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1. EMERGENCY CESAREAN SECTION WITH REDO MITRAL VALVE REPLACEMENT FOR ACUTE PROSTHETIC VALVE DYSFUNCTION: A CASE REPORT

Author

I. KHOLOD, E. BUHMAN, S. GRISARU-GRANOVSKY, T. AVITAN, S. TAGER, A. NIR, A. TVITO, Y. GOZAL, and A. IOSCOVICH

Subjects
pregnancy, cesarean delivery, anesthetic management, mechanical valve, valve dysfunction, valve replacement., Public aspects of medicine, RA1-1270
Abstract

Objective: Cardiovascular diseases emerge as one of the leading causes of maternal morbidity and mortality in developed countries. These risks are even higher in women with prosthetic cardiac valves. The core of the care for these women and the fetus during the hypercoagulable state of the pregnancy and postpartum period is the achievement of coagulation control using adjusted anticoagulation therapy protocols. A multidisciplinary team that includes obstetricians, cardiologists, hematologists, and anesthesiologists in a referral center is essential for an optimal maternal-fetal outcome. In particular, these measures are directed at preventing one of the most serious complications associated with mechanical valve dysfunction. The dysfunctional valve in the mitral position increases maternal and fetal mortality by 30%, especially in the presence of heart failure symptoms. Here we present a case of a 32-week pregnant woman diagnosed with dysfunction of the mechanical mitral valve (MV) and an emergency multidisciplinary approach to her treatment.

Published
2023
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5. Factors associated with failed epidural blood patch after accidental dural puncture in obstetrics: a prospective, multicentre, international cohort study

