Peripartum cardiomyopathy (PPCM) is a disease affecting the parturient during late pregnancy or immediately after delivery. This unique disorder not just endangers the life of mother and progeny but is also a financial burden to the health system due to its potential to cause prolonged and persistent cardiac function insufficiency in the mother. The hallmark of the disease is onset of decreased cardiac ejection fraction either in the late pregnancy or early puerperium. Over the last few decades, the disease has been extensively researched and investigated to formulate diagnostic guidelines and therapeutic approaches. Many theories regarding its pathophysiology have also been proposed. The clinical presentation and the basic and intensive interventional strategies of the disease are more or less similar to that of dilated cardiomyopathy due to any other cause; however, at all points of time the pregnant or lactating state of mother and the subsequent effect of the medication and therapeutic interventions on the fetus or neonate needs to be considered. Apart from intensive care management, these patients may also require anaesthetic intervention for management of painless labor and/or either vaginal or operative delivery. Favorable maternal and fetal outcome require that the basic hemodynamic goals be always kept in mind while choosing the techniques and drugs to provide anaesthesia to the patients with PPCM. Literature search of the anaesthetic management of patients with diagnosis of PPCM undergoing operative delivery reveals both general and regional anaesthesia being used with comparable outcomes.

Background : The present audit was initiated to evaluate the knowledge, attitude, perception and acceptance of women toward labor analgesia and caesarean section, in a Medical College Hospital in Udaipur, India. Materials and Methods : A semi-structured interview of 200 antenatal women was conducted, to assess the knowledge, attitude and perception regarding labor analgesia and caesarean section (CS) and to estimate the correlation of awareness and acceptability with demographic variables. The data were analyzed using Epi Info 6 and the Likert type scale (0 - 10), as also the chi square test, to calculate the statistical significance. Results : Most of the patients (n = 181, 90.50%) were unaware of labor analgesia. When the option of labor analgesia was offered, only 23% (n = 46) accepted it and the most significant reason for refusal was to experience natural child birth (n = 114 / 154, 74.03%). An educational status of the graduate level had a positive impact on knowledge about labor analgesia (P = 0.0001). When the option for CS was offered, 73.50% women (n = 147; P = 0.008) refused and the most common reasons for refusal were fear of operation (53.06%, n = 78) and delay in resuming household work (46.26%, n = 68). Educational status up to the graduate level and previous surgical experience of CS had a positive correlation with preference for CS (P = 0.0092 and P = 0.0001, respectively). Conclusions : Awareness and acceptance for labor analgesia was relatively low among the prospective parturients. A higher level of education had a significant impact on their decisions regarding delivery.

Background : A double-blinded, prospective, randomized, controlled study was designed to determine the analgesic efficacy and tolerability of intravenous magnesium sulfate versus intrathecal fentanyl, in patients with severe pre-eclampsia, scheduled for caesarean section, under spinal anaesthesia. Materials and Methods : One hundred and five patients were randomly allocated to one of the three groups; the control group B received spinal anaesthesia with 10 mg of 0.5% heavy bupivacaine, the test group FB received spinal anaesthesia with 10 mg of 0.5% heavy bupivacaine plus 25 ΅g of preservative-free fentanyl and the test group MB received spinal anaesthesia with 10 mg of 0.5% heavy bupivacaine along with intravenous magnesium sulfate (6 gm iv as a loading dose over 20-30 minutes, followed by infusion of magnesium sulfate 2 gm per hour for 24 hours). Results : The time required for the first postoperative analgesic requirement was significantly more in groups FB and MB, as compared to the control group. (Group FB: 6.85 + 1.7 hours, group MB: 7.05 + 1.95 hours and Group B: 3.75 + 0.75 hours). This difference, however, was not significant between group FB and group MB. The frequency of postoperative analgesic requirement was significantly less in the FB and MB groups, as compared to the control group. (Control group: 3.9 + 0.5, group FB 2.3 + 0.25 and group MB: 2.5 + 0.4). Perioperative sedation was significantly higher in group FB as compared to group B and group MB. Nine patients in group FB had postoperative nausea and vomiting, whereas, none of the patients in the control group or group MB experienced this. This difference too was statistically significant. Conclusion : Intravenous magnesium sulfate and intrathecal fentanyl in the doses mentioned, increased the duration of postoperative analgesia in severely pre-eclamptic patients undergoing caesarean section under spinal anaesthesia; however, patients who received intravenous magnesium sulfate experienced lesser side effects than those who received intrathecal fentanyl.

