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Pregnancy with a Left Ventricular Assist Device: A Narrative Review.
Ann Card Anaesth
January 2025
Department of Cardiothoracic Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
This narrative review discusses the various challenges associated with the presence of a left ventricular assist device (LVAD) during pregnancy. Given the hemodynamic and coagulation changes associated with pregnancy, the presence of an LVAD adds a layer of complexity with respect to optimal management. This review will discuss the anesthetic considerations when dealing with this subset of patients who may have other comorbidities alongside their advanced heart failure.
View Article and Find Full Text PDFA Rare Case of Severe Burns in a Pregnant Woman.
Cureus
December 2024
Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana University Medical Centre, Ljubljana, SVN.
Although burns are an extremely rare injury during pregnancy, they place a significant additional burden on the body, which is physiologically adapted to pregnancy and therefore limited in its ability to respond effectively to stress. Due to the low incidence of burns during pregnancy, the existing literature is scarce. Case reports are mostly from third-world countries, and there are no official guidelines or recommendations.
View Article and Find Full Text PDFTransitioning from the safety of the womb to the outside world for neonates with life-threatening cardiovascular conditions: The IMmediate Postpartum Access to Cardiac Therapy (IMPACT) Procedure.
Pediatr Cardiol
January 2025
Fetal Heart Program, Division of Cardiology. Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
The IMmediate Postpartum Access to Cardiac Therapy (IMPACT) procedure is a multidisciplinary, collaborative, highly coordinated clinical service in which a planned delivery and intensive neonatal care are offered for conditions where there is a high likelihood of postnatal instability. This process includes prenatal consultation with the parent(s), involving each service engaged with the delivery, postnatal resuscitation, and procedural care. A Cesarean section delivery is planned in an operating room with immediate access to a multifunctional procedural suite where the neonate can undergo rapid cardiac evaluation and initiation of interventional treatments which can have a positive, life-saving impact.
View Article and Find Full Text PDFPostnatal management of preterm infants with congenital diaphragmatic hernia.
Pediatr Surg Int
January 2025
Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada.
Introduction: Congenital diaphragmatic hernia (CDH) in the preterm population is increasingly common in the current era of fetal endoluminal tracheal occlusion (FETO) therapy. There remains a lack of clinical guidance for clinicians and surgeons regarding optimal management strategies for such infants. We aimed to describe our experience in managing preterm CDH in a single quaternary neonatal intensive care unit (NICU).
View Article and Find Full Text PDFPICC Lines in Pregnancy and Other Peripartum Vascular Access Considerations.
Obstet Gynecol Surv
January 2025
Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC.
Importance: To decrease associated infectious and thrombotic morbidity, it is important to understand the indications and risks of peripherally inserted central catheters (PICCs) and other vascular access means in pregnancy.
Objectives: The objectives are 3-fold: (1) discuss indications and contraindications, approach to placement, and associated complications for PICC lines, arterial catheters, centrally inserted central catheters, and peripheral intravenous catheters; (2) review available data regarding complications associated with these catheters in pregnancy; and (3) propose an evidence-based approach to clinical decision making regarding vascular access in 2 clinical scenarios among pregnant patients.
Evidence Acquisition: A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines, with a focus on obstetrical anesthesia and obstetric literature.
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