Taxonomy and predicted distribution of a rare Indian skink, Eutropis innotata (Blanford, 1870) (Reptilia: Scincidae) with the redescription of its holotype.

We examined the holotype of Euprepes innotatus Blanford, 1870 which was presented to the Natural History Museum, London (NHMUK) by Blanford himself, and is redescribed herein. Based on the morphological similarity, we placed Eutropis innotata within the E. carinata group (contra Blanford, 1870), as it is closely allied to E. dissimilis and E. carinata in morphological and morphometric traits. Based on the current distribution pattern, we conducted Species Distribution Modelling using the Maximum Entropy algorithm and the distribution range of this species was predicted to be wider than the currently known limits within the south-central parts of the Deccan plateau. Furthermore, we updated the conservation status of E. innotata using the criteria of the IUCN Red List, and suggested it be considered as a species of Least Concern.

Labor analgesia and cesarean section in women affected by tuberous sclerosis: report of two cases.

Tuberous sclerosis is a multi-system disease characterized by the presence of benign growths in many tissues, mostly localized in skin, brain, kidney and lungs. Epileptic seizures and renal hemorrhage are frequent in such patients. Apart from life-threatening hemorrhage after rupture of angiomyolipomatoma, few data are available about anesthetic considerations during pregnancy. We report two cases of pregnant patients with tuberous sclerosis, one scheduled for medical termination of pregnancy at 27 weeks of gestational, the other a cesarean section for breech presentation under general anesthesia. We review and discuss the ability to perform regional anesthesia in each case.

[Acute fatty liver of pregnancy: a rare pathology of the third trimester]. / Stéatose hépatique aiguë gravidique: une pathologie rare du troisième trimestre de grossesse.

Acute fatty liver of pregnancy is a rare clinical syndrome of pregnancy that occurs during the third trimester. Clinicians must have a high index of suspicion for this condition when a woman has nausea or vomiting during the last trimester. Early diagnosis and prompt delivery improve foetal and maternal prognosis. We report a case of a previously healthy 23-year-old woman who presented an acute fatty liver of pregnancy with intrauterine fetal death. Based on this experience as well as on medical literature, characteristics of this uncommon pathology are discussed.

[Request of epidural analgesia by women and obstetrical teams in four French areas. Part I: Request for analgesia]. / Demande d'analgésie périmédullaire par les patientes et les équipes obstétricales dans quatre régions françaises. Partie I : demande d'analgésie.

OBJECTIVE: Epidural analgesia (EA) is widely used in France to treat the labour pain. The aim of this study was to evaluate and analyse the reasons of EA requirements by parturients and obstetricians. STUDY DESIGN: An epidemiological survey was sent in all maternity units of four French areas. PATIENTS AND METHODS: Forty-eight of the 84 maternity units entered the study. In each centre, 25 patients fulfilled the questionnaire and the medical team fulfilled a questionnaire about the organisation of the ward. Demands of EA by parturients during pregnancy, labour and for the next delivery were recorded, and also the offer of EA by midwives and the possibility to move in an other town to obtain an EA. Student t-test, chi2 test and logistic regression model were used as requested. p<0.05 was considered as significant. RESULTS: One thousand one hundred forty-two women entered the study. During pregnancy 79% of women asked for an EA, they were 72% during labour. Factors influencing the request of an EA were parity, educational level, pain, preanaesthetic evaluation and the size and the kind of maternity unit (university, public or private hospital). During labour, the request of an EA was more frequent when anaesthesiologists were on call in the hospital (77.7 vs 66.7%, p<0.001). Midwives offered EA to 69% of women. For the next delivery 79.9% of women hoped an EA, the factors of this new request were parity, pain during this labour and EA during this labour; 42.8% would be ready to move in an other town to obtain an EA. The medical indications for EA occurred in 1.8% of patients. DISCUSSION: The request for EA mainly comes from women. Probably, in France, the request for EA will not diminish in the future. Analgesia networks could be considered.

[Request of epidural analgesia by women and obstetrical teams in four French areas. Part II: Management of epidural analgesia]. / Demande d'analgésie périmédullaire par les patientes et les équipes obstétricales dans quatre régions françaises. Partie II : réalisation des analgésies périmédullaires.

