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Patil S, Rupwate K, Kesh R. The type of anesthesia and outcome in preeclamptic patients undergoing cesarean section: An observational study. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_270_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Maternal and neonatal outcomes of preeclamptic and normotensive women who underwent cesarean section under spinal anesthesia: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ezihe-Ejiofor A, Lucas D, Mushambi M. The power of marginal gains in obstetric anaesthesia. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.4.2460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Ezihe-Ejiofor
- London North West University Healthcare NHS Trust, UK
- Guys and St Thomas’ NHS Foundation Trust, UK
- University Hospitals of Leicester, UK
| | - D.N. Lucas
- London North West University Healthcare NHS Trust, UK
- Guys and St Thomas’ NHS Foundation Trust, UK
- University Hospitals of Leicester, UK
| | - M.C. Mushambi
- London North West University Healthcare NHS Trust, UK
- Guys and St Thomas’ NHS Foundation Trust, UK
- University Hospitals of Leicester, UK
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Sobhy S, Dharmarajah K, Arroyo-Manzano D, Navanatnarajah R, Noblet J, Zamora J, Thangaratinam S. Type of obstetric anesthesia administered and complications in women with preeclampsia in low- and middle-income countries: A systematic review. Hypertens Pregnancy 2017; 36:326-336. [PMID: 29125378 DOI: 10.1080/10641955.2017.1389951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Delivery is often expedited with cesarean section, necessitating anesthesia, to prevent complications in women with preeclampsia. Anesthesia-associated risks in these women from low- and middle-income countries (LMICs) are not known. METHODS We searched major databases (until February 2017) for studies on general vs. regional anesthesia in women with preeclampsia. We summarized the association between outcomes and type of anesthesia using a random effects model and reported as odds ratio (OR) with 95% confidence intervals (95% CIs). FINDINGS We included 14 studies (10,411 pregnancies). General anesthesia was associated with an increase in the odds of maternal death sevenfold (OR 7.70, 95% CI 1.9 to 31.0, I2 = 58%) than regional anesthesia. The odds of pulmonary edema (OR 5.16, 95% CI 2.5 to 10.4, I2 = 0%), maternal intensive care unit admissions (OR 16.25, 95% CI 9.0 to 29.5, I2 = 65%), and perinatal death (OR 3.01, 95% CI 1.4 to 6.5, I2 = 56%) were increased with general vs. regional anesthesia. CONCLUSION General anesthesia is associated with increased complications in women with preeclampsia undergoing cesarean section in LMIC.
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Affiliation(s)
- Soha Sobhy
- a Women's Health Research Unit, Barts and The London School of Medicine and Dentistry , Queen Mary University of London , London , UK
| | - Kuhan Dharmarajah
- d Department of Obstetrics and Gynaecology , University College London Hospital , London, UK
| | - David Arroyo-Manzano
- b Clinical Biostatistics Unit , Hospital Ramon y Cajal (IRYCIS, CIBERESP) , Madrid , Spain
| | | | - James Noblet
- e Department of Anaesthesia , Barts Health NHS Trust
| | - Javier Zamora
- a Women's Health Research Unit, Barts and The London School of Medicine and Dentistry , Queen Mary University of London , London , UK.,b Clinical Biostatistics Unit , Hospital Ramon y Cajal (IRYCIS, CIBERESP) , Madrid , Spain.,c Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry , Queen Mary University of London , London , UK
| | - Shakila Thangaratinam
- a Women's Health Research Unit, Barts and The London School of Medicine and Dentistry , Queen Mary University of London , London , UK.,c Multidisciplinary Evidence Synthesis Hub (mEsh), Barts and The London School of Medicine and Dentistry , Queen Mary University of London , London , UK
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Uribe-Leitz T, Jaramillo J, Maurer L, Fu R, Esquivel MM, Gawande AA, Haynes AB, Weiser TG. Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data. LANCET GLOBAL HEALTH 2017; 4:e165-74. [PMID: 26916818 DOI: 10.1016/s2214-109x(15)00320-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical interventions occur at lower rates in resource-poor settings, and complication and death rates following surgery are probably substantial but have not been well quantified. A deeper understanding of outcomes is a crucial step to ensure that high quality accompanies increased global access to surgical care. We aimed to assess surgical mortality following three common surgical procedures--caesarean delivery, appendectomy, and groin (inguinal and femoral) hernia repair--to quantify the potential risks of expanding access without simultaneously addressing issues of quality and safety. METHODS We collected demographic, health, and economic data for 113 countries classified as low income or lower-middle income by the World Bank in 2005. We did a systematic review of Ovid, MEDLINE, PubMed, and Scopus from Jan 1, 2000, to Jan 15, 2015, to identify studies in these countries reporting all-cause mortality following the three commonly undertaken operations. Reports from governmental and other agencies were also identified and included. We modelled surgical mortality rates for countries without reported data using a two-step multiple imputation method. We first used a fully conditional specification (FCS) multiple imputation method to establish complete datasets for