylor DW. Trial of labor after previous cesarean section: prognostic indicators of outcome. Am J Obstet Gynecol. 1982;142(6 Pt 1):640–642.
Roberts JM, Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet. 2001;357(9249):53–56.
Hubel CA. Oxidative stess and preeclampsia. Fetal Mat Med Rev. 1997;9:73–101.
Kambam JR, Handte RE, Brown WU, Smith BE. Effect of normal and preeclamptic pregnancies on the oxyhemoglobin dissociation curve. Anesthesiology. 1986;65(4):426–427.
Lyall F, Greer IA. Pre-eclampsia: a multifaceted vascular disorder of pregnancy. J Hypertens. 1994;12(12):1339–1345.
Zeeman GG, Dekker GA. Pathogenesis of preeclampsia: a hypothesis. Clin Obstet Gynecol. 1992;35(2):317–337.
Ghoneim MM, Long JP. The interaction between magnesium and other neuromuscular blocking agents. Anesthesiology. 1970;32(1):23–27.
Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995;345(8963):1455–1463.
Roberts JM. Magnesium for preeclampsia and eclampsia. N Engl J Med. 1995;333(4):250–251.
Mabie WC, Ratts TE, Sibai BM. The central hemodynamics of severe preeclampsia. Am J Obstet Gynecol. 1989;161(6 Pt 1):1443–1448.
Cotton DB, Lee W, Huhta JC, Dorman KF. Hemodynamic profile of severe pregnancy-induced hypertension. Am J Obstet Gynecol. 1988;158(3 Pt 1):523–529.
Newsome LR, Bramwell RS, Curling PE. Severe preeclampsia: hemodynamic effects of lumbar epidural anesthesia. Anesth Analg. 1986;65(1):31–36.
Strauss RG, Keefer JR, Burke T, Civetta JM. Hemodynamic monitoring of cardiogenic pulmonary edema complicating toxemia of pregnancy. Obstet Gynecol. 1980;55(2):170–174.
Benedetti TJ, Kates R, Williams V. Hemodynamic observations in severe preeclampsia complicated by pulmonary edema. Am J Obstet Gynecol. 1985;152(3):330–334.
Clark SL, Greenspoon JS, Aldahl D, Phelan JP. Severe preeclampsia with persistent oliguria: management of hemodynamic subsets. Am J Obstet Gynecol. 1986;154(3):490–494.
Jouppila P, Jouppila R, Hollmen A, Koivula A. Lumbar epidural analgesia to improve intervillous blood flow during labor in severe preeclampsia. Obstet Gynecol. 1982;59(2):158–161.
Ramos-Santos E, Devoe LD, Wakefield ML, Sherline DM, Metheny WP. The effects of epidural anesthesia on the Doppler velocimetry of umbilical and uterine arteries in normal and hypertensive patients during active term labor. Obstet Gynecol. 1991;77(1):20–26.
Kelton JG, Hunter DJ, Neame PB. A platelet function defect in preeclampsia. Obstet Gynecol. 1985;65(1):107–109.
de Boer K, ten Cate JW, Sturk A, Borm JJ, Treffers PE. Enhanced thrombin generation in normal and hypertensive pregnancy. Am J Obstet Gynecol. 1989;160(1):95–100.
Mallett SV, Cox DJ. Thrombelastography. Br J Anaesth. 1992;69(3):307–313.
Srinivasa V, Gilbertson LI, Bhavani-Shankar K. Thromboelastography: where is it and where is it heading? Int Anesthesiol Clin. Winter 2001;39(1):35–49.
Orlikowski CE, Rocke DA, Murray WB, et al. Thrombelastography changes in pre-eclampsia and eclampsia. Br J Anaesth. 1996;77(2):157–161.
Sharma SK, Philip J, Whitten CW, Padakandla UB, Landers DF. Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography. Anesthesiology. 1999;90(2):385–390.