Author

Casier, Isabelle, Bryon, Bart, Soetens, Filiep, Dewandre, Pierre-Yves, Lambert, Geraldine, Christiaen, Jan, Schepers, Roel, Van Houwe, Patrick, Kalmar, Alain, Vanoverschelde, Henk, Bauters, Monique, Roofthooft, Eva, Devroe, Sarah, Van de Velde, Marc, Jadrijevic, Ana, Jokic, Aleksandra, Marin, Damjan, Sklebar, Ivan, Mihaljević, Slobodan, Kosinova, Martina, Stourac, Petr, Adamus, Milan, Kufa, Christian, Volfová, Ivana, Zaoralová, Blažena, Froeslev-Friis, Christina, Mygil, Bjoern, Krebs Albrechtsen, Charlotte, Kavasmaa, Tomi, Alahuhta, Seppo, Mäyrä, Anne, Mennander, Susanna, Rautaneva, Kati, Hiekkanen, Tuula, Kontinen, Vesa, Linden, Kirsti, Toivakka, Sara, Boselli, Emmanuel, Greil, Pierre-Édouard, Mascle, Olivier, Courbon, Aurelie, Lutz, Jean., Simonet, Thérèse, Barbier, Marie, Hlioua, Tarik, Meniolle d’Hauthville, Fleur, Quintin, Christine, Bouattour, Karim, Lecinq, Agnès, Mercier, Frederic, Bonnet, Marie-Pierre, Carbonniere, Mathieu, Fischer, Catherine, Picard, Paola-Carla, Bonnin, Martine, Storme, Brigitte, Bouthors, Anne-Sophie, Detente, Thomas, Nguyen, Truong Minh, Keita, Hawa, Nebout, Sophie, Osse, Lauranne, Delmas, Anne, Vial, Florence, Kaufner, Lutz, Hoefing, Christoph, Mueller, Stefan, Becke, Karin, Blobner, Manfred, Lewald, Heidrun, Schaller, Stefan Josef, Muggleton, Ellis, Bette, Birgit, Neumann, Claudia, Weber, Stefan, Grünewald, Matthias, Ohnesorge, Henning, Helf, Antonia, Jelting, Yvonne, Kranke, Peter, von Heymann, Christian, Welfle, Sabine, Staikou, Chryssoula, Stavrianopoulou, Antonia, Stamelos, Mattheios, Kalopita, Konstantina, Loukeri, Anastasia, Valsamidis, Dimitrios, Matsota, Paraskevi, Thorsteinsson, Adalbjörn, Tome, Riad, Eidelman, Leonid A., Davis, Atara, Orbach-Zinger, Sharon, Ioscovich, Alexander, Ramona, Iacob, De Simone, Luigi, Pesetti, Barbara, Brazzi, Luca, Zito, Alessandro, Camorcia, Michela, Della Rocca, Giorgio, Aversano, Marco, Frigo, Maria Grazia, Todde, Cristina, Macas, Andrius, Keraitiene, Grazina, Rimaitis, Kestutis, Borg, Francis, Tua, Carl, Kuijpers-Visser, Agnes Geertje, Schyns-van den Berg, Alexandra, Hollmann, Markus W., van den Berg, Tijs, Koolen, Eric, Dons, Ilse, van der Knijff, Anouk, van der Marel, Caroline, Ruysschaert, Nele, Pelka, Michal, Pluymakers, Christine, Koopman, Seppe, Teunissen, Aart-Jan, Cornelisse, Dick, van Dasselaar, Nick, Verdouw, Bastiaan, Beenakkers, Ingrid, Dahl, Vegard, Hagen, Robert, Vivaldi, Francesco, Eriksen, John Reidar, Wiszt, Radovan, Aslam Tayyba, Naz, Ringvold, Else-Marie, Chutkowski, Radosław, Skirecki, Tomasz, Wódarski, Bartłomiej, Faria, Maria Aida, Ferreira, Amélia, Sampaio, Ana Catarina, Ferreira, Irene, Matias, Bernardo, Teixeira, Joana, Araujo, Rita, Cabido, Herminia, Fortuna, Rosario, Lemos, Paulo, Cardoso, Carolina, Moura, Fernando, Pereira, Cristiana, Pereira, Sandra, Abecasis, Manuel, Lança, Filipa, Muchacho, Paulo, Ormonde, Lucindo, Guedes-Araujo, Isabel, Pinho-Oliveira, Vitor, Paredes, Paulo, Bentes, Carla, Gouveia, Francisco, Milheiro, Ana, Castanheira, Cláudia, Neves, Miriam, Pacheco, Vânia, Cortez, Mara, Tranquada, Raquel, Tareco, Glória, Furtado, Inês, Pereira, Estela, Marinho, Luísa, Seabra, Manuel, Bulasevic, Aleksandra, Kendrisic, Mirjana, Jovanovic, Lidija, Pujić, Borislava, Kutlesic, Marija, Grochova, Monika, Simonova, Jana, Pavlovic, Gordana, Rozman, Ales, Blajic, Iva, Graovac, Dragan, Stopar Pintaric, Tatjana, Chiquito, Teresa, Monedero, Pablo, De Carlos-Errea, Joaquin, Guillén-Casbas, Roque, Veiga-Gil, Leonor, Basso, Morena, Garcia Bartolo, Carolina, Hernandez, Cristian, Ricol, Laura, De Santos, Maroto Pinar, Gràcia Solsona, Josep A., López-Baamonde, Manuel, Magaldi Mendaña, Marta, Plaza Moral, Ana María, Vendrell, Marina, Trillo, Lourdes, Perez Garcia, Anibal Ricardo, Alamillo Salas, Clara, Moret, Enric, Ramió, Laura, Aguilar Sanchez, Jose Luis, Soler Pedrola, Maria, Valldeperas Hernandez, Maria Inmaculada, Aldalur, Gorka, Bárcena, Estíbaliz, Herrera, Julia, Iturri, Fernando, Martínez, Alberto, Martínez, Leire, Serna, Rosa, Gilsanz, Fernando, Guasch Arevalo, Emilia, Iannuccelli, Fabrizio, Latorre, Julieta, Rodriguez Roca, Cristina, Pérez Pardo, Osvaldo Ceferino, Sierra Biddle, Natalia, Suárez Castaño, Ceferina, Hernández González, Lourdes, Remacha González, Caridad, Sánchez Nuez, Raquel, Anta, Diego, Beleña, Jose M., García-Cuadrado, Carmen, Garcia, Irene, Manrique, Susana, Suarez, Elena, Hein, Anette, Arbman, Elisabet, Hansson, Helena, Tillenius, Monika, Al-Taie, Ruaa, Ledin-Eriksson, Susanne, Lindén-Söndersö, Anja, Rosén, Ola, Austruma, Evija, Gillberg, Lars, Darvish, Bijan, Gupta, Anil, Jörnvall, Henrik, Nordström, Johan, Persson, Jan, Rosenberg, Jan, Brühne, Lars, Forshammar, Johan, Ugarph Edfeldt, Malin, Rolfsson, Håkan, Hellblom, Anna, Levin, Katarina, Rabow, Sofus, Thorlacius, Karin, Bansch, Peter, Robertson (Baeriswyl), Moira, Stamer, Ulrike, Mathivon, Stanislas, Savoldelli, Georges, Auf der Maur, Pia, Filipovic, Miodrag, Dullenkopf, Alexander, Brunner, Maya, Girard, Thierry, Vonlanthen, Claudia, Ozbilgin, Sule, Gunaydin D, Berrin, Corman Dincer, Pelin, Tas Tuna, Ayca, Daamen, Sylvia, Farsi, Slama, Feijten, Prisca, Harlet, Pierre, Leva, Brigitte, Plichon, Benoît, Magnuson, Anders, Guasch, Emilia, Mercier, Frédéric J., and Schyns-van den Berg, Alexandra M.J.V.

