Extracorporeal membrane oxygenation (ECMO) in pregnancy and peripartum: a focused review.

As the medical complexity of pregnant patients increases, the rate of maternal morbidity has risen. Maternal cardiovascular disease is a leading cause of maternal morbidity and mortality followed closely by sepsis and infection, both of which may be associated with respiratory failure. There has been an expansion in the application of extracorporeal life support in pregnant and peripartum patients which requires obstetric anesthesiologists to understand the indications, obstetric and medical considerations, relative advantages and potential complications of this invasive technology in this population.

Cardiogenic Shock and Utilization of Mechanical Circulatory Support in Pregnancy.

Maternal mortality rates are rising in the United States, a trend which is in contrast to that seen in other high-income nations. Cardiovascular disease and hypertensive disorders of pregnancy are consistently the leading causes of maternal mortality both in the United States and globally, accounting for about one-quarter to one-third of maternal and peripartum deaths. A large proportion of cardiovascular morbidity and mortality stems from acquired disease in the context of cardiovascular risk factors, which include obesity, pre-existing diabetes and hypertension, and inequities in care from maternal care deserts and structural racism.

Anesthesia for cesarean delivery in a patient with congenitally corrected transposition of the great arteries: A case report.

Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease often associated with other cardiac defects. The adaptations and physiologic changes in pregnancy can present maternal challenges and complications; multidisciplinary care allows for the safest management of pregnancy and delivery in these patients. We present a case of the anesthetic management of cesarean delivery in a woman with CCTGA with her pregnancy complicated by recurrent volume overload, pulmonary hypertension, and dysrhythmias.

Epoprostenol Exposure During Pregnancy.

Institutional policies restricting pregnant providers from caring for patients receiving inhaled epoprostenol exist across the nation based on little to no data to substantiate this practice. Over the last 2 decades, the use of inhaled pulmonary vasodilators has expanded in patients with cardiac and respiratory disease providing more evidence for the safety of these medications in obstetrical patients. We propose a thoughtful consideration and review of the literature to remove this restriction to reduce the need to reveal early pregnancy status to employers, to alleviate undue stress for pregnant caregivers who are exposed to patients receiving epoprostenol, and to ensure safe, equal employment, and learning opportunities for pregnant providers.

Methylene blue for vasodilatory shock in the intensive care unit: a retrospective, observational study.

Background: Refractory vasodilatory shock is a state of uncontrolled vasodilation associated with underlying inflammation and endothelial dysregulation. Rescue therapy for vasoplegia refractory to catecholamines includes methylene blue (MB) which restores vascular tone. We hypothesized that (1) at least 40% of critically ill patients would respond positively to MB administration and (2) that those who responded to MB would have a survival benefit.

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center.

The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis. A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled.

Escalating Care on Labor and Delivery.

Maternal morbidity and mortality are rising due in part to the rising prevalence of chronic illness, socioeconomic and racial disparities, and advanced maternal age. Prevention of maternal adverse outcomes requires prompt escalation of care to facilities with appropriate capabilities including intensive care services. The development of obstetrical-specific risk assessment tools and protocolized care for the most common causes of maternal intensive care unit (ICU) admission has helped to reduce preventable complications.

Stone induced ureteral rupture: The worst-case scenario. A case report.

Forniceal rupture secondary to acute ureteral obstruction is relatively common. However, spontaneous ureteral rupture is less frequently encountered. Most reported cases were stone related, localized at the ureteropelvic junction and managed in a minimally invasive manner.

Risk stratification for upper tract urinary carcinoma.

Upper tract urinary carcinoma (UTUC) is a heterogeneous group of rare tumors. The aim of this article is to critically review current therapeutic strategies and to propose a change in the risk-stratification of the disease. A non-systematic review of the literature was performed using the Medline database with the search terms: "upper tract urothelial carcinoma" together with "prognostic factor", "risk stratification", "risk factor", "recurrence", "predictive tool", "nomograms" and "treatment".

Extracorporeal Life Support in Pregnancy: A Systematic Review.

Background The use of extracorporeal life support (ECLS) has expanded to include unique populations such as peripartum women. This systematic review aims to (1) quantify the number of cases and indications for ECLS in women during the peripartum period reported in the literature and (2) report maternal and fetal complications and outcomes associated with peripartum ECLS. Methods and Results This review was registered in PROSPERO (CRD42018108142).

Testicular microlithiasis: Systematic review and Clinical guidelines.

Introduction: There are no clear recommendations on how patients with testicular microlithiasis should be followed up. The aim of our systematic review is to give clinical guidelines based on the evidence in the literature.

Methods: A web search was conducted during February 2018 based on Pubmed data, Embase and Cochrane database.

Agreement Between Transesophageal Echocardiographic Tricuspid Annular Plane Systolic Excursion Measurement Methods in Cardiac Surgery Patients.

Objective: To assess the agreement between 2-dimensional tricuspid annular plane systolic excursion (2D-TAPSE), 2D-TAPSE-apex, and 2D speckle tracking echocardiography (STE-TAPSE) in a cross-section of routine cardiac surgery patients.

Design: Retrospective, observational study.

Setting: Tertiary, academic referral hospital.

Influence of patient rotational malpositioning on pelvic parameters assessed on lateral radiographs.

Aim: To estimate the effect of patients' axial rotation (AR) during pelvic radiograph acquisition, on the reliability and validity of sagittal pelvic parameters.

Materials And Methods: Lateral digitally reconstructed radiographs (LDRRs) were obtained from the pelvic computed tomography (CT) scans of eight children and nine adults. Then, the AR of the pelvis was simulated and the corresponding LDRRs were reconstructed at 5°, 10°, 15°, and 20° of the AR.

Proximal subscapularis release for the treatment of adduction-internal rotation shoulder contracture in obstetric brachial plexus palsy.

Introduction: The purpose of this paper was to evaluate the results on shoulder function following isolated proximal subscapularis release in children with Erb's palsy.

Methods: A retrospective study was conducted on 64 consecutive children with Erb's palsy who underwent a Carlioz proximal subscapularis release between 2001 and 2012. Fifty children with complete records and a minimum follow-up of 2 years were included for evaluation.

Olmesartan medoxomil-induced acute renal failure in a premature newborn following maternal exposure during pregnancy: a case report and review of the literature.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II (AT II) receptor blockers (ARBs) are widely used antihypertensives with well-recognized renoprotective and cardioprotective effects. Although treatment with these agents generally does not result in adverse metabolic consequences, their use during human pregnancy has been associated with negative reactions. Here we report a premature baby with a history of oligohydramnios and maternal exposure to the ARB olmesartan medoxomil who was transferred to our institution with acute renal failure.

[Vasoplegic shock and myocardial infarction during administration of iloprost].

Introduction: The association of vasoplegic shock and myocardial infarction in a patient under iloprost treatment for critical ischemia of the lower limbs has not previously been reported.

Observation: A 56 year-old man suffering from type 2 diabetes, hypertension and dyslipidemia developed critical ischemia of the right leg and was treated with iloprost. On the 19th day of infusion, he developed a vasoplegic shock with myocardial infarction.

Pancreatic pseudocysts: 10 years of experience.

Background: Pancreatic pseudocysts (PP) are considered to be one of the major complications of acute, chronic, and posttraumatic pancreatitis. Their treatment has always been a surgical challenge. Surgical treatment was for many years the only choice in the management of PP.