Hood DD, Curry R. Spinal versus epidural anesthesia for cesarean section in severely preeclamptic patients: a retrospective survey. Anesthesiology. 1999;90(5):1276–1282.
Wallace DH, Leveno KJ, Cunningham FG, Giesecke AH, Shearer VE, Sidawi JE. Randomized comparison of general and regional anesthesia for cesarean delivery in pregnancies complicated by severe preeclampsia. Obstet Gynecol. 1995;86(2):193–199.
Aya AG, Mangin R, Vialles N, et al. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg. 2003;97(3):867–872.
Karinen J, Rasanen J, Alahuhta S, Jouppila R, Jouppila P. Maternal and uteroplacental haemodynamic state in pre-eclamptic patients during spinal anaesthesia for Caesarean section. Br J Anaesth. 1996;76(5):616–620.
Jouppila P, Kirkinen P, Koivula A, Ylikorkala O. Labetalol does not alter the placental and fetal blood flow or maternal prostanoids in pre-eclampsia. Br J Obstet Gynaecol. 1986;93(6):543–547.
Fenakel K, Fenakel G, Appelman Z, Lurie S, Katz Z, Shoham Z. Nifedipine in the treatment of severe preeclampsia. Obstet Gynecol. 1991;77(3):331–337.
Lawes EG, Downing JW, Duncan PW, Bland B, Lavies N, Gane GA. Fentanyl-droperidol supplementation of rapid sequence induction in the presence of severe pregnancy-induced and pregnancy-aggravated hypertension. Br J Anaesth. 1987;59(11):1381–1391.
Johannsen EK, Munro AJ. Remifentanil in emergency caesarean section in pre-eclampsia complicated by thrombocytopenia and abnormal liver function. Anaesth Intensive Care. 1999;27(5):527–529.
Palacio FJ, Ortiz-Gomez JR, Fornet I, Lopez MA, Morillas P. [Remifentanil bolus for cesarean section in high-risk patients: study of 12 cases]. Rev Esp Anestesiol Reanim. 2008;55(2):86–89.
Moore TR, Key TC, Reisner LS, Resnik R. Evaluation of the use of continuous lumbar epidural anesthesia for hypertensive pregnant women in labor. Am J Obstet Gynecol. 1985;152(4):404–412.
Weinstein L. Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol. 15 1982;142(2):159–167.
Frenk V, Camann W, Shankar KB. Regional anesthesia in parturients with low platelet counts. Can J Anaesth. 2005;52(1):114.
Vandermeulen EP, Van Aken H, Vermylen J. Anticoagulants and spinal-epidural anesthesia. Anesth Analg. 1994;79(6):1165–1177.
Crowther C. Magnesium sulphate versus diazepam in the management of eclampsia: a randomized controlled trial. Br J Obstet Gynaecol. 1990;97(2):110–117.
Dommisse J. Phenytoin sodium and magnesium sulphate in the management of eclampsia. Br J Obstet Gynaecol. 1990;97(2):104–109.
Frison LM, Dorsey DL. Epidural blood patch and late postpartum eclampsia. Anesth Analg. 1996;82(3):666–668.
Harnett MJ, Hepner DL, Datta S, Kodali BS. Effect of amniotic fluid on coagulation and platelet function in pregnancy: an evaluation using thromboelastography. Anaesthesia. 2005;60(11):1068–1072.
Lew TW, Tay DH, Thomas E. Venous air embolism during cesarean section: more common than previously thought. Anesth Analg. 1993;77(3):448–452.
Parry S, Strauss JF, 3rd. Premature rupture of the fetal membranes. N Engl J Med. 1998;338(10):663–670.
Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342(20):1500–1507.
Jackson GM, Edwin SS, Varner MW, Casal D, Mitchell MD. Regulation of fetal fibronectin production in human amnion cells. J Soc Gynecol Investig. 1996;3(2):85–88.
Segal S. Preterm labor. In: Datta S, ed. Anesthetic and Obstetric Management of High-Risk Pregnancy. 3rd ed. New York: Springer; 2003:291–302.