Published
2022
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8. Rotational thromboelastometry reference range during pregnancy, labor and postpartum period: A systematic review with meta-analysis

Author

Alexander M Ronenson, Efim M Shifman, Aleksandr V Kulikov, Yu S Raspopin, Klaus Görlinger, Alexander M Ioscovich, and Galina P Tikhova

Subjects
coagulopathy, hemorrhage, point-of-care testing, pregnancy, thromboelastometry, Anesthesiology, RD78.3-87.3, Gynecology and obstetrics, RG1-991
Abstract

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) have become increasingly popular for urgent assessment of the hemostasis system. Accordingly, TEG and ROTEM algorithms and their corresponding cut-off values are not interchangeable. ROTEM provides fast results (including validated early clot firmness parameters [A5 and A10]), that are easy to use, and the graphical display of the results is easy to interpret. ROTEM manufacturer, Tem Innovations GmbH (Munich, Germany), mentions in the user manual that the manufacturer has not set any strict reference values for INTEM, EXTEM, FIBTEM, APTEM, and NATEM in any patient population (including pregnant women) and that these values are highly variable in healthy subjects. To date, no systematic review assessing ROTEM parameters in pregnant, parturient, and postpartum women is available. With the increasing usage of ROTEM, we conducted this systematic review and meta-analysis to determine the reference values of ROTEM parameters in pregnant, parturient, and postpartum women compared with non-pregnant population.

Published
2022
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14. Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand

Author

Gal Schtrechman-Levi, Alexander Ioscovich, Jacob Hart, Jacob Bar, Ronit Calderon-Margalit, Eshel A. Nir, and Yehuda Ginosar

Subjects
Obstetric anesthesia, Health service, Workload, Workforce, Epidural analgesia, Cesarean section, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract Background We planned an observational study to assess obstetric anesthesia services nationwide. We aimed to assess the effect of the anesthesia workload/workforce ratio on quality and safety outcomes of obstetric anesthesia care. Methods Observers prospectively collected data from labor units over 72 h (Wednesday, Thursday and Friday). Independent variables were workload (WL) and workforce (WF). WL was assessed by the Obstetric Anesthesia Activity Index (OAAI), which is the estimated time in a 24-h period spent on epidurals and all cesarean deliveries. Workforce (WF) was assessed by the number of anesthesiologists dedicated to the labor ward per week. Dependent variables were the time until anesthesiologist arrival for epidural (quality measure) and the occurrence of general anesthesia for urgent Cesarean section, CS, (safety measure). This census included vaginal deliveries and unscheduled (but not elective) CS. Results Data on 575 deliveries are from 12 maternity units only, primarily because a major hospital chain chose not to participate; eight other hospitals lacked institutional review board approval. The epidural response rate was 94.4%; 321 of 340 parturients who requested epidural analgesia (EA) received it. Of the 19 women who requested EA but gave birth without it, 14 (77%) were due to late arrival of the anesthesiologist. Median waiting times for anesthesiologist arrival ranged from 5 to 28 min. The OAAI varied from 4.6 to 25.1 and WF ranged from 0 to 2 per shift. Request rates for EA in hospitals serving predominantly orthodox Jewish communities and in peripheral hospitals were similar to those of the entire sample. More than a fifth (13/62; 21%) of the unscheduled CS received general anesthesia, and of these almost a quarter (3/13; 23%) were attributed to delayed anesthesiologist arrival. Conclusions Inadequate WF allocations may impair quality and safety outcomes in obstetric anesthesia services. OAAI is a better predictor of WL than delivery numbers alone, especially concerning WF shortage. To assess the quality and safety of anesthetic services to labor units nationally, observational data on workforce, workload, and clinical outcomes should be collected prospectively in all labor units in Israel.

