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Eshraghi N, Karandish H, Mazouri A, Abdi A, Kashaki M, Bordbar A. Comparative analysis of neonatal umbilical cord blood gases across various delivery modes at a referral center. Arch Gynecol Obstet 2024; 310:705-709. [PMID: 38874777 DOI: 10.1007/s00404-024-07594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND This study aimed to address the increasing prevalence of cesarean section and the importance of evaluating newborn health through arterial blood gas analysis. Its primary objective was to compare the umbilical cord blood gas levels in newborns delivered through different delivery methods. METHOD This retrospective descriptive cross-sectional study included singleton pregnancies with a gestational age between 37 and 42 weeks and infants weighing between 2500 and 4000 g. Newborns with an Apgar score of 7 or higher at 1 and 5 min were included. Umbilical cord blood samples were collected from each newborn for blood gas analysis within 60 min after birth. RESULT The study included 340 neonates, with 170 born via caesarean section and 170 born through vaginal delivery. No significant differences were observed in Apgar scores between two groups. ABG analysis showed that vaginally born neonates had lower pH (7.24 ± 0.08 vs. 7.27 ± 0.07, P < 0.001), PCO2 (P = 0.015), and HCO3 (P < 0.001). Cesarean section neonates had higher oxygen saturation (P = 0.007) and pressure of oxygen (P < 0.001), and less negative base excess (P < 0.001). In the subgroup analysis, neonates whose mothers received epidural anesthesia had lower pH (7.23 ± 0.07 vs. 7.25 ± 0.08, P = 0.021) and more negative base excess (P = 0.026). Other parameters of ABG did not differ significantly between the groups (P > 0.05). CONCLUSION It has been proven that the mode of delivery, whether it is vaginal or cesarean, as well as the administration of epidural anesthesia during vaginal delivery, have a significant impact on newborns at birth. Newborns delivered vaginally exhibit metabolic acidosis compared to those delivered via cesarean section. Although these differences are statistically significant, they do not have a notable clinical significance, as the average values of the evaluated parameters in both groups fall within the normal range.
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Affiliation(s)
- Nasim Eshraghi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadiseh Karandish
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ali Mazouri
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Amir Abdi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mandana Kashaki
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Arash Bordbar
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Kraft F, Wohlrab P, Meyer EL, Helmer H, Leitner H, Kiss H, Jochberger S, Ortner CM, Klein KU. Epidural analgesia and neonatal short-term outcomes during routine childbirth: a 10-year retrospective analysis from the national birth registry of Austria. Minerva Anestesiol 2024; 90:491-499. [PMID: 38869263 DOI: 10.23736/s0375-9393.24.17921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Epidural analgesia (EA) is well-accepted for pain relief during labor. Still, the impact on neonatal short-term outcome is under continuous debate. This study assessed the outcome of neonates in deliveries with and without EA in a nationwide cohort. METHODS We analyzed the National Birth Registry of Austria between 2008 and 2017 of primiparous women with vaginal birth of singleton pregnancies. Neonatal short-term morbidity was assessed by arterial cord pH and base excess (BE). Secondary outcomes were admission to a neonatological intensive care unit, APGAR scores, and perinatal mortality. Propensity score-adjusted regression models were used to investigate the association of EA with short-term neonatal outcome. RESULTS Of 247,536 included deliveries, 52 153 received EA (21%). Differences in pH (7.24 vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89±3.2 vs. -6.15±3.2 mmol/L; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR score at five minutes <7 was more frequent with EA (OR 1.45; 95% CI: 1.29 to 1.63). Admission to a neonatological intensive care unit occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2 (95% CI: 1.14 to 1.26). EA was not associated with perinatal mortality (OR 1.33; 95% CI: 0.79 to 2.25). CONCLUSIONS EA showed no clinically relevant association with neonatal short-term outcome. Higher rates of NICU admission and APGAR score after five minutes <7 were observed with EA. The overall use of EA in Austria is low, and an investigation of causes may be indicated.
