Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial.

Background: Case reports on recombinant human factor VIIa (rhuFVIIa) use in women with severe postpartum hemorrhage (PPH) showed encouraging results, but no randomized controlled trial (RCT) is available.

Patients And Methods: Eighty-four women with severe PPH unresponsive to uterotonics were randomized to receive one early single rhuFVIIa infusion (n = 42) or standard care (no rhuFVIIa; n = 42). The primary efficacy outcome measure was the reduction of the need for specific second-line therapies, such as interventional hemostatic procedures, for blood loss and transfusions.

Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: a pilot study.

Background: In some cases of severe preeclampsia/eclampsia, brain imaging displays signs compatible with raised intracranial pressure. We aimed to estimate the incidence of raised intracranial pressure in preeclampsia using ocular ultrasonography.

Methods: Optic nerve sheath diameter (ONSD) measurements were compared in 26 preeclamptic and 25 healthy pregnant women.

[Spinal anaesthesia for caesarean section: fluid loading, vasopressors and hypotension].

Objective: To analyze the different preventive and curative strategies for the management of hypotension during spinal anaesthesia for caesarean section.

Data Sources: Data related to hypotension during spinal anesthesia for caesarean section were searched in the Medline database. Trials published in English or French were reviewed.

Epidural analgesia for parturients with type 1 von Willebrand disease.

Background: Epidural analgesia is usually contraindicated in von Willebrand disease. However, in type 1, the increased synthesis of von Willebrand factor (vWF) and factor VIII (FVIII:C) during pregnancy can lead to a correction of biological abnormalities and may allow epidural analgesia to be performed for delivery.

Methods: The clinical files of pregnant patients with type 1 von Willebrand disease who delivered in our tertiary perinatal unit were reviewed.

[Recombinant activated factor VII as a life-saving therapy for severe postpartum haemorrhage unresponsive to conservative traditional management].

Postpartum haemorrhage remains the main cause of maternal morbidity and mortality. Treatment aims at maintaining hemodynamic circulation and preventing shock by stopping blood loss both medically and surgically. We report two cases of major postpartum haemorrhage due to uterine atony.

[Management of delivery in patients with Marfan's syndrome presenting aortic dilatation].

Objective: We report the anesthesic and obstetrical management of two pregnant patients with Marfan's syndrome. An important dilatation of the root of aorta was established at the beginning of the pregnancy. Based on a review of the literature and our experience, we searched for clues to identify the ideal term and the best mode of delivery, and which type of anesthesia may be the more appropriate in patients with aortic dilatation.

Phenylephrine added to prophylactic ephedrine infusion during spinal anesthesia for elective cesarean section.

Background: Because ephedrine infusion (2 mg/min) does not adequately prevent spinal hypotension during cesarean delivery, the authors investigated whether adding phenylephrine would improve its efficacy.

Methods: Thirty-nine parturients with American Society of Anesthesiologists physical status I-II who were scheduled for cesarean delivery received a crystalloid preload of 15 ml/kg. Spinal anesthesia was performed using 11 mg hyperbaric bupivacaine, 2.