Published
2021
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15. Peripartum anesthetic management of patients with inflammatory bowel disease, a retrospective case-control study

Author

Andres Freundlich, Eytan Gozal, Sorina Grisaru-Granovsky, Ariel Grass, Ariella Bar-Gil Shitrit, and Alexander Ioscovich

Subjects
Inflammatory bowel diseases, Anesthesia, Obstetrics, Peripartum period, Intraoperative complications, Gynecology and obstetrics, RG1-991
Abstract

Objective: Inflammatory bowel diseases (IBD) are a group of pathologies associated with an increased rate of abortions, premature deliveries, cesarean sections and other morbidity during the peripartum period. The objective of this retrospective study was to investigate the anesthetic management for delivery of women with IBD. Material and methods: The records of patients with IBD, who delivered at our Center, were obtained for data which included anesthetic and obstetric management as well as neonatal outcome. Five subgroups were defined based on mode of delivery, presence or absence of epidural in normal vaginal delivery (NVD) and urgency of cesarean section, each of which was compared with control groups of healthy parturients in the same period. Additionally, the rate of cesarean sections and the use of epidural analgesia for NVD were compared with the general obstetric population of our center in the same period. Results: 107 patients with IBD who delivered at our center were studied. The rates of cesarean sections and emergency cesarean sections were significantly higher compared to the general population. However, the rate of instrumental delivery and of epidural analgesia use for NVD were similar. Among those who underwent cesarean sections, no significant differences were found in anesthesia type, surgery duration, number of complications, type of monitoring or postoperative management compared to the control group. Conclusion: Peripartum anesthetic management of patients with IBD does not differ significantly from that of parturients without it. Anesthesiologists can plan their anesthesia in a similar way as they do in healthy parturients.

Published
2021
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17. Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