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Affiliation(s)
- Felix Kraft
- Department of Anesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Vienna, Austria -
| | - Peter Wohlrab
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Elias L Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Hanns Helmer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tyrolean Federal Institute for Integrated Care, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Jochberger
- Department of Anesthesia and Intensive Care Medicine, St. Johann Hospital, St. Johann, Austria
| | - Clemens M Ortner
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Klaus U Klein
- Department of Anesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Vienna, Austria
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Amin Z, El-Naggar AK, Offiah I, Dua A, Freeman R. Systematic Review and Meta-analysis of the Prevalence of Levator Ani Avulsion with Obstetric Anal Sphincter Injury and its Effects on Pelvic Floor Dysfunction. Int Urogynecol J 2024; 35:955-965. [PMID: 38523161 DOI: 10.1007/s00192-024-05756-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the prevalence of levator ani avulsion (LAA) among primiparous women with obstetric anal sphincter injury (OASI) and how this association could affect future pelvic floor dysfunction. METHODS Three electronic databases (MEDLINE/PubMed/EMBASE) were searched in December 2018 and again in October 2022. Nine full-text articles were included in the analysis. The exclusion criteria were language other than English, studies not based on primiparous women only, conference abstracts, and evaluation without ultrasound or MRI. RESULTS The overall prevalence of LAA was 24% (95% CI: 18-30%). Those with OASI, were at a higher risk of LAA, OR 3.49 (95% CI: 1.46 to 8.35). In women with LAA + OASI versus OASI alone, Three of Five studies showed worsened AI symptoms. Three of Five studies assessing urinary incontinence (UI) reported no significant difference in UI, whereas two reported increased UI. All studies that looked at pelvic organ prolapse reported a higher incidence of symptomatic prolapse and reduced pelvic floor muscle strength in women with LAA + OASI compared with those without LAA. CONCLUSION Levator ani avulsion is prevalent following vaginal birth and is strongly associated with OASI. Incidence of AI does not increase in women with LAA and OASI, but they had greater symptom bother. OASI with LAA appears to increase the incidence of pelvic floor weakness and pelvic organ prolapse. There is no consensus agreement on the effect of LAA + OASI on UI.
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Affiliation(s)
- Zohra Amin
- The Royal Oldham Hospital NHS Trust, Oldham, UK.
| | | | | | - Anupreet Dua
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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Duangkum C, Sirikarn P, Kongwattanakul K, Sothornwit J, Chaiyarah S, Saksiriwuttho P, Somjit M, Komwilaisak R, Hayagangchart S, Lumbiganon P. Subcutaneous vs intravenous fentanyl for labor pain management: a multicenter randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101310. [PMID: 38342306 DOI: 10.1016/j.ajogmf.2024.101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Labor pain is the most intense pain a woman will experience during her lifetime. Epidural anesthesia is recommended as the most effective method for pain relief, but it has several limitations. Fentanyl has high analgesic potency with short-acting duration, but the large-scale trials that assessed the effectiveness and safety of it for labor pain management are still limited. OBJECTIVE This study aimed to compare the effectiveness and harm and maternal satisfaction of subcutaneous vs intravenous fentanyl for labor pain management. STUDY DESIGN We conducted a multicenter, open-label randomized controlled trial. A total of 226 women were randomized to receive intravenous or subcutaneous fentanyl for labor pain management. Pain scores were evaluated before and after fentanyl administration at 5, 30, and 60 minutes and then every 60 minutes until delivery. The data were analyzed based on the intention-to-treat principle. RESULTS Both intravenous and subcutaneous fentanyl significantly decreased labor pain from baseline to delivery (overall mean change, -1.39; 95% confidence interval, -1.62 to -1.17; and -0.89; 95% confidence interval, -1.24 to -0.05, respectively). The reduction in the pain score between the 2 groups was not different (overall mean difference, -0.35; 95% confidence interval, -0.76 to 0.05). Maternal satisfaction was high for both intravenous and subcutaneous fentanyl (89.4% and 93.8%, respectively). There was no difference in the maternal satisfaction rate between the 2 groups (relative risk, 0.95; 95% confidence interval, 0.88-1.03). No serious maternal and neonatal adverse effects were observed. CONCLUSION Both intravenously and subcutaneously administered fentanyl were safe and significantly reduced pain from baseline to delivery among low-risk pregnancies. Maternal satisfaction with the childbirth experience was high regardless of the route of administration of fentanyl. No serious adverse effects of fentanyl were observed in either the mothers or the neonates.
