Search

The purpose of this study was to assess whether applying dorsal table tilt to a seated parturient positioned for neuraxial anaesthesia (i.e. facing laterally with her legs over the side of the table) increased the size of the target area for the neuraxial needle. We performed lumbar ultrasonography on 20 pregnant women with the table level (0°) and tilted 8° and 15° dorsally. For each position, the size of the 'target area', defined as the visible length of the ligamentum flavum in the longitudinal paramedian view, and the interlaminar distance, were measured at the L3-4 interspace. There were significant increases in the mean (SD) size of the target area with increasing table tilt (10.7 (1.3) mm at 0°, 11.5 (1.3) mm at 8° and 12.2 (1.7) mm at 15°; p < 0.0001). Interlaminar distances were not significantly increased. These data show that using dorsal table tilt in obstetric patients increases the target area for neuraxial needles. Additional research is required to assess whether this eases the placement of neuraxial needles in clinical practice. [ABSTRACT FROM AUTHOR]

We designed and internally validated an aggregate weighted early warning scoring system specific to the obstetric population that has the potential for use in the ward environment. Direct obstetric admissions from the Intensive Care National Audit and Research Centre's Case Mix Programme Database were randomly allocated to model development (n = 2240) or validation (n = 2200) sets. Physiological variables collected during the first 24 h of critical care admission were analysed. Logistic regression analysis for mortality in the model development set was initially used to create a statistically based early warning score. The statistical score was then modified to create a clinically acceptable early warning score. Important features of this clinical obstetric early warning score are that the variables are weighted according to their statistical importance, a surrogate for the FIO2/PaO2 relationship is included, conscious level is assessed using a simplified alert/not alert variable, and the score, trigger thresholds and response are consistent with the new non-obstetric National Early Warning Score system. The statistical and clinical early warning scores were internally validated using the validation set. The area under the receiver operating characteristic curve was 0.995 (95% CI 0.992-0.998) for the statistical score and 0.957 (95% CI 0.923-0.991) for the clinical score. Pre-existing empirically designed early warning scores were also validated in the same way for comparison. The area under the receiver operating characteristic curve was 0.955 (95% CI 0.922-0.988) for Swanton et al.'s Modified Early Obstetric Warning System, 0.937 (95% CI 0.884-0.991) for the obstetric early warning score suggested in the 2003-2005 Report on Confidential Enquiries into Maternal Deaths in the UK, and 0.973 (95% CI 0.957-0.989) for the non-obstetric National Early Warning Score. This highlights that the new clinical obstetric early warning score has an excellent ability to discriminate survivors from non-survivors in this critical care data set. Further work is needed to validate our new clinical early warning score externally in the obstetric ward environment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess whether applying dorsal table tilt to a seated parturient positioned for neuraxial anaesthesia (i.e. facing laterally with her legs over the side of the table) increased the size of the target area for the neuraxial needle. We performed lumbar ultrasonography on 20 pregnant women with the table level (0°) and tilted 8° and 15° dorsally. For each position, the size of the 'target area', defined as the visible length of the ligamentum flavum in the longitudinal paramedian view, and the interlaminar distance, were measured at the L3-4 interspace. There were significant increases in the mean (SD) size of the target area with increasing table tilt (10.7 (1.3) mm at 0°, 11.5 (1.3) mm at 8° and 12.2 (1.7) mm at 15°; p < 0.0001). Interlaminar distances were not significantly increased. These data show that using dorsal table tilt in obstetric patients increases the target area for neuraxial needles. Additional research is required to assess whether this eases the placement of neuraxial needles in clinical practice. [ABSTRACT FROM AUTHOR]

The latest CEMACH report1 recommends the use of modified early warning scores (MEWS) to assist in identifying the obstetric patient at risk of deterioration. By using critically ill obstetric patients from the Case Mix Program (CMP) data set and examining their unit mortality ,we aim to evaluate the ability of various pre-existing MEWS to identify the obstetric patient at risk. After ethical approval, all female admissions (aged 16- 50 yr) during the 13 yr study period were extracted from the CMP database. The data (n=71 107) were randomly split into two sets. All analyses have been carried out on set 1. Set 2 was reserved for future analysis. Cases with an obstetric cause as their primary or secondary reason for admission (direct obstetric admissions) were identified. A variety of MEWS scores were selected for evaluation. These included published, unpublished, general, and obstetric specific scores. Using physiological data collected within the first 24 h of admission, we calculated nine different MEWS for each direct obstetric admission. The ability of the nine MEWS to predict outcome (unit mortality) was evaluated. Discrimination was assessed using area under ROC curves. Within 'set 1', 2240 direct obstetric admissions were identified. Unit mortality was 1.7%. ROC curve analysis (Table 1) showed that all nine MEWS were able to distinguish, with varying degrees of discrimination, intensive care survivors from non-survivors within the study group. The 'obstetric' MEWS did not confer any additional benefit. Our obstetric data set (n=2240) comprises parameters measured after admission to critical care. Ideally, to evaluate a MEWS, the parameters in the period before admission should be used. An estimated 0.06% of maternities require critical care. Prospective data collection of a similarly sized data set is unfeasible as it would require participation by all the CMP units over a 6 yr period. Our findings confirm that the MEWS studied can be used to predict unit mortality among obstetric admissions and identify the at risk obstetric patient. [ABSTRACT FROM AUTHOR]

An abstract of the study "A survey of post-sternotomy chronic pain following cardiac surgery," by C. Carle and colleagues is presented.