Author

Casier, Isabelle, Bryon, Bart, Soetens, Filiep, Dewandre, Pierre-Yves, Lambert, Geraldine, Christiaen, Jan, Schepers, Roel, Van Houwe, Patrick, Kalmar, Alain, Vanoverschelde, Henk, Bauters, Monique, Roofthooft, Eva, Devroe, Sarah, Van de Velde, Marc, Jadrijevic, Ana, Jokic, Aleksandra, Marin, Damjan, Sklebar, Ivan, Mihaljević, Slobodan, Kosinova, Martina, Stourac, Petr, Adamus, Milan, Kufa, Christian, Volfová, Ivana, Zaoralová, Blažena, Froeslev-Friis, Christina, Mygil, Bjoern, Krebs Albrechtsen, Charlotte, Kavasmaa, Tomi, Alahuhta, Seppo, Mäyrä, Anne, Mennander, Susanna, Rautaneva, Kati, Hiekkanen, Tuula, Kontinen, Vesa, Linden, Kirsti, Toivakka, Sara, Boselli, Emmanuel, Greil, Pierre-Édouard, Mascle, Olivier, Courbon, Aurelie, Lutz, Jean, Simonet, Thérèse, Barbier, Marie, Hlioua, Tarik, Meniolle d’Hauthville, Fleur, Quintin, Christine, Bouattour, Karim, Lecinq, Agnès, Soued, Mickaël, Bonnet, Marie-Pierre, Carbonniere, Mathieu, Fischer, Catherine, Picard, Paola-Carla, Bonnin, Martine, Storme, Brigitte, Bouthors, Anne-Sophie, Detente, Thomas, Nguyen Troung, Minh, Keita, Hawa, Nebout, Sophie, Osse, Lauranne, Delmas, Anne, Vial, Florence, Kaufner, Lutz, Hoefing, Christoph, Mueller, Stefan, Becke, Karin, Blobner, Manfred, Lewald, Heidrun, Schaller, Stefan Josef, Muggleton, Ellis, Bette, Birgit, Neumann, Claudia, Weber, Stefan, Grünewald, Matthias, Ohnesorge, Henning, Helf, Antonia, Jelting, Yvonne, Kranke, Peter, von Heymann, Christian, Welfle, Sabine, Staikou, Chryssoula, Stavrianopoulou, Antonia, Tsaroucha, Athanasia, Kalopita, Konstantina, Loukeri, Anastasia, Valsamidis, Dimitrios, Matsota, Paraskevi, Thorsteinsson, Adalbjörn, Tome, Riad, Eidelman, Leonid A., Davis, Atara, Orbach-Zinger, Sharon, Ioscovich, Alexander, Ramona, Iacob, De Simone, Luigi, Pesetti, Barbara, Brazzi, Luca, Zito, Alessandro, Camorcia, Michela, Della Rocca, Giorgio, Aversano, Marco, Frigo, Maria Grazia, Todde, Cristina, Morina, Qamile, Macas, Andrius, Keraitiene, Grazina, Rimaitis, Kestutis, Borg, Francis, Tua, Carl, Kuijpers-Visser, Agnes Geertje, Schyns-van den Berg, Alexandra, Hollmann, Markus W., Van den Berg, Tijs, Koolen, Eric, Dons, Ilse, van der Knijff, Anouk, van der Marel, Caroline, Ruysschaert, Nele, Pelka, Michal, Pluymakers, Christine, Koopman, Seppe, Teunissen, Aart-Jan, Cornelisse, Dick, van Dasselaar, Nick, Verdouw, Bastiaan, Beenakkers, Ingrid, Dahl, Vegard, Hagen, Robert, Vivaldi, Francesco, Eriksen, John Reidar, Wiszt, Radovan, Aslam Tayyaba, Naz, Ringvold, Else-Marie, Chutkowski, Radosław, Skirecki, Tomasz, Wódarski, Bartłomiej, Faria, Maria Aida, Ferreira, Amélia, Sampaio, Ana Catarina, Ferreira, Irene, Matias, Bernardo, Teixeira, Joana, Araujo, Rita, Cabido, Herminia, Fortuna, Rosario, Lemos, Paulo, Cardoso, Carolina, Moura, Fernando, Pereira, Cristiana, Pereira, Sandra, Tavares, Francisca, Vasconcelos, Pedro, Abecasis, Manuel, Lança, Filipa, Muchacho, Paulo, Ormonde, Lucindo, Guedes-Araujo, Isabel, Pinho-Oliveira, Vitor, Paredes, Paulo, Bentes, Carla, Gouveia, Francisco, Milheiro, Ana, Castanheira, Cláudia, Neves, Miriam, Pacheco, Vânia, Cortez, Mara, Tranquada, Raquel, Tareco, Glória, Furtado, Inês, Pereira, Estela, Marinho, Luísa, Seabra, Manue, Bulasevic, Aleksandra, Kendrisic, Mirjana, Jovanovic, Lidija, Pujić, Borislava, Kutlesic, Marija, Grochova, Monika, Simonova, Jana, Pavlovic, Gordana, Rozman, Ales, Blajic, Iva, Graovac, Dragan, Stopar Pintraic, Tatjana, Chiquito, Teresa, Monedero, Pablo, Carlos-Errea, De Joaquin, Guillén-Casbas, Roque, Veiga-Gil, Leonor, Basso, Morena, Garcia Bartolo, Carolina, Hernandez, Cristian, Ricol, Laura, De Santos, Maroto Pinar, Gràcia Solsona, Josep A., López-Baamonde, Manuel, Magaldi Mendaña, Marta, Plaza Moral, Ana María, Vendrell, Marina, Trillo, Lourdes, Perez Garcia, Anibal Ricardo, Alamillo Salas, Clara, Moret, Enric, Ramió, Laura, Aguilar Sanchez, Jose Luis, Soler Pedrola, Maria, Valldeperas Hernandez, Maria Inmaculada, Aldalur, Gorka, Bárcena, Estíbaliz, Herrera, Julia, Iturri, Fernando, Martínez, Alberto, Martínez, Leire, Serna, Rosa, Gilsanz, Fernando, Guasch Arevalo, Emilia, Iannuccelli, Fabrizio, Latorre, Julieta, Rodriguez Roca, Cristina, Pérez Pardo, Osvaldo Ceferino, Sierra Biddle, Natalia, Suárez Cendaña, Ceferina, Hernández González, Lourdes, Remacha González, Caridad, Sánchez Nuez, Raquel, Anta, Diego, Beleña, Jose M., García-Cuadrado, Carmen, Garcia, Irene, Manrique, Susana, Suarez, Elena, Hein, Anette, Arbman, Elisabet, Hansson, Helena, Tillenius, Monika, Al-Taie, Ruaa, Ledin-Eriksson, Susanne, Lindén-Söndersö, Anja, Rosén, Ola, Austruma, Evija, Gillberg, Lars, Darvish, Bijan, Gupta, Anil, Nordstöm, Johan L., Persson, Jan, Rosenberg, Jan, Brühne, Lars, Forshammar, Johan, Ugarph Edfeldt, Malin, Rolfsson, Håkan, Hellblom, Anna, Levin, Katarina, Rabow, Sofus, Thorlacius, Karin, Bansch, Peter, Robertson (Baeriswyl), Moira, Stamer, Ulrike, Mathivon, Stanislas, Savoldelli, Georges, Auf der Maur, Pia, Filipovic, Miodrag, Dullenkopf, Alexander, Brunner, Maya, Girard, Thierry, Vonlanthen, Claudia, Ozbilgin, Sule, Gunaydin D, Berrin, Corman Dincer, Pelin, Tas Tuna, Ayca, Magnuson, Anders, Fernando, Roshan, Mercier, Frédéric J., and Schyns-van den Berg, Alexandra M.J.V.