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Affiliation(s)
- Chatuporn Duangkum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon).
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand (Dr Sirikarn)
| | - Kiattisak Kongwattanakul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Jen Sothornwit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Dr Sothornwit)
| | - Sukanya Chaiyarah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Piyamas Saksiriwuttho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Monsicha Somjit
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Dr Somjit)
| | - Rattana Komwilaisak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Suppasiri Hayagangchart
- Department of Obstetrics and Gynecology, Khon Kaen Hospital, Khon Kaen, Thailand (Dr Hayagangchart)
| | - Pisake Lumbiganon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
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Cavoretto PI, Silvani P, Farina A. Does intrapartum epidural analgesia influence rate of emergency delivery for fetal compromise? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:621-623. [PMID: 37910799 DOI: 10.1002/uog.27494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023]
Abstract
Linked articles: This Editorial comments on Damhuis et al. and Tabernée Heijtmeijer et al.
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Affiliation(s)
- P I Cavoretto
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - P Silvani
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A Farina
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Watanabe K, Sakamaki D, Shiko Y, Kawasaki Y, Noguchi S, Mazda Y. Comparison between neonatal outcomes of labor and delivery with labor neuraxial analgesia and without analgesia: A propensity score-matched study. J Obstet Gynaecol Res 2023; 49:1144-1153. [PMID: 36734027 DOI: 10.1111/jog.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
AIM This single-center observational study aimed to investigate the association between labor neuraxial analgesia (LNA) and neonatal outcomes. METHODS We conducted a retrospective cohort study at a tertiary perinatal center and included all vaginal deliveries performed between November 2015 and December 2021. Obstetric and neonatal outcomes were compared between deliveries with LNA (LNA group) and without analgesia (control group). Propensity score (PS) matching was used for statistical analysis. RESULTS We included 2343 singleton deliveries performed in 1367 nulliparous and 976 multiparous women, in whom LNA was induced in 352 and 178 deliveries, respectively. After PS matching, the nulliparous LNA group had a significantly higher incidence of Apgar scores <7 at 1 (7.1% vs. 3.6%, p = 0.0139) and 5 min (2.3% vs. 0.7%, p = 0.0397) and meconium staining (29.8% vs. 23.2%, p = 0.0272) than the nulliparous control group. Other neonatal outcomes, including umbilical artery pH and neonatal intensive care unit admission rate, were comparable between the nulliparous LNA and control groups. No significant differences in neonatal outcomes were seen in multiparous women. Regarding fetal heart rate abnormalities, severe late deceleration (4.8% vs. 1.7%, p = 0.0036) and severe prolonged deceleration (17.0% vs. 11.9%, p = 0.0224) were more common in the nulliparous LNA group than in the nulliparous control group, and the multiparous LNA group exhibited more severe variable deceleration (21.3% vs. 14.3%, p = 0.0485) than the multiparous control group. CONCLUSION Our findings suggest that LNA is associated with short-term adverse neonatal and obstetric outcomes in vaginal deliveries. LNA should be performed with precautionary measures and adequate medical resources.
