Emergency cesarean section has always been a challenge for patients, surgeons, and anesthesiologists, as it endangers the safety of both parturients and fetuses. Obesity and hypertension are common among pregnant women, but severe obesity combined with refractory hypertension is very rare in clinical practice. The optimal anesthetic management strategy for obese pregnant women with a difficult airway and poorly controlled hypertension remains debatable. This report presents a 32-year-old woman with severe obesity and refractory hypertension at 36 weeks and 6 days of pregnancy. Owing to fetal heart rate abnormalities, she was scheduled for emergency cesarean section. Given the urgency of the fetal condition and the challenges posed by the patient's obesity for epidural puncture, the anesthesiologist opted for rapid sequence induction and tracheal intubation instead of intervertebral anesthesia. Short-acting antihypertensive medications were adminstrated preoperatively to control elevated blood pressure, and vasopressor agents were continuously infused during surgery to prevent severe hypotension induced by anesthetic drugs. The entire anesthesia and surgical procedure proceeded uneventfully, with no major adverse events observed. Both the patient and fetus achieved favorable outcomes. This case indicates that early anesthetic risk assessment and meticulous pre-delivery planning are paramount, necessitating personalized management of airway and hemodynamics to optimize outcomes in obese parturients.
Humans ; Female ; Cesarean Section/methods* ; Pregnancy ; Adult ; Hypertension/complications* ; Obesity/complications* ; Obesity, Morbid/complications* ; Anesthesia, Obstetrical/methods*

Pregnancy complicated with acute myeloid leukemia is uncommon,requiring the collaborative management by specialists from departments of hematology,obstetrics,anesthesiology,and neonatology for both the parturient and the neonate.This article reports an anesthesic management process of a parturient woman with acute myeloid leukemia and reviews relevant literature published in recent years to systematically summarize the approach for anesthesia-related perinatal management of such patients.
Humans ; Female ; Pregnancy ; Leukemia, Myeloid, Acute/complications* ; Pregnancy Complications, Neoplastic ; Adult ; Anesthesia, Obstetrical/methods*

BACKGROUND

The Obstetric Quality of Recovery-10 (ObsQoR-10) is a patient-reported outcome measure that provides a holistic assessment on the quality of in-hospital postpartum functional recovery. Validated across several countries in various languages, it has shown great potential for widespread global acceptance in both clinical practice and research. We aimed to develop a Filipino version of the ObsQoR-10 and to evaluate its validity, reliability, and feasibility.

One hundred women who had elective cesarean delivery (CD) completed the ObsQoR-10-Filipino and EuroQol five-dimensional 3 L Filipino version questionnaires (including a Global Health Visual Analog Scale [GHVAS]) 24 h after delivery. Twenty-five women completed the ObsQoR-10-Filipino survey again 25 h after delivery. Validity was assessed by evaluation of convergent validity, discriminant validity, and hypothesis testing. Reliability was assessed by evaluating internal consistency, split-half reliability, and test–retest reliability; and (iv) floor and ceiling effects.

The ObsQoR-10-Filipino scores showed good and moderate correlation to the EQ-5D-3 L scores (r = −0.636; 95% confidence interval [CI]: −0.740–−0.503, P < 0.001) and to the GHVAS scores (r = 0.387; 95% CI: 0.207–0.543, P < 0.001), respectively. ObsQoR-10-Filipino discriminated well between good (GHVAS score ≥ 70, 68.4 ± 12.9) and poor recovery (GHVAS score < 70, 55.1 + 12.9). Internal consistency was acceptable (Cronbach’s α =0.76), and split-half reliability was very good (Spearman–Brown Prophesy Reliability Estimate = 0.87). Test–retest reliability was excellent (intraclass correlation coefficient = 0.973; 95% CI: 0.873–0.976). No floor or ceiling effects were observed. The recruitment rate and completion rate were 92% and 91%, respectively. No correlation was observed between the ObsQoR-10-Filipino scores and factors such as maternal age, gestational age, blood loss, and American Society of Anesthesiologists classification.