OBJECTIVE: Epidural analgesia (EA) is widely used in France to treat the labour pain. The aim of this study was to evaluate and analyse the rate of EA and the ratio between EA required by parturients and total EA realised (performance ratio). STUDY DESIGN: An epidemiological survey was sent in all maternity units of 4 French areas. Patients and methods. - 48 of the 84 maternity units were participating to the study. In each centre, 25 patients fulfilled the questionnaire and the medical team fulfilled a questionnaire about the organisation of the ward. Rate of EA and performance ratio were calculated. Student t test, chi2 test and logistic regression model were used as requested; p<0.05 was considered as significant. RESULTS: The mean rate of epidural analgesia (EA) rate, in the French areas studied, was 61.6%. It was significantly higher in university (79+/-13.7%) and private hospital (73.1+/-20.4%) than in general hospitals (54.6+/-19.6%, p<0.01), and also in those where anaesthesiologists are dedicated to the maternity unit (71.3+/-17.8 vs 54.6+/-22.1%, p<0.01) and in hospitals where anaesthesiologists were on duty in the hospital versus on call at home (69.8+/-21.4 vs 56.1+/-19%, p<0.02). Median duration of EA was 180 minutes, and 21.3% of them lasted more than five hours. Most of EA was performed between 8 AM and 6 PM. Patients' request was the major reason of EA insertion (OR=11.81), then the midwife request (OR=9.01). Other significant factors were the type of the hospital, the anaesthesiologist on duty and parity of women. The ratio between the number of EA requested by parturients and the total number of EA performed was significantly better in university hospitals (100.3+/-13%) and private hospitals (92.2+/-15.7%) than in general hospitals (79.4+/-17.3%, p<0.02). For the patients who had requested EA and did not have EA, the main reason was that labour was too fast (122/167) and then that there was a fail in anaesthesiological organization (59/167). The contraindications were rare (14/167). CONCLUSION: To correctly answer to the request of EA, it seems necessary that one or more anaesthesiologists were dedicated to the maternity units, and that they were on duty into the hospital. So it seems important to have large maternities with adequate number of anaesthesiologists.

[Smoking and anesthesia]. / Tabac et anesthésie.

There is no specific study about consequences of smoking in anesthetized pregnant women. General anesthesia is mainly involved in adverse effects of smoking. Among smoking patients, there is a significant increase in the incidence of cardiac and respiratory complications during and after anaesthesia. Post operative anxiety increases in smokers patients. But smoking decreases the incidence of nausea and vomiting after surgery. It would be better if smoking cessation took place 2 months before surgery, it is necessary to stop smoking 12 hours before anaesthesia. For general anaesthesia, propofol and sevoflurane provide less respiratory complications than other drugs. If possible, regional anaesthesia is the best choice for smoking patients.

[Type of birth center and conditions of transfer of neonates under 1500 g or gestational age under 33 weeks]. / Lieux de naissance et conditions de transferts des enfants de moins de 1500 g ou d'âge gestationnel strictement inférieur à 33 semaines.

BACKGROUND: Perinatal care's organization has been widely discussed in France during this last decade. Until now, transfer of high-risk neonates from their birth maternity to a pediatric unit using mobile vehicles led by specialized teams is encouraged in this country. POPULATION AND METHODS: Retrospective analysis of the type of maternities of birth for a population of 717 newborns, weighing less than 1,500 g and/or of gestational age under 33 weeks, extracted from a sample of 84,279 births in 1991. RESULTS: Only 15.6% of studied births took place in a maternity including a special intensive care pediatric unit (international level 3); 58.7% of those newborns where transferred outborn. There was a significant difference between the immediate access of newborns to a level 3 pediatric unit according to the location-of birth: significantly fewer newborns were directly transferred to a level 3 unit when born in a facility that included a level 2 pediatric unit, compared with those born in facilities that included a level 1 or 3 pediatric unit. CONCLUSION: Strong efforts should be made to identify mothers at high risk of giving birth to extremely prematured babies or babies with a very low birthweight so that births could take place in maternities properly equipped for their care. Perinatal care's organization should be built on a hierarchical network of maternities and pediatric services related to the risk of the population. Accreditation of maternities and pediatric services could help moving towards this kind of organization.

[Nocturnal paroxysmal hemoglobinuria disclosed during pregnancy. Apropos of a case]. / Hémoglobinurie paroxystique nocturne découverte au décours d'une grossesse. A propos d'un cas.