Published
2020
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22. Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study

Author

Alexandr M. Ronenson, Yu. S. Raspopin, E. M. Shifman, A. V. Kulikov, and A. M. Ioscovich A. M. Ioscovich

Subjects
Anesthesiology and Pain Medicine, Emergency Medicine, Critical Care and Intensive Care Medicine, Law
Abstract

INTRODUCTION: Continuous monitoring of the hemostasis system during postpartum hemorrhage is an essential aspect of intensive care. Rotational thromboelastometry (ROTEM) provides rapid and differentiated detection of hemostasis system disorders. OBJECTIVE: To evaluate the effect of implementing the rotational thromboelastometry on the need for blood transfusion in massive postpartum hemorrhage in the practice of perinatal centers. MATERIALS AND METHODS: A retrospective cohort multicenter study was conducted in two perinatal centers. The BEFORE group included females with massive postpartum hemorrhage (PPH) (> 30 % of circulating blood volume (CBV) or > 2 L) within 2 years prior to ROTEM implementation in tertiary care hospitals; the AFTER group included females with massive postpartum hemorrhage within 2 years after ROTEM implementation. The primary endpoint of the study was a comparative evaluation of the frequency of fresh frozen plasma (FFP) transfusion for hemostasis correction in massive PPH before and after ROTEM implementation as an urgent method for coagulopathy diagnosis. RESULTS: A total of 97 patients were included in the study: 48 in the BEFORE group and 49 in the AFTER group. A significant relative risk (RR) of reduced frequency of FFP transfusion RR = 0.53 (0.32, 0.85; p = 0.009) with NNT = 3.6 after implementation of ROTEM into clinical practice was found. The frequency of cryoprecipitate transfusion increased. Analysis of cases of PPH over 50 % of the CBV (PPH in the BEFORE and AFTER groups 68.2 ± 12.4 and 72.3 ± 35.9, respectively, p = 0.673) showed a twofold significant risk of reducing the number of parturient women requiring FFP transfusion: RR = 0.5 (0.25, 0.99); p = 0.049), with NNT = 2. CONCLUSION: Rapid information on the status of the hemostasis system can reduce unnecessary FFP transfusion. Introducing the ROTEM method into the clinical practice of obstetric hospitals will improve the outcomes of intensive care for one of the most challenging categories of patients — postpartum women with massive postpartum hemorrhage.

Published
2023
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31. Concurrent medical conditions among pregnant women - ignore at their peril: report from an antenatal anesthesia clinic

Author

Carolyn F. Weiniger, Sharon Einav, Uriel Elchalal, Vladislav Ozerski, Daniel Shatalin, Alexander Ioscovich, and Yehuda Ginosar

Subjects
Antenatal, Anesthesia, Comorbid, Maternal, Medical, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Care of pregnant women with concurrent medical conditions can be optimized by multidisciplinary antenatal management. In the current study we describe women with concurrent medical conditions who attended our antenatal anesthesia clinic over a 14-year period, 2002–2015 and, based on the findings, we suggest new policies, strategies and practices to improve antenatal care. Methods In 2002, an antenatal anesthesia clinic was established in Hadassah Medical Center. Each consultation focused on the concurrent medical condition. A written anesthesia strategy according to the medical condition and its anesthesia considerations was discussed and given to the patient. Data regarding clinic visits were recorded. Results A total of 451 clinic women attended the antenatal anesthesia clinic. Maternal age was 31.7 ± 6.0 years (mean ± SD), with gestational age of pregnancy 33.0 ± 5.4 weeks at the clinic visit. Musculoskeletal conditions (23% of all the women seen) were the most frequent concurrent conditions, followed by anesthesia related concerns 20%, neurologic conditions 19%, and cardiac conditions 15%. Women were provided plans that were deliberated carefully rather than being concocted during labor. Conclusions A wide range of concurrent medical conditions was seen in the antenatal anesthesia clinic, however fewer women attended the clinic than expected according to known population frequencies of concurrent medical conditions. Women with concurrent medical conditions should have labor and anesthesia plans considered during the nine months of pregnancy, prior to delivery, and hospitals should have a means of obtaining this information in a timely manner. Finally, there is a need to develop additional antenatal anesthesia clinics.

