Retrosternal goitre: a cause of dyspnoea in pregnancy.

During pregnancy, the thyroid undergoes several changes including altered function and gland enlargement. We describe the management of a 38-week pregnant woman presenting with cough and increasing breathlessness. She gave a 5-year history of asthma which initially obscured the final diagnosis of upper-airway obstruction secondary to tracheal compression by a large retrosternal goitre.

Epidural anaesthesia and neural tube defects.

This is a retrospective record of the analgesic management during labour of 16 patients with spina bifida seen at Leicester Royal Infirmary Maternity Hospital between March 1994 and February 1996. The information highlights the potential difficulties in providing epidural analgesia for this patient group, and demonstrates how an antenatal pre-anaesthetic clinic can help to optimize pain management by providing the opportunity to formulate a realistic analgesic plan, which can be documented in the notes.

Spinal analgesia for transvaginal oocyte retrieval.

Day case transvaginal ultrasound-guided needle puncture is currently the method of choice for oocyte retrieval. The risk of morbidity from this procedure increases with sudden patient movement in response to needle manipulation. The provision of effective pain relief can limit this risk, but is complicated by the need to balance efficacy with day case compatibility.