Background : Control of post spinal shivering is essential for optimal perioperative care, which can be achieved either by oral or parental medications. The present study is designed to evaluate the efficacy and safety of intravenous low-dose clonidine and tramadol in the treatment of post spinal shivering. Materials and Methods : In this prospective, a double blind, randomized study, 90 ASA grade I or II, parturients aged 18 - 35 years, undergoing caesarean section under spinal anaesthesia, who subsequently developed shivering grade 3 or 4, were randomized into two groups, to receive either clonidine or tramadol. The efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting, hypotension, bradycardia, dry mouth, sedation, skin rash and headache, if present, were recorded. All data were analyzed by using the Chi square test and the Z-test. Results : There were significant differences in the response rate between the drugs (P < 0.05). Time taken from the starting of treatment to cessation of shivering was significantly less with the tramadol group (P < 0.05), however, the frequency of nausea, vomiting, sedation and headache were also significantly more in the tramadol group Conclusion : In our study we concluded that both clonidine and tramadol control shivering. However, the response rate was higher and time taken to control shivering was lesser with tramadol, but the response rate and the side effects were lesser with clonidine.

Background : Pain relief after caesarean is more compelling than any other surgery. As most commonly used modalities are associated with various side-effects, a multimodal approach is recommended. Transversus abdominis plane (TAP) block and transcutaneous electrical nerve stimulation (TENS) as part of multimodal postoperative analgesia regimes have been shown to be promising following caesarean section. Materials and Methods : 40 patients undergoing caesarean section under spinal anaesthesia were randomly allocated into 2 groups, first group receiving TAP block and second receiving TENS. In postoperative period pain, nausea and vomiting, sedation was recorded at 30 minutes, 2, 4, 6, 12 and 24 hours. Results : Both TAP block and TENS were effective for post caesarean analgesia as a part of multimodal regimen. In both groups VAS was less than 3 at each time interval. None of the patients required rescue analgesia. There was no complication with TAP block. Three patients in TENS group complained of discomfort and apprehension because of tingling sensation of TENS. Conclusion : Both TAP block and TENS as a part of multimodal analgesia are effective following caesarean delivery. Both decrease requirement of opioids and thus associated side effects as a result of which the mother is able to care for baby more effectively.

Antiphospholipid antibody syndrome is an autoimmune disorder characterized by venous and/or arterial thromboses. When present in women of reproductive age, it is associated with recurrent loss of pregnancy. This case report summarizes the perioperative course and anaesthetic management in a patient with bad obstetrics history who had to undergo emergency caesarean section.

Hypertrophic obstructive cardiomyopathy (HOCM) is a complex cardiovascular disorder with autosomal dominant inheritance and an incidence of 0.1-0.5% in pregnant females. Anaesthetic management of a pregnant female with HOCM posted for elective caesarean section is a challenge, as even minor hemodynamic insults may lead to life-threatening complications. We report successful management of one such patient using epidural anaesthesia with 0.75% Ropivacaine.

Anaesthetic management for caesarean section of a patient with peripartum cardiomyopathy (PPCM) can be challenging. In this case report, we describe the anaesthetic management of two cases of PPCM posted for emergency caesarean section. Anaesthetic management was directed towards optimization of myocardial contractility, preload and after load. No adverse events or complications were observed.