Faculty Bibliography

INTRODUCTION/BACKGROUND:There is currently no consensus regarding the minimum threshold platelet count to ensure safe neuraxial procedures. Numerous reports describe the safe performance of lumbar punctures in severely thrombocytopenic patients but reports of neuraxial anesthetic procedures in thrombocytopenic patients are limited. To date, the focus on specific populations in contemporary reviews has failed to include any actual hematoma cases. This systematic review aggregates reported lumbar neuraxial procedures from diverse thrombocytopenic populations to best elucidate the risk of spinal epidural hematoma. METHODS:/L) who received a lumbar neuraxial procedure (lumbar puncture; spinal, epidural, or combined spinal-epidural analgesia/anesthesia; epidural catheter removal), whether spinal epidural hematoma occurred. RESULTS:/L or above, reflecting a low probability of spinal epidural hematoma in this sample. Of the 19 spinal epidural hematoma cases for which the onset of symptoms was reported, 18 (95%) were symptomatic within 48 h of the procedure. CONCLUSIONS:/L or above, reflecting an estimated low spinal epidural hematoma event rate with more certainty given a larger sample size and inclusion of spinal epidural hematoma cases. Thrombocytopenic patients should be monitored, particularly in the first 48 h, and educated about symptoms concerning for spinal epidural hematoma.

Abnormally implanted, invasive, or adherent placenta has become one of the most serious problems in obstetrics, comprising a leading cause of maternal hemorrhage, the most common cause of peripartum hysterectomy and an increasingly important contributor to cesarean delivery morbidity. Currently, up to 3 in 1000 pregnancies in the USA are complicated by placenta accreta, increta, or percreta, and the incidence is increasing in parallel with the rising cesarean delivery rate. Yet, despite the high morbidity and mortality associated with placenta accreta, consensus guidelines are lacking regarding the management of women with this condition. This article reviews anesthetic and obstetric management of patients with placenta accreta based on clinician experience and the current literature, with emphasis on several controversial aspects of care, including timing of delivery, whether and when conservative obstetric management should be considered, the role of perioperative interventional radiology, and the risks and benefits of general versus neuraxial anesthesia. Antenatal diagnosis and multidisciplinary planning, when possible, with individualized consideration of patient preferences, are essential for the management of placenta accreta. Contingency plans for emergency delivery should be made for each patient and disseminated among all members of the multidisciplinary team

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Bb, the active fragment of complement factor B (fB), has been reported to be a predictor of preeclampsia. However, conflicting results have been found by some investigators. We hypothesized that the disagreement in findings may be due to the racial/ethnic differences among various study groups, and that fB activation is significant in women of an ethnic minority with preeclampsia. We investigated the maternal and fetal levels of Bb (the activated fB fragment) in pregnant women of an ethnic minority with or without preeclampsia. We enrolled 291 pregnant women (96% of an ethnic minority, including 78% African-American). Thirteen percent of these were diagnosed with preeclampsia. Maternal venous blood was collected from all participants together with fetal umbilical cord blood samples from 154 deliveries in the 291 women. The results were analyzed using the Mann-Whitney U test and multivariate analyses. Maternal Bb levels were significantly higher in the preeclamptic group than in the nonpreeclamptic group. Levels of Bb in fetal cord blood were similar in both groups. Subgroup analyses of African-American patients' results confirmed the study hypothesis that there would be a significant increase in Bb in the maternal blood of the preeclamptic group and no increase in Bb in the fetal cord blood of this group. These results suggest that a maternal immune response through complement fB might play a role in the development of preeclampsia, particularly in African-American patients.