Published
2018
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34. Automating medical simulations

Author

Gershov, Sapir, primary, Braunold, Daniel, additional, Spektor, Robert, additional, Ioscovich, Alexander, additional, Raz, Aeyal, additional, and Laufer, Shlomi, additional

Published
2023
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36. Correction to: Obstetric anesthesia services in Israel snapshot (OASIS) study: a 72 hour cross-sectional observational study of workforce supply and demand

Author

Gal Schtrechman-Levi, Alexander Ioscovich, Jacob Hart, Jacob Bar, Ronit Calderon-Margalit, Eshel A. Nir, and Yehuda Ginosar

Subjects
Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

An amendment to this paper has been published and can be accessed via the original article.

Published
2021
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41. Neostigmine induced coronary artery spasm: A case report and literature review

Author

Shimon Kolker, Dan Tzivoni, David Rosenmann, Shmuel Meyler, and Alexander Ioscovich

Subjects
Anesthesia, cardiology, complication, muscle relaxants, postoperative care, Anesthesiology, RD78.3-87.3, Pharmacy and materia medica, RS1-441
Abstract

Neostigmine is a cholinesterase inhibitor which does not cross the blood brain barrier and a commonly used for reversal of nondepolarizing muscle relaxants. In the following case report, we present a patient who developed coronary artery spasm, after the administration of repeated doses of neostigmine. Ours is the first case to demonstrate such a longstanding coronary artery vasospasm that lasted several hours in response to neostigmine, resulting in myocardial damage and left ventricular dysfunction. We would like to draw the attention of the anesthesiologists to this rare effect that may lead to perioperative cardiac complications.

Published
2017
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46. Peripartum anesthetic management of women with SARS-CoV-2 infection in eight medical centers across three European countries: prospective cohort observation study.

Author

Ioscovich, Alexander, Guasch, Emilia, Brogly, Nicolas, Shatalin, Daniel, Manrique-Muñoz, Susana, Sánchez Royo, Maria Elena, Zimro, Sabastine, Ginosar, Yehuda, Lages, Neusa, Weinstein, Jacob, Berkenstadt, Haim, Greenberger, Chaim, Lazutkin, Alexey, Izakson, Alexander, Ioscovich, Daniel, Orbach-Zinger, Sharon, and Weiniger, Carolyn F.

Subjects
*PERIPARTUM cardiomyopathy, *MEDICAL centers, *CESAREAN section, *ANESTHESIA in obstetrics, *ACADEMIC medical centers, *SARS-CoV-2
Abstract

Objective: Several reports of obstetric anesthesia management have been published since the onset of the COVID-19 pandemic. We aimed to collect high-quality broad and detailed data from different university medical centers in several European Society of Anesthesiologist countries. Methods: This prospective observational survey was performed in eight medical centers in Spain, Israel and Portugal from 1st April to 31st July 2020. Institutional review board approval was received at each participating center. Inclusion criteria: all women with a positive test for COVID-19. Retrieved data included maternal, delivery, anesthetic, postpartum details, and neonatal outcomes. Descriptive data are presented, and outcomes were compared for women with versus without respiratory signs and symptoms. Results: Women with respiratory symptoms (20/12.1%) had significantly higher mean (standard deviation) temperature (37.2 C (0.8) versus 36.8 C (0.6)), were older (34.1 (6.7) years versus 30.5 (6.6)) and had higher body mass index kg m-2 – (29.5 (7.5) versus 28.2 (5.1)). Women with respiratory symptoms delivered at a significantly earlier gestational age (50% < 37 weeks) with a 65% cesarean delivery rate (versus 22.1% in the group without respiratory symptoms) and 5- fold increased rate of emergency cesarean delivery, 30% performed under general anesthesia. A higher rate of intrauterine fetal death (3%) was observed than expected from the literature (0.2–0.3%) in developed countries. There was no evidence of viral vertical transmission. Conclusion: Well-functioning neuraxial analgesia should be available to manage laboring women with respiratory symptoms, as there is a higher frequency of emergency cesarean delivery. We report a higher rate of undiagnosed parturient and intrauterine fetal death. [ABSTRACT FROM AUTHOR]