The ObsQoR-10-Filipino is a valid, reliable, and feasible tool for assessing inatient postpartum recovery in Filipino-speaking women undergoing elective CD.

A rare comorbidity seen in pregnant patients would be the presence of an anterior mediastinal mass. Anesthetic management of such cases in a non-thoracocardiovascular surgery would be potentially difficult since multiple factors must be taken into consideration – preoperative evaluation and imaging, anesthetic plan, and patient positioning. This case report talks about the anesthetic management of an obstetric patient with an anterior mediastinal mass, presenting with orthopnea and dyspnea, who is to undergo an emergency cesarean section.

Gorham–Stout disease (GSD) is a rare bone condition characterized by osteolysis, angiomatosis, and lymphangiomatosis. This paper presents a case, in which a 38-year-old pregnant female with GSD underwent cesarean delivery due to a low-lying placenta. Her medical history, which included a previous surgical intervention for an intraoral mass attributed to GSD and a course of radiotherapy, suggested potential difficulties in both securing the airway and instituting neuraxial anesthesia, as well as potential complications, including perioperative bleeding. In this case, tailored anesthetic management strategies and interdisciplinary collaboration helped achieve optimal outcomes for the mother and successful delivery of a healthy baby. In particular, combined spinal and epidural anesthesia avoided the need for GA, and provided a rapid onset and titratable anesthesia with minimal systemic effects. Furthermore, vigilant monitoring of hemodynamic parameters was also paramount in mitigating the risks associated with both GSD and pregnancy itself.

BACKGROUND

The Obstetric Quality of Recovery-10 (ObsQoR-10) is a patient-reported outcome measure that provides a holistic assessment on the quality of in-hospital postpartum functional recovery. Validated across several countries in various languages, it has shown great potential for widespread global acceptance in both clinical practice and research. We aimed to develop a Filipino version of the ObsQoR-10 and to evaluate its validity, reliability, and feasibility.

One hundred women who had elective cesarean delivery (CD) completed the ObsQoR-10-Filipino and EuroQol five-dimensional 3 L Filipino version questionnaires (including a Global Health Visual Analog Scale [GHVAS]) 24 h after delivery. Twenty-five women completed the ObsQoR-10-Filipino survey again 25 h after delivery. Validity was assessed by evaluation of convergent validity, discriminant validity, and hypothesis testing. Reliability was assessed by evaluating internal consistency, split-half reliability, and test–retest reliability; and (iv) floor and ceiling effects.

The ObsQoR-10-Filipino scores showed good and moderate correlation to the EQ-5D-3 L scores (r = −0.636; 95% confidence interval [CI]: −0.740–−0.503, P < 0.001) and to the GHVAS scores (r = 0.387; 95% CI: 0.207–0.543, P < 0.001), respectively. ObsQoR-10-Filipino discriminated well between good (GHVAS score ≥ 70, 68.4 ± 12.9) and poor recovery (GHVAS score < 70, 55.1 + 12.9). Internal consistency was acceptable (Cronbach’s α =0.76), and split-half reliability was very good (Spearman–Brown Prophesy Reliability Estimate = 0.87). Test–retest reliability was excellent (intraclass correlation coefficient = 0.973; 95% CI: 0.873–0.976). No floor or ceiling effects were observed. The recruitment rate and completion rate were 92% and 91%, respectively. No correlation was observed between the ObsQoR-10-Filipino scores and factors such as maternal age, gestational age, blood loss, and American Society of Anesthesiologists classification.

The ObsQoR-10-Filipino is a valid, reliable, and feasible tool for assessing inatient postpartum recovery in Filipino-speaking women undergoing elective CD.

