Haemodynamic changes associated with caesarean section under epidural anaesthesia

Summary. Serial haemodynamic investigations were performed in 15 women delivered by elective caesarean section under epidural anaesthesia at 38–40 weeks gestation. Cardiac output was measured by Doppler and cross-sectional echocardiography at the aortic valve. No haemodynamic changes were demonstrable after attainment of surgical anaesthesia (T5 or above). Stroke volume increased 13% after delivery of the placenta and remained elevated until the end of the operation at which time cardiac output was 11% above pre-operative values. Stroke volume and cardiac output fell during the first postoperative day. Heart rate remained elevated at pre-operative values for 48 h after delivery. There was a fall in heart rate and cardiac output between the second and the sixth days after delivery. By 2 weeks after delivery cardiac output was 28% lower than pre-operative values. Compared with pre-operative values, diastolic blood pressure was lower on the first and second postnatal days.     

Obstetric acute renal failure 1956–1987

Summary. A total of 142 women with severe acute renal failure (ARF) resulting from obstetric causes was treated by dialysis at a single centre from 1956 to 1987. One-year survival was 78·6%, which compares favourably with other causes of ARF. Abortion, haemorrhage and preeclampsia comprised 95% of cases, with survival being best (82·9%) with abortion. Survival was adversely affected by increasing age. Acute cortical necrosis (12·7% of patients) carried 100% mortality after 6 years. Follow-up of survivors showed normal renal function up to 31 years following ARF; 25-year patient survival was 71·6%. Improvements in obstetric care and the disappearance of illegal abortions have resulted in a dramatic decline in the incidence of obstetric ARF.