Published
2022
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48. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study

Author

Michael Stav, Yuri Matatov, Dana Hoffmann, Philip Heesen, Vincent Gliesche, Yair Binyamin, Alexander Ioscovich, Leonid A. Eidelman, and Sharon Orbach‐Zinger

Subjects
Anesthesiology and Pain Medicine, Pregnancy, Cesarean Section, Incidence, Dietary Supplements, Humans, Anesthesia, Obstetrical, Female, General Medicine, Anesthetics, Local, Anesthesia, General, Anesthesia, Spinal, Bupivacaine
Abstract

Conversion from spinal anaesthesia to general anaesthesia (GA) was shown to be associated with more complications. It has been postulated that spinal injection of a low dose of local anaesthetic is a risk factor. We aimed to discover the rate of conversion from spinal anaesthesia to GA in women who received at least 10 mg heavy bupivacaine and opioids and assess its risk factors.All women that underwent spinal anaesthesia for caesarean section from 1 January 2017 to 31 December 2020 were included in this analysis. Spinal anaesthesia was performed according to department protocol using heavy bupivacaine 0.5% 10-13 mg, fentanyl 20 μg, and morphine 0.1 mg. We examined rate of conversion from spinal anaesthesia to GA and rate of need for analgesia/sedation.There were 1.7% of women that required conversion to GA. Bupivacaine dose (OR 0.54 [95% CI 0.38 to 0.75], p 0.001), surgery time (OR 1.03 [95% CI 1.02 to 1.04], p 0.001), emergency caesarean section (OR 1.06 [95% CI 1.16 to 3.76], p = 0.015), and postpartum haemorrhage (OR 5.96 [95% CI 1.09 to 25.18], p = 0.025) were independent predictors of need for conversion to GA. Of the women who had CS under spinal anaesthesia, 4.1% of parturients required intraoperative analgesics/sedatives and 9.1% required anxiolysis.A small proportion of women required conversion to GA. This conversion occurred especially with emergency caesarean section and when low spinal bupivacaine doses were used.

Published
2022

49. Epidural analgesia and vacuum-assisted delivery in primiparous women: maternal and neonatal outcomes

Author

Alexander Ioscovich, Hen Y. Sela, Misgav Rottenstreich, Sorina Grisaru-Granovsky, Eyal Lang Ben Nun, and Reut Rotem

Subjects
Male, medicine.medical_specialty, Vacuum Extraction, Obstetrical, business.industry, Obstetrics, Vacuum assisted, Infant, Newborn, Obstetrics and Gynecology, Database study, Retrospective cohort study, Delivery, Obstetric, humanities, Analgesia, Epidural, body regions, Parity, Pregnancy, Neonatal outcomes, Pediatrics, Perinatology and Child Health, Odds Ratio, Humans, Medicine, Female, business, Retrospective Studies
Abstract

We aimed to evaluate the effect of epidural analgesia (EA) on maternal and neonatal outcomes.We conducted a retrospective cohort database study on primiparous women who underwent a vacuum-assisted delivery (VAD) trial between 2005 and 2019 at a university-affiliated tertiary medical center. We compared women with and without the standard "one protocol" patient-controlled EA. The primary outcome was VAD failure. Secondary outcomes were maternal and neonatal morbidities. We performed univariate analysis, followed by multivariable logistic regression analysis to control for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.Overall, 7042 primiparous women attempted VAD during the study period; 6238 (88.3%) and 804 (11.7%) women used and did not use EA, respectively. The VAD failure rate was significantly lower among women with than without EA use (2.5%EA use in primiparous women is associated with lower rates of VAD failure without an increase in adverse maternal or neonatal outcomes.

Published
2021
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50. Incidence of conversion to general anaesthesia and need for intravenous supplementation in parturients undergoing caesarean section under spinal anaesthesia: A retrospective observational study

Author

Stav, Michael, primary, Matatov, Yuri, additional, Hoffmann, Dana, additional, Heesen, Philip, additional, Gliesche, Vincent, additional, Binyamin, Yair, additional, Ioscovich, Alexander, additional, Eidelman, Leonid A., additional, and Orbach‐Zinger, Sharon, additional

Published
2022
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