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired, intrinsic haemolytic anaemia believed to occur with an incidence of 1.5 per million in France. The disease is characterised by acute and chronic intravenous haemolysis and pancytopenia, without leukocytopenia. Pregnancy is rare and a high incidence of spontaneous abortion has been reported. The case reported here describes the successful outcome of a pregnancy where PNH was diagnosed. A 25 year old primigravida was admitted for evaluation of pancytopenia discovered in the 32nd week of an hypertensive pregnancy. On admittance R.B.C. were 1.67 x 10(12)/1, W.B.C. 3.4 x 10(9)/1 and platelets 12 x 10(9)/1; Hb was 6.8 g/dl and MGV 126 mu 3. Initial arterial pressure was 160/90 mm/Hg, with oedema and proteinuria 0.7 g per day. Obstetrical parameters were good and physical examination revealed to spontaneous haemorrhage, no jaundice, no dark urine, no organomegaly, no consumptive coagulopathy (C.C.) and no biological liver abnormalities. The patient received saline-washed packed red cells and fresh platelets. R.B.C. increased to 2.5 x 10(12)/1 and remained stable and platelets decreased to 5 x 10(9)/1 with increased arterial pressure and proteinuria, and appearance of C.C. A Caesarean section was performed, under general anaesthesia, and a male healthy baby weighing 2750 g was delivered. The post operative course was uneventful, except for a parietal haematoma which needed surgical evacuation. Because of the low platelet count, no heparin was given and the patient had no thrombosis and no infection.(ABSTRACT TRUNCATED AT 250 WORDS)

[Maternal paralysis of obstetrical origin. Two case reports]. / Paralysie maternelle d'origine obstétricale. A propos de deux cas.

We report two cases of maternal obstetrical paralysis by injuries to the sacral plexus (lumbosacral trunk). This nervous lesion is rare and occurs more often in young small primigravidae, carrying a large fetus, during a prolonged labor and a delivery requiring midforceps. The symptoms appear usually a few hours after delivery: paresthesias of the leg and the foot as well as weakness and possible footdrop (the paralysis may be mild or severe). The different mechanisms involved are inspected. The prognosis of this lesion is good, the patients recover usually within a period of three months. The treatment appears to be physiotherapy.

[Analysis of delivery facilities and conditions in 1991 in mothers of infants with birth weights below 1500 grams and/or gestational age under 33 weeks]. / Analyse des lieux et des conditions d'accouchement en 1991 des mères d'enfants dont le poids de naissance était inférieur à 1500 g et/ou l'âge gestationnel inférieur strictement à 33 sem.

AIMS: To identify maternities (in terms of level of activity and linkage with pediatric services) where, in 1991, mothers gave birth to infants of gestational age less than 33 weeks and/or with birth weight under 1500 g. To analyse factors linked to the probability of choosing a particular maternity as place of delivery for this population and measure the impact of maternal transferts on the rates of deliveries. To estimate the number of neonate transferts which could be avoided with simple recommendations. To propose policies that would allow France to come closer to the results of other reference countries in term of management of obstetrical and neonate care. MATERIAL AND METHOD: We extracted from a retrospective sample of 84,279 births (out of a total of 770,148), 717 infants meeting previously defined criteria and related to the population described above, using univariate and multivariate analysis and logistic regression. RESULTS: The Odds-ratio for a delivery to take place in a maternity with a volume of more than 2000 deliveries a year, compared with those doing less than 300 deliveries, is 4, 12. Only 15.8% of those deliveries took place in maternities linked to a level 3 pediatric unit (i.e where an intensive care neonates unit was located in the same building). 39.5% of births took place in level 1 maternities where no required pediatric service existed. Logistic regression techniques showed that the choice of a maternity for mother referral was more linked to the number of deliveries than to its level of pediatric services. In the studied population, 46% of the difference between the observed number of births in high volume maternities (compared to the expected number) could be explained by a maternal referral. The analysis of deliveries showed that for 34% of mothers who gave birth to a baby in a level 1 or 2 maternity, there was a possibility of being referred easily in a level 3 maternity. CONCLUSION: This study shows that the level of care of mothers at high risk of delivering a very premature and/or hypotrophic infant is far from international standards. Simple actions could double the number of births taking place in adapted maternities. We propose to both obstetricians and pediatrists, a common program to enhance the level of care.

[Evaluation of the demand for access to peridural obstetrical anesthesia in maternity units]. / Evaluation de la demande et de l'accès à la péridurale de travail dans une maternité de niveau III.

