A Successful Pregnancy with Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a degenerative motor neurone disease that is rarely seen in the obstetric population. We present a 32-year-old patient who presented in her fourth pregnancy with a background history of ALS. There was complete involvement of the upper and lower motor neurone system and bulbar system without involvement of the sensory system. At 34 weeks of gestation, she had a full course of steroids and an elective caesarian section under general anaesthesia due to extreme restricted mobility and difficulty of breathing. A multidisciplinary team managed the pregnancy, and both maternal and fetal outcomes were good.

Effects of 5 IU oxytocin bolus and 20 IU oxytocin infusion compared to 5 IU oxytocin bolus and normal saline infusion in the control of blood loss during and after ante-partum lower segment caesarean section: a randomized controlled trial

Introduction: Obstetric haemorrhage is the leading cause of maternal mortality worldwide and in most cases it relates to uterine atony. Even though an oxytocin bolus is used routinely, additional infusion of oxytocin may be required if haemorrhage occurs. Objectives: To compare the effects of 20 IU oxytocin infusion and 5 IU bolus with 5 IU bolus and 500ml normal saline on the control of blood loss in antepartum lower segment caesarean section. Methods: A double-blind randomized controlled trial was conducted in the Teaching Hospital, Peradeniya, Sri Lanka. Ninety two pregnant women, forty six from each group were randomized to receive either intravenous slow 5 IU oxytocin bolus over 1 minute and additional 20 IU oxytocin infusion in 500 ml of 0.9% saline solution over 4 hours (Group-A) or 5 IU oxytocin bolus over 1 minute and 500 ml of 0.9% Saline over 4 hours (Group B). Visual assessment of mean blood loss was done by the surgeon and anaesthetist. Blood loss was calculated based on the body weight and haematocrit before and 48 hours after delivery. Results: Calculated mean blood loss (456.0ml vs 569.8ml) was significantly less in group A (p=0.046). Visual estimation of blood loss by surgeon (476.9 vs 552.1) (p=0.01) and anaesthetist (492.7 vs 557.2) (p= 0.03) were also significantly less in group A. Conclusions: Additional oxytocin infusion at antepartum caesarean section reduces blood loss during and after caesarean section significantly.