all missing variables that we considered potentially predictive of surgical mortality. We then used regression-based predictive mean matching imputation methods, specified within the multiple imputation FCS method, for selected predictors for each operation using the completed dataset to predict mortality rates along with confidence intervals for countries without reported mortality data. To account for variability in data availability, we aggregated results by subregion and estimated surgical mortality rates. FINDINGS From an initial 1302 articles and reports identified, 247 full-text articles met our inclusion criteria, and 124 provided data for surgical mortality for at least one of the three selected operations. We identified 42 countries with mortality data for at least one of the three procedures. Median reported mortality was 7·9 per 1000 operations for caesarean delivery (IQR 2·8-19·9), 2·2 per 1000 operations for appendectomy (0·0-17·2), and 4·9 per 1000 operations for groin hernia (0·0-11·7). Perioperative mortality estimates by subregion ranged from 2·8 (South Asia) to 50·2 (East Asia) per 1000 caesarean deliveries, 2·4 (South Asia) to 54·0 (Central sub-Saharan Africa) per 1000 appendectomies, and 0·3 (Andean Latin America) to 25·5 (Southern sub-Saharan Africa) per 1000 hernia repairs. INTERPRETATION All-cause postoperative mortality rates are exceedingly variable within resource-constrained environments. Efforts to expand surgical access and provision of services must include a strong commitment to improve the safety and quality of care. FUNDING None.
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Affiliation(s)
| | | | - Lydia Maurer
- Stanford University School of Medicine, Stanford, CA, USA
| | - Rui Fu
- Management Science and Engineering, Stanford University, Stanford, CA, USA
| | | | - Atul A Gawande
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex B Haynes
- Ariadne Labs: a Joint Center for Health System Innovation, Boston, MA, USA; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Keerath K, Cronje L. Observational study of choice of anaesthesia and outcome in patients with severe pre-eclampsia who present for emergency Caesarean section. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2012.10872854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K Keerath
- King Edward VIII Hospital Nelson R Mandela School of Medicine
| | - L Cronje
- King Edward VIII Hospital Department of Anaesthesiology, Nelson R Mandela School of Medicine, University of Kwazulu-Natal
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Lamacraft G, Schmidt MJ, Diedericks BJS, Joubert G. An Audit of the Use of Regional Anaesthesia for Caesarean Section in the Free State: from 2002 to 2004. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2007.10872494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Spinal Anaesthesia for Emergency Caesarean Section in a Morbid Obese Woman with Severe Preeclampsia. Case Rep Anesthesiol 2012; 2012:586235. [PMID: 23094164 PMCID: PMC3474965 DOI: 10.1155/2012/586235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/16/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Morbid obesity in a pregnancy is a great challenge to medical practice especially when the patient requires caesarean section.Case Summary. A 38-year-old unbooked gravida 3 Para 2+0weight 195 kg, height 1.7 m with a blood pressure of 210/160 mmhg had spinal anaesthesia for emergency caesarean section which was technically difficult for severe preeclampsia at 32-week gestation. She had poor wound healing and spent 18 days postoperatively on hospital admission.Conclusion. Morbid obesity is a challenge to both obstetric and anaesthetic practice. Antenatal care is necessary in reducing both maternal morbidity and mortality.
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Vanderlelie J, Perkins AVA. Selenium and preeclampsia: A global perspective. Pregnancy Hypertens 2011; 1:213-24. [PMID: 26009029 DOI: 10.1016/j.preghy.2011.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/26/2011] [Accepted: 07/04/2011] [Indexed: 11/30/2022]
Abstract
Preeclampsia is a complex multisystem disorder of pregnancy where oxidative stress plays an important aetiological role. The role of selenium in the synthesis of endogenous antioxidants is well documented, and a significant reduction in selenium has been reported in preeclamptic women. The objective of this study was to map global selenium status and preeclampsia incidence. This study identified peer reviewed journal articles reporting national preeclampsia incidence (%) and matched these with reported values of selenium intake and plasma/serum selenium concentrations (μg/L). Matched data were obtained for 45 regions, reporting 6456,570 births, spanning Europe, Asia, Australasia, Africa, North and South America. Increasing plasma selenium concentration was found to be correlated with a reduction in preeclampsia incidence (Pearson's r=-0.604, P<0.0001). Countries with a reported serum/plasma selenium level of ⩾95μg/L were considered selenium sufficient and a significant reduction in preeclampsia incidence for countries above this value (P=0.0007) was noted. Significant reductions in preeclampsia incidence were found to coincide with increases in plasma/serum selenium concentration in the New Zealand (P=0.0003) and Finland (0.0028) populations following Government intervention. This study supports the hypothesis that selenium supplementation may be beneficial in reducing oxidative stress in women at risk of preeclampsia.