OBJECTIVES: This prospective study was initiated by a multicentric work. Each participating hospital, was asked to give data about 20 patients. Because of the importance of these informations for our practice, we decided to continue the evaluation, using the same inquiry, until 200 patients were enrolled. PATIENTS AND METHODS: An independent student (resident pharmacist), using a preprinted inquiry from interviewed two hundred consecutive in the, 48 hours after delivery in order to evaluate the following aspects: reasons to wish an epidural analgesia (EA) or not, modalities of achievement of EA. Statistical study: Chi-square and logistic regression. RESULTS: Among 199 analyzable files, 137 women wished for an EA (68.5%) but in only 90 the procedure was performed. Reasons for non-achievement of EA were the following: labour too advanced (43/47), obstetrical contraindication (2/47), anaesthesiologist non available (2/47). Delay between arrival at hospital and EA performance was 5 h 30 during daytime and 4 h 40 during nighttime. Delay and rate of EA achievement were not different between day and night time. Logistic regression analysis found following criteria related to: Wish for an EA analgesia: anaesthesiology consultation (OR = 193, p < 0.001), nulliparity (OR = 4, p < 0.002) and satisfactory information about EA (OR 35, p = 0.051). Achievement of EA: nulliparity (OR 38, p < 0.002), length of labour (OR = 1.01/min, p < 0.001). CONCLUSION: This study underlined the fact that one third of parturients do not wish for an epidural analgesia, mainly out of fear for neurological complications. When the obstetrician indicated an EA, our organisation allowed its achievement in 98% of cases. The latency between arrival and EA should be shortened.

[Indications of albumin for vascular loading during pregnancy]. / Indications de l'albumine dans le remplissage vasculaire en cours de grossesse.

Albumin infusion is used during pregnancy for volume loading in preeclampsia and/or intra-uterine growth retardation, before regional anaesthesia for Caesarean section, compensation of blood loss during haemorrhages of parturition, as well as prevention and treatment of ovarian hyperstimulation syndrome after in vitro fertilization. In preeclampsia, albumin is used for volume loading before initiating antihypertensive therapy. However it neither decreases blood pressure, nor increases uterine blood flow. Before regional anaesthesia for Caesarean section, an infusion of albumin 5% at a rate of 15 mL.kg-1 prevents hypotension in mothers (P < 0.05 versus Ringer lactate) and provides better Apgar scores in neonates (P < 0.05). Albumin is used to treat hypovolaemia in severe ovarian hyperstimulation syndrome. Recent studies have shown that in patients at high risk of ovarian hyperstimulation syndrome, 500 mL albumin 5% administered after ovocytes retrieval diminished the incidence of this syndrome (P < 0.05 versus normal saline).

[Anesthesia for cesarean section and excision of pheochromocytoma caused by Sipple's syndrome]. / Anesthésie pour césarienne et exérèse d'un phéochromocytome dû au syndrome de Sipple.

A case of a 23-year-old primigravida with a tumour of the left adrenal gland and a medullary thyroid carcinoma is reported. Her blood pressure remained at about 100/60 mmHg throughout pregnancy. She was scheduled for elective Caesarean section combined with removal of both adrenal glands. Anaesthesia was carried out using 10 micrograms.kg-1 alfentanil, 5 mg.kg-1 thiopentone, 1.5 mg.kg-1 succinylcholine and 0.5 vol % enflurane. A single hypertensive crisis (190/100 mmHg) occurred intraoperatively, during dissection of the left adrenal gland. This responded well to 1 mg.min-1 phentolamine. The postoperative course was uneventful for both the mother and the child. Total thyroidectomy with block dissection of the lymph nodes was to be carried out within three weeks after the Caesarean section. Only two similar cases of multiple endocrine neoplasia associated with pregnancy have previously been published.

[Prospective national survey on alternatives to obstetrical peridural analgesia]. / Enquête nationale prospective sur les alternatives à l'analgésie péridurale obstétricale.