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Affiliation(s)
- Kaede Watanabe
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Daisuke Sakamaki
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yuki Shiko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Shohei Noguchi
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yusuke Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study. J Anesth 2023; 37:39-48. [PMID: 36251094 DOI: 10.1007/s00540-022-03125-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/10/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE This study aimed to elucidate the effects of neuraxial analgesia on labor in women classified based on the Robson classification system. METHODS We retrospectively reviewed the clinical data of singleton cephalic nulliparous deliveries in labor at term between January 2018 and December 2021 and compared obstetrical outcomes between deliveries with and without neuraxial analgesia in women of Robson group 1 (spontaneous labor) and group 2a (induced labor). Statistical analyses were performed using the Wilcoxon ranked-sum test, Fisher's exact test, and logistic regression model. Statistical significance was set at p < 0.05. RESULTS We identified 2726 deliveries during the period, of which 387 deliveries (215 with analgesia and 172 without analgesia) were in Robson group 1 and 502 deliveries (258 with analgesia and 244 without analgesia) in Robson 2a. In Robson group 1 pregnancies, the cesarean section (CS) rate was higher in those who received analgesia (15%) than in those who did not (3%) (p = 0.0001). Multivariate analysis revealed that labor with analgesia was a significant risk factor for CS (p < 0.0001). Similarly, in Robson group 2a pregnancies, we observed a higher CS rate in those with analgesia than in those without analgesia (18 vs. 11%, p = 0.042). CONCLUSION A higher CS rate was observed in deliveries with analgesia than in those without analgesia both in the Robson group 1 and group 2a pregnancies.
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Seidenari A, Cavoretto PI, Carbone IF, Germano C, Iurlaro E, Gaeta G, Cetera GE, Amodeo S, Morano D, Masturzo B, Di Martino DD, Giambanco L, Candiani M, Farina A. The cumulative incidence of neonatal metabolic acidemia after terminal bradycardia in the 2nd stage of labor: a survival-based model. Arch Gynecol Obstet 2022; 307:1407-1414. [PMID: 35635618 DOI: 10.1007/s00404-022-06619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study was to estimate by a survival analysis model the hazard function (HF) for neonatal metabolic acidemia (MA) throughout the 2nd stage of labor (2STG) at the time of occurrence of a terminal bradycardia ≥ 10 min requiring expedited delivery, and the cumulative incidence function (CIF) for MA according with the duration of bradycardia stratified in 10-12 min and > 12 min. METHODS Singleton pregnancies experiencing terminal fetal bradycardia requiring expedited delivery in the 2STG at 38 + 0-41 + 3 weeks and delivering in the year 2019, were identified. The presence of MA (pH < 7 and/or BE ≤ - 12 mmol/L) was determined based on the acid-base status in the umbilical artery cord blood. Survival analysis was used to assess the hazard function (HF) and the cumulative incidence function (CIF) for MA occurring after terminal fetal bradycardia, at the 2STG. RESULTS Out of a non-consecutive population of 12,331 pregnancies, there were 52 cases that fit the inclusion criteria. Twenty-four (46.2%) of those develop MA. Abnormal quantitative pH values and the HF for MA correlated with the duration of 2STG at the time of bradycardia onset, but not with bradycardia duration. After 60 min of duration of 2STG, the HF (or instantaneous rate of failure) increased dramatically (from 1.2 to 20 about at 120 min). At paired duration of 2STG, a higher CIF was observed for the terminal bradycardia > 12 min. CONCLUSION Forty-six percent of term fetuses with terminal bradycardia had MA at birth. Despite the low sensitivity and a non-significant association with quantitative pH values, the duration of terminal bradycardia in the 2STG is associated with a higher CIF for MA.
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Affiliation(s)
- Anna Seidenari
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
| | - Paolo Ivo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - Ilma Floriana Carbone
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Center, Milan, Italy
| | - Chiara Germano
- Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Enrico Iurlaro
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Center, Milan, Italy
| | - Gerarda Gaeta
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - Giulia Emily Cetera
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Center, Milan, Italy
| | - Silvia Amodeo
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy
| | - Danila Morano
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Cona, Ferrara, Italy.
| | - Bianca Masturzo
- Department of Surgical Sciences, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Daniela Denis Di Martino
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Center, Milan, Italy
| | - Laura Giambanco
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy
| | - Massimo Candiani
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Bologna, Italy
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Abhirami GR, Sathyavani C, George CE. The Effect of Epidural Analgesia on the Maternal and Fetal Outcomes in Mothers Undergoing Induction of Labour. J Obstet Gynaecol India 2022; 72:174-179. [PMID: 35928064 PMCID: PMC9343558 DOI