Following the introduction of epidural for labor analgesia, debate has centered on the issue of its effect on outcome of labor; in terms of length of labor and increase in the rate of instrumental vaginal delivery and cesarean section (CS). There is no ideal study on the effect of epidural analgesia (EA) on the outcome of labor due to logistic problems in randomization, blinding and getting a control group; as a result these queries are partly answered. Despite these problems, it has been established that labor epidural has minimal effect on progress of established labor and maternal request should be a sufficient indication to start an epidural. Although instrumental vaginal delivery is probably increased with epidural but obstetrician practice, pain free patient and teaching opportunity are likely factors increasing the incidence. Maternal-fetal factors and obstetric management and not the use of EA are the most important determinants of the CS rate. The purpose of this review is to summarize data from controlled trials addressing the question of whether neuraxial labor analgesia causes an increased risk of CS or rate of instrumental delivery. In addition, the review discusses whether the timing of initiation of analgesia infl uences the mode of delivery.

Remifentanil is in clinical use for over 15 years. In spite of its unparalleled popularity, largely due to its unique pharmacokinetics, its place in labor analgesia is yet to be determined. Narrow therapeutic window and ability to cause rapid and severe respiratory depression are some of the major setbacks. Need for close monitoring, at least in the initial implementation stage is mandatory. Education of the labor suite nurses along with innovative monitoring technique is needed to realize the full potential of remifentanil in the labor room.

Background: Data on the effects of general anesthesia on the fetal and neonatal brain are limited. Animal studies demonstrated that anesthetic agents leave their consequences in the form of learning and memory deficits. The effects of propofol on the fetal neurodevelopment are not clear yet. Materials and Methods: This is a telephone-based questionnaire survey that addressed the effect of general anesthesia by propofol during cesarean section at term with no perinatal complications on the psychosocial behavior of children at 8-10 years of age compared with children having same characteristics except for delivery under neuraxial anesthesia using the Pediatric Symptom Checklist as a score. Results: A total of 187 children were born at term between January 1, 2002 and December 31, 2004 with no perinatal distress under induction of general anesthesia by propofol. 66 children (35.3%) were lost to follow-up and parents of two children (1.1%) refused to participate. A total of 189 children were included in the study: 119 were born by cesarean section under general anesthesia and 70 were born by cesarean section under neuraxial block. The incidence of psychosocial behavior impairment at 8-10 years of age was not found to be affected by the mode of anesthesia during delivery by cesarean section nor by neonatal nor parental characteristics. Conclusion: Exposure to propofol as an induction agent for general anesthesia or cesarean section does not seem to increase the psychosocial behavior disorder development risk at 8-10 years of age.

Background: The effect of a low dose of spinal local anesthetic on the incidence of hypotension has not been evaluated till date in severely preeclamptic women undergoing cesarean delivery. In this study, we compared the mean arterial pressure changes associated with low and conventional doses of spinal anesthetic in these women using invasive pressure monitoring. Materials and Methods: Twenty four severely preeclamptic women scheduled for elective cesarean delivery were randomly allocated to receive 7.5 mg [Group 1] or 10 mg [Group 2] of bupivacaine with 20 μg of fentanyl for spinal anesthesia. Heart rate and mean arterial pressure (MAP) were measured continuously using invasive arterial pressure monitoring. Phenylephrine boluses were used to maintain the MAP of >80% of baseline. The incidence of hypotension was compared between the two groups. Neonatal outcome was assessed using Apgar scores, umbilical cord blood gases, and need for resuscitation. Results: Incidence of hypotension was less in Group 1 as compared to Group 2 (41.6% vs. 91.6%, P = 0.009). Duration of hypotension was significantly longer in Group 2 compared to Group 1 (P = 0.005). Hypotensive episodes requiring vasopressors were more frequent in Group 2 (1.5 [1-3] vs. 0 [0-1]), P = 0.01) [Table 2]. There was no difference in Apgar scores, umbilical cord blood gases, and need for resuscitation between the two groups. Conclusion: Low dose of spinal bupivacaine resulted in a lower incidence of hypotension, higher predelivery MAP and decreased use of vasopressors in severely pre-eclamptic women undergoing cesarean section.

Supraventricular tachycardia (SVT) during pregnancy or immediate postpartum is the commonest arrhythmia during pregnancy. Usually, the clinical symptoms are mild or go unrecognized. Rarely as in our case, can patient present with severe symptoms of agitation and restlessness which can mimic puerperal psychosis. A 12 lead electrocardiogram (ECG) and an echocardiogram usually are sufficient to diagnose SVT. Amiodarone, even though is not the drug recommended to be used during pregnancy, in resistant types of SVT it is an useful drug.

We present an unusual case of a young parturient who was diagnosed to have a complete heart block during her first pregnancy and permanent pacemaker was implanted. She underwent an elective cesarean section under subarachnoid block without any complications. The same patient presented after 15 months for emergency cesarean section. The surgery was again performed successfully under spinal anesthesia. The maternal and fetal outcome was excellent.

Management of a parturient with systemic lupus erythematosus (SLE) requires a multidisciplinary approach. Although the ideal treatment strategy has not been formulated, certain management principles are recommended. We discuss the perioperative course and anesthetic management of five parturient with history of SLE who underwent cesarean section.

Ebstein's anamoly is a rare congenital heart defect comprising less than 1% of patients with congenital heart disease. Among the congenital heart lesions, Ebstein's anamoly is one of the most diverse in presentation, severity and management. Even though pregnancy in women with Ebstein's anamoly is usually well-tolerated, they are at increased risk of developing ventricular and supraventricular tachycardias, congestive cardiac failure, sudden collapse and even death. Here, we report a case of the pregnant woman with mild pre-eclampsia, known case of Ebstein's anamoly posted for emergency caesarean section.

Since the last few years a new strain of influenza virus H1N1 has infected people of all age groups and has caused significant morbidity and mortality. Pregnant females are at special risk especially during the second and third trimester. We present the anesthetic management of a case of cesarean section of a parturient at 32 weeks with confirmed H1N1 who had developed acute respiratory distress syndrome and discuss the various issues concerning the perioperative management.

Transient osteoporosis of pregnancy (TOP) is a rare and self-limited disease with an unknown etiology. A 29-year-old woman complained at her 39 ^th week of pregnancy of focalized pain in the right hip with functional disability and instability. Pain increased during the early puerperium after removal of the epidural catheter. The X-ray and magnetic resonance imaging (MRI) showed a displaced intracapsular fracture in the right femur, which needed surgical correction. The patient underwent urgent orthopedic surgery. We reviewed the anesthetic implications of this rare disease, particularly the use of a regional technique that removes the restrictive effect of the hip pain, and therefore increases the risk of a fracture.

Acute pancreatitis (AP) during peripartum is a rare life-threatening condition which poses as a real challenge for clinician to diagnose it early. Here, we present a case of severe AP occurring in early postpartum period.