OBJECTIVE: To assess the type of an alternative technique for epidural analgesia for pain relief during labour, the reason of its choice and its efficiency. STUDY DESIGN: A one-year prospective survey in 34 french hospitals. MATERIAL AND METHODS: A questionnaire was filled for each request for a non-epidural technique during labour. The data recorded the reason for this non-epidural method, the technique used, the repeated visual analog scale (VAS) pain scores before (T0) and during the treatment (T30, T60 T120,...), the maternal and foetal side effects of the method, and the maternal satisfaction. RESULTS: 177 questionnaires were studied among the 270 collected. The lack of VAS measurements was the main reason for excluding questionnaires. Refusing the epidural by the obstetric patient was the most frequent reason for requesting a non-epidural method (39%). Five non-epidural methods were identified: nalbuphine (NAL, n = 75), sufentanil by patient-controlled analgesia (SUF, n = 44), nitrous oxide/oxygen inhalation (N2O, n = 22), pethidine (PET, n = 19), and spinal analgesia (SA, n = 17). The choice of the method was dependant on the prescribe (midwife or anaesthetist) and of the cervical dilation. The SA group exhibited the most pain relief compared to the other groups during the treatment. No difference in pain relief was noted between the 4 groups (SUF, NAL, PET, N2O). Only in the PET group did the VAS pain score remain unchanged at T30. There were 25 maternal side effects, with a significant maternal sedation in the NAL group, and pruritus in the SA group. There were 6 respiratory depressions in infants, unrelated with the analgesic method. Maternal satisfaction was higher in the SA, SUF and N2O groups than in the PET and NAL groups. Factors explaining lack of analgesic effect (i.e. no decrease in VAS pain score more than 10 mm during the treatment) were the use of pethidine, the VAS pain score at T0 and the induced labour. CONCLUSION: Epidural and spinal analgesia are the most efficient methods for pain relief during labour. The analgesic effect of non-regional methods during labour is minimal, associated with some maternal side effects. Due to its lack of analgesic effect, pethidine should be avoided in this indication.

-Anesthesia and analgesia practice patterns in French obstetrical patients-. / Anesthésies et analgésies pratiquées dans les maternités françaises.

OBJECTIVE: To assess the rate of epidural analgesia (EA) for parturition and the techniques of anaesthesia for Caesarean section (CS). STUDY DESIGN: Retrospective study. PATIENTS: A series of 84,235 deliveries. METHODS: The series was extracted from a total of 770,054 deliveries carried out in 1991, according to the number of births in each hospital (1/1 if the births were < or = 100 per year, up to 1/25 if they were > or = 2,000 per year). The data analyzed included: anaesthesia technique, whether or not there was an anaesthetist on night duty at the hospital, birth rate in the hospital, type of hospital: university (UH), general (GH) or private (PH). For vaginal deliveries, the mode of labour commencement (spontaneous or induced), the multiplicity of pregnancies and a history of past CS were also noted. RESULTS: Vaginal deliveries: the overall rate of EA was 37.2%. EA were not carried out in 5% of maternity hospitals. In cases of spontaneous labour, the average rate was 32.1%, significantly less than for induced labour (59.6%, P < 0.0001) and in cases of previous CS (39%, P < 0.05). There was no statistical difference in cases of multiple pregnancies (35.7%). The average rate of EA was correlated to the number of annual births (P < 0.001) and was increased when the anaesthetist was present in hospital at night (P < 0.001). It was also significantly lower in GH (P < 0.001) than in UH or PH, which were equivalent. Scheduled CS: general anaesthesia (GA) was carried out at a significantly higher rate than regional anaesthesia (RA) (49.7% vs 48.4%, P < 0.05). In 15.1% of hospitals, RA was not available. The incidence of RA was influenced neither by the rate of annual births nor by the presence of the anaesthetist in the hospital during night. However, RA was significantly less frequent in GH (46.3%, P < 0.001) than in UH (48.6%) and in PH (53.6%) which were equivalent. CS during labour: the incidence of RA was significantly higher than GA (53.2% vs 44.1%, P < 0.001). In 17.1% of hospitals, RA was never carried out. The rate of RA was correlated to the size of the maternity hospital, and significantly higher (P < 0.001) when the anaesthetist was present in hospital during night. The differences between UH, GH and EP were the same than for scheduled CS. CONCLUSION: In France in 1991, the average rate of 37.2% for EA for obstetrics was high when compared to the rate in United Kingdom. It was equivalent to those in United States and Ontario, Canada. The discrepancies between hospitals were mainly related to structural and organizational factors. The influence of the size of the maternity hospital, the 24-hour service of EA was also shown in other studies. However, the difference between GA and UH and PH is a French particularity. The high rate of GA for CS differs largely with those in the UK or the USA. The time saving aspect of GA was probably an important factor for the choice of this technique. This study must be reactualized and enlarged to determine the demand of EA for labour by parturients and obstetricians.

