Epoprostenol treatment for idiopathic pulmonary arterial hypertension in pregnancy.

Idiopathic pulmonary arterial hypertension is a rare condition associated with significant maternal mortality. We report the management of a 37-year-old multigravida with severe disease using epoprostenol, a multidisciplinary approach, and a planned delivery. Although the patient survived the pregnancy, her pulmonary function significantly worsened. Epoprostenol, a pulmonary vasodilator, should be considered when indicated during pregnancy. Neither fetal nor neonatal harm was identified.

Antiemetics for obstetric and gynecological procedures.

Nausea and vomiting is a troublesome side-effect that occurs more frequently during obstetric and gynecological procedures than during most other surgical procedures. Recent research has focused on the efficacy and safety of new antiemetic medications, primarily 5-hydroxytryptamine subtype 3 receptor antagonists, as well as clinical comparisons of these new drugs with older, established antiemetics. In the current healthcare environment, the cost-effectiveness of available antiemetic therapies has also become increasingly important, and this has been addressed in some of the recent literature.

Epidural analgesia in a preeclamptic parturient after normalization of a prolonged bleeding time with DDAVP.

BACKGROUND AND OBJECTIVES: Despite several advantages to the use of epidural analgesia for the management of labor pain in preeclamptic parturients, this procedure is withheld from many such patients owing to associated thrombocytopenia and platelet dysfunction. METHODS: A preeclamptic parturient with mild thrombocytopenia and platelet dysfunction manifested by a prolonged bleeding time received intravenous DDAVP (0.3 microgram/kg) in an attempt to correct her coagulation abnormality. RESULTS: The patient's bleeding time was normalized with DDAVP administration, allowing her to receive epidural analgesia. CONCLUSIONS: Preeclampsia-induced platelet dysfunction might be corrected with DDAVP: A controlled study is required before its routine use can be advocated.

Measurements of protein binding of lidocaine throughout pregnancy.

Pregnancy-related anatomic and physiologic changes result in altered pharmacologic and toxicologic responses to local anesthetics. Reductions in serum protein binding have been implicated in enhanced toxic effects. Previous studies have demonstrated these reductions in protein binding only in the term parturient. The present study defines the pattern of protein binding changes of lidocaine throughout gestation. Venous samples were obtained from pregnant patients of varying gestational age, as well as from nonpregnant control patients. The percent free drug at a fixed concentration (2 micrograms/mL) was determined for each sample using an ultrafiltration technique. The free concentration of lidocaine increased significantly throughout gestation, reflecting a corresponding decrease in protein binding. However, these changes were small compared to those in the nonparturient, which suggests that toxicity to lidocaine should not vary during pregnancy.