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Affiliation(s)
- J Vanderlelie
- School of Medical Science, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
| | - A V A Perkins
- School of Medical Science, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
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Ajuzieogu OV, Ezike HA, Amucheazi AO, Enwereji J. A retrospective study of the outcome of cesarean section for women with severe pre-eclampsia in a third world setting. Saudi J Anaesth 2011; 5:15-8. [PMID: 21655010 PMCID: PMC3101746 DOI: 10.4103/1658-354x.76480] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To compare the outcome of subarachnoid block (spinal anesthesia) and general anesthesia in Cesarean delivery for women with severe pre-eclampsia. Methods: A retrospective study of women with severe pre-eclampsia requiring Cesarean section from January 2005 to June 2009 was carried out. Maternal age, parity, gestational age at delivery, booking status, Apgar scores, maternal and perinatal mortality of the sub-arachnoid block group were compared with those of general anesthesia group using χ2, Student t-test and Fischer exact test. Results: There were no significant difference between the two groups in overall maternal mortality (5.4% vs. 11.9%, P=0.5) and perinatal mortality (2.7% vs. 11.9%, P=0.15). The general anesthesia group had significantly more birth asphyxia than the spinal group (55.9% vs. 27.0%, P=0.0006). Conclusion: There was no significant difference in the maternal and perinatal mortality outcome of cesarean delivery between women with severe pre-eclampsia who had regional anesthesia and those that had general anesthesia. There was significantly higher proportion of birth asphyxia in babies of women who received general anesthesia.
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Affiliation(s)
- Obinna V Ajuzieogu
- Department of Anaesthesia, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Aya AGM, Vialles N, Ripart J. [Anesthesia and preeclampsia]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2010; 29:e141-e147. [PMID: 20478690 DOI: 10.1016/j.annfar.2010.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An assessment of the patient must take place as early as possible in view of anaesthesia. It is recommended to perform a clotting screen as close as possible to the performing of an epidural anaesthesia. The use of aspirin, if indicated for the prevention of PE, does not as such, constitute a contraindication to performing an epidural anaesthesia if: With regards to the minimum platelet count, the recommended cut-off value for the performing of an epidural and spinal anaesthesia are 75 & 50 x 10(9)/l respectively, only if all of the following conditions are met: It is recommended to quickly set up an epidural anaesthesia because this will improve the blood pressure as well as the utero-placenteric haemodynamics and also because this will facilitate the management in case of a caesarean section. Whereas methylergometrine (Methergin) is contraindicated in the preeclamptic patient, it is possible to use oxytocin (Syntocinion) during and after labour. Before performing a spinal anaesthesia, it is recommended to restrain the administration of crystalloids to a maximum of 1000 ml. Also the i.v. antihypertensive treatment should be reduced or interrupted until complete establishment of the anaesthetic. In case a general anaesthesia is to be performed, an assessment of the criteria for difficult intubation should be performed immediately prior to the induction. The technique employed should be a rapid sequence induction with intubation, while preventing a surge in blood pressure induced by the tracheal intubation. Difficulties to extubate should systematically be anticipated. It is possible to perform a loco-regional anaesthesia following an eclamptic crisis if the following conditions are met: In case of overlapping seizures and/or impaired consciousness, a general anaesthesia is recommended.
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Affiliation(s)
- A G M Aya
- Département anesthésie-douleur, GHU Caremeau, place du Pr Robert-Debré, 30029 Nîmes cedex 9, France.