[Indications of the different components of blood and outcome of transfusion practices in postpartum hemorrhage]. / Indications des différents constituants du sang et évolution des pratiques transfusionnelles dans l'hémorragie du post-partum.

Despite a high incidence of mortality associated with post-partum haemorrhage, indications for transfusion of blood and its components in obstetrics remain ill defined. Transfusion is often massive if needed. Transfusion management depends upon appreciation of blood loss, with systematic research of associated disseminated intravascular coagulopathy (DIC) or other preexisting coagulation disorders. If DIC is ruled out, the classic rules of volemic substitution apply, besides certain qualitative characteristics intrinsic to the blood components or products used. Treatment of DIC calls for fresh frozen safely screened plasma, fibrinogen or platelets concentrates. Indications for autologous transfusion are very limited in these circumstances.

[Conduction anesthesia and the newborn infant]. / Anesthésie loco-régionale et nouveau-né.

The placental transfer of local anaesthetics (LA) depends on maternal, placental and fetal factors. The assessment of effects of LA and epidural anaesthesia (EA) on the fetus is based on the monitoring of fetal heart rate (FHR) and the measurement of the fetal pH. Apgar score and neurobehavioral tests allow an evaluation of the neonatal effects of the drugs used. Direct effects of LA: a diminution of variability of FHR was observed shortly after the beginning of an EA using lidocaine but there was no modification of FHR after EA using bupivacaine or lidocaine with epinephrine. Fetal neurological toxicity is rare and there are very few alterations of neurobehavioral scores after EA. Indirect effects on uteroplacental blood flow (UBF): in high concentration, LA can induce vasoconstriction of uterine arteries but maternal arterial hypotension that impedes directly uteroplacental blood flow is the main effect. Prevention of aortocaval compression is essential because it allows better Apgar scores and arterial pH at birth. Use of colloids has not a better preventive efficacy than an equal volume of cristalloids while dextrans are formally contra-indicated because of serious fetal accidents. Large iv infusion of dextrose solutions are responsible for maternal and fetal hyperglycemia and hyperinsulinemia leading to neonatal hypoglycemia. The utilization of IM prophylactic ephedrine is not useful while the therapeutic administration of ephedrine to treat maternal arterial hypotension is efficient. Phenylephrine used in case of maternal arterial hypotension seems as efficient as is ephedrine. Epidural narcotics: the use of morphine by epidural route can induce neonatal respiratory depression and low neurobehavioral scores. The epidural administration of fentanyl does not alter the variability of the FHR and does not modify neither Apgar or neurobehavioral scores, nor respiratory adaptation of the newborn. Use of epidural alfentanil or sufentanil does not lead to low neurobehavioral scores unless very high doses are used. For elective caesarean section, newborns present a lower Apgar score at 1 min and necessitate respiratory assistance more frequently after general anaesthesia (GA) than after EA. Neurobehavioral scores are better after EA than after GA. For emergency caesarean section, the percentage of newborns with an Apgar score < 4 or necessitating a respiratory assistance is more important after GA than after EA. However, the perinatal mortality is not more important after GA than after EA.

[Epidemiology of complications of obstetrical epidural analgesia]. / Epidémiologie des complications de l'analgésie péridurale obstétricale.

Epidural analgesia (EA) is the best technique to obtain pain relief during labour. But the needle, the catheter and the local anaesthetics (LA) are 3 reasons to cause maternal complications. In France we do not know the exact number of EA performed every year and it is very difficult to appreciate the incidence of maternal complications. Therefore, it is necessary to know it and try to reduce the incidence of some of them. Maternal complications after EA are classically: 1. caused by catheter or needle: massive subarachnoid injection, toxic intravenous injection with convulsions and/or cardiac arrest; 2. secondary to infectious problems: meningitis or epidural abscess; 3. due to LA with the very rare anaphylactoid reactions; 4. due to prolonged neurologic complications with epidural and subdural haematomas, subarachnoid cysts or arachnoiditis. These complications are rare: 1/4,700 in the largest series of literature, involving more than 500,000 EA. In France, we tried to quantify maternal complications among nearly 300,000 EA performed over a period of 5 years. The overall incidence of serious complications was 1/4,005 EA. The most frequent are accidental dural puncture (1/156), massive subarachnoid injections (1/8,010) and convulsions (1/9,011). The incidence of these 3 complications must be reduced by better training, material or attention during bolus injection of LA.