A rare comorbidity seen in pregnant patients would be the presence of an anterior mediastinal mass. Anesthetic management of such cases in a non-thoracocardiovascular surgery would be potentially difficult since multiple factors must be taken into consideration – preoperative evaluation and imaging, anesthetic plan, and patient positioning. This case report talks about the anesthetic management of an obstetric patient with an anterior mediastinal mass, presenting with orthopnea and dyspnea, who is to undergo an emergency cesarean section.

Gorham–Stout disease (GSD) is a rare bone condition characterized by osteolysis, angiomatosis, and lymphangiomatosis. This paper presents a case, in which a 38-year-old pregnant female with GSD underwent cesarean delivery due to a low-lying placenta. Her medical history, which included a previous surgical intervention for an intraoral mass attributed to GSD and a course of radiotherapy, suggested potential difficulties in both securing the airway and instituting neuraxial anesthesia, as well as potential complications, including perioperative bleeding. In this case, tailored anesthetic management strategies and interdisciplinary collaboration helped achieve optimal outcomes for the mother and successful delivery of a healthy baby. In particular, combined spinal and epidural anesthesia avoided the need for GA, and provided a rapid onset and titratable anesthesia with minimal systemic effects. Furthermore, vigilant monitoring of hemodynamic parameters was also paramount in mitigating the risks associated with both GSD and pregnancy itself.

BACKGROUND: No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. METHODS: Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. RESULTS: A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). CONCLUSIONS The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.
Pregnancy ; Female ; Humans ; Post-Dural Puncture Headache/epidemiology* ; Anesthesia, Obstetrical/adverse effects* ; Retrospective Studies ; Punctures ; Starch ; Blood Patch, Epidural

OBJECTIVE: To explore the effect of epidural labor analgesia duration on the outcomes of different anesthetic approaches for conversion to cesarean section. METHODS: We retrospectively collected the clinical data of pregnant women undergoing conversion from epidural labor analgesia to cesarean section at Sichuan Maternal and Child Health Hospital and Jinjiang District Maternal and Child Health Care Hospital between July, 2019 and June, 2020. For cesarean section, the women received epidural anesthesia when the epidural catheter was maintained in correct position with effective analgesia, spinal anesthesia at the discretion of the anesthesiologists, or general anesthesia in cases requiring immediate cesarean section or following failure of epidural anesthesia or spinal anesthesia. Receiver-operating characteristic curve analysis was performed to determine the cutoff value of the analgesia duration using Youden index. The women were divided into two groups according to the cut off value for analyzing the relative risk using cross tabulations. RESULTS: A total of 820 pregnant women undergoing conversion to cesarean section were enrolled in this analysis, including 615 (75.0%) in epidural anesthesia group, 186 (22.7%) in spinal anesthesia group, and 19 (2.3%) in general anesthesia group; none of the women experienced failure of epidural or spinal anesthesia. The mean anesthesia duration was 8.2±4.7 h in epidural anesthesia, 10.6±5.1 h in spinal anesthesia group, and 6.7 ± 5.2 h in general anesthesia group. Multivariate logistic regression analysis showed that prolongation of analgesia duration by 1 h (OR=1.094, 95% CI: 1.057-1.132, P < 0.001) and an increase of cervical orifice by 1 cm (OR=1.066, 95% CI: 1.011-1.124, P=0.017) were independent risk factors for epidural analgesia failure. The cutoff value of analgesia duration was 9.5 h, and beyond that duration the relative risk of receiving spinal anesthesia was 1.204 (95% CI: 1.103-2.341, P < 0.001). CONCLUSION Prolonged epidural labor analgesia increases the risk of failure of epidural analgesia for conversion to epidural anesthesia. In cases with an analgesia duration over 9.5 h, spinal anesthesia is recommended if immediate cesarean section is not required.
Analgesia, Epidural/adverse effects* ; Analgesia, Obstetrical/adverse effects* ; Anesthesia, Obstetrical ; Cesarean Section ; Child ; Female ; Humans ; Pregnancy ; Retrospective Studies