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Okafor UV, Efetie ER, Igwe W, Okezie O. Anaesthetic management of patients with pre-eclampsia/eclampsia and perinatal outcome. J Matern Fetal Neonatal Med 2009; 22:688-92. [DOI: 10.1080/14767050902994473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Okafor UV, Ezegwui HU, Ekwazi K. Trends of different forms of anaesthesia for caesarean section in South-eastern Nigeria. J OBSTET GYNAECOL 2009; 29:392-5. [DOI: 10.1080/01443610902932390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maternal and perinatal outcome after caesarean delivery in preeclampsia or eclampsia in Enugu, Nigeria: four years on. Int J Obstet Anesth 2009; 18:292-3. [PMID: 19447596 DOI: 10.1016/j.ijoa.2009.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 01/06/2009] [Accepted: 01/08/2009] [Indexed: 11/24/2022]
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Dyer RA, Piercy JL, Reed AR. The role of the anaesthetist in the management of the pre-eclamptic patient. Curr Opin Anaesthesiol 2007; 20:168-74. [PMID: 17479015 DOI: 10.1097/aco.0b013e328136c1ac] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Recent literature on the anaesthetist's role in the management of the patient with severe pre-eclampsia is reviewed, with particular emphasis on the role of regional anaesthesia. RECENT FINDINGS Laboratory findings in pre-eclamptic women include increased levels of markers of oxidative stress and circulating tyrosine kinase 1, and inflammatory activation of leucocytes. Magnesium sulphate is the most effective agent for seizure prophylaxis. The optimal pharmacological agents for acute control of blood pressure remain controversial. The benefits of epidural analgesia in labour are well established. Single-shot spinal anaesthesia for caesarean section is safe in the absence of contraindications. Successful use of combined spinal-epidural anaesthesia has been described. Most studies on maternal haemodynamics have employed heart rate and blood pressure data as surrogate measures of cardiac output. Noninvasive cardiac output studies provide further insight into the haemodynamic response during neuraxial techniques for caesarean section. SUMMARY The value of regional anaesthesia cannot be over-emphasized. Recent research into spinal anaesthesia for caesarean section suggests a lower susceptibility to hypotension and probably less impairment of cardiac output than in healthy parturients. Noninvasive cardiac output measurement may also have advantages in critical care management.
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Affiliation(s)
- Robert A Dyer
- Department of Anaesthesia, University of Cape Town and New Groote Schuur Hospital, Cape Town, South Africa.
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Okafor UV, Aniebue U. Anaesthesia for uterine rupture in a Nigerian teaching hospital: maternal and fetal outcome. Int J Obstet Anesth 2006; 15:124-8. [PMID: 16488135 DOI: 10.1016/j.ijoa.2005.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Accepted: 10/22/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND An observational retrospective study was conducted at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria to determine the outcome for patients with rupture of the gravid uterus who had anaesthesia for laparotomy over a four-year period, July 2000 to June 2004. METHODS The hospital records (case files, labour ward and theatre records) of patients over a four-year period with rupture of the uterus were reviewed. RESULTS A total of 2707 deliveries took place at UNTH, Enugu, Nigeria. There were 2556 live births (94.8% of deliveries) and 714 (26.4%) caesarean deliveries. Twenty-three cases of uterine rupture occurred, giving a prevalence of 8.5/1000 deliveries. In nine patents (39.1%) the uterus was already scarred. The patients' mean age was 30.2 years. No nulliparous patients suffered ruptured uterus. General anaesthesia with muscle relaxants was administered to all patients. Twenty-two patients (95.6%) received blood transfusions. All the patients received normal saline and one patient also received Haemacel. Five (21.7%) patients had preoperative hypotension and two (8.6%) had intraoperative hypotension. There was one maternal death which occurred three days after the cesarean section. Twenty-three (96.3%) fetal deaths, including the loss of a set of twins, were recorded. Fetal deaths from ruptured uterus represented 32.4% of all fetal loss following caesarean section during the study period. There were no neonatal deaths. CONCLUSION Rupture of the gravid uterus presents the anaesthetist with the unique challenge of maintaining haemodynamic status before haemostasis is secured, often with the patient in shock. Choice of anaesthetic drugs and availability of blood are important, as well as the skill and experience of the anaesthetist. The maternal mortality rates in other West African studies reviewed were generally higher than those in this series. The maternal outcome re-emphasises the vital role of prompt intervention and availability of blood in reducing maternal mortality following rupture of the uterus.
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Affiliation(s)
- U V Okafor
- Department of Anaesthesia, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.
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Okafor UV. Evolution of obstetric anaesthesia in West Africa: current trends. Int J Obstet Anesth 2006; 15:176-7. [PMID: 16488144 DOI: 10.1016/j.ijoa.2005.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Accepted: 10/01/2005] [Indexed: 10/25/2022]
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Banks A, Levy D. Life-threatening complications of pregnancy: Key issues for anaesthetists. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cacc.2006.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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