Eggleston MK. Management of preterm labor and delivery. Clin Obstet Gynecol. 1986;29(2):230–239.
Hatjis CG, Swain M. Systemic tocolysis for premature labor is associated with an increased incidence of pulmonary edema in the presence of maternal infection. Am J Obstet Gynecol. 1988;159(3):723–728.
Spielman FJ, Herbert WN. Maternal cardiovascular effects of drugs that alter uterine activity. Obstet Gynecol Surv. 1988;43(9):516–522.
Finley J, Katz M, Rojas-Perez M, Roberts JM, Creasy RK, Schiller NB. Cardiovascular consequences of beta-agonist tocolysis: an echocardiographic study. Obstet Gynecol. 1984;64(6):787–791.
Mannino F. Neonatal complications of postterm gestation. J Reprod Med. 1988;33(3):271–276.
Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. 2000;356(9239):1375–1383.
Marx GF, Luykx WM, Cohen S. Fetal-neonatal status following caesarean section for fetal distress. Br J Anaesth. 1984;56(9):1009–1013.
Brown I, Brustman L, Santos A. Intrauterine fetal death. In: Datta S, ed. Anesthetic and Obstetric Management of High-Risk Pregnancy. 3rd ed. New York: Springer; 2003:515–528.
Pritchard JA. Fetal death in utero. Obstet Gynecol. 1959;14:573–580.
Johansson PI, Stensballe J, Rosenberg I, Hilslov TL, Jorgensen L, Secher NH. Proactive administration of platelets and plasma for patients with a ruptured abdominal aortic aneurysm: evaluating a change in transfusion practice. Transfusion. 2007;47(4):593–598.
Gonzalez EA, Moore FA, Holcomb JB, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. 2007;62(1):112-119.
Gill R, Herbertson M. Recombinant factor VIIa: a universal haemostatic agent? Ann Card Anaesth. 2006;9(2):97–99.
O'Connell NM, Perry DJ, Hodgson AJ, O'Shaughnessy DF, Laffan MA, Smith OP. Recombinant FVIIa in the management of uncontrolled hemorrhage. Transfusion. 2003;43(12):1711–1716.
Alfirevic Z, Elbourne D, Pavord S, et al. Use of recombinant activated factor VII in primary postpartum hemorrhage: the Northern European registry 2000–2004. Obstet Gynecol. 2007;110(6):1270–1278.
Franchini M, Franchi M, Bergamini V, Salvagno GL, Montagnana M, Lippi G. A critical review on the use of recombinant factor VIIa in life-threatening obstetric postpartum hemorrhage. Semin Thromb Hemost. 2008;34(1):104–112.
Bonica JJ, Johnson WL. Principles and Practice of Obstetric Analgesia and Anesthesia. Vol 2. Philadelphia: FA Davis; 1969.
Cunningham FG, MacDonald PC, Gant NF, et al. William Obstetrics. 20th ed. East Norwalk, CN: Appleton-Lange, Crofts; 1997.
Walsh SW. Pre-eclampsia: an imbalance in placental prostacyclin and thromboxane production. Am J Obstet Gynecol. 1985;152–335.
Hawker F. Pulmonary edema associated with beta 2-sympathomimetic treatment of premature labour. Anaesth Intensive Care. 1984;12:143.
Benedetti TJ. Maternal complications of parenteral beta sympathomimetic therapy for premature labor. Am J Obstet Gynecol. 1983;145:1.
Shnider SM, Levinson G. Anesthesia for Obstetrics. Baltimore, MD: Williams and Wilkins; 1987.
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Datta, S., Kodali, B.S., Segal, S. (2010). High-Risk Pregnancy: Pregnancy-Related Problems. In: Obstetric Anesthesia Handbook. Springer, New York, NY. https://doi.org/10.1007/978-0-387-88602-2_15
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DOI: https://doi.org/10.1007/978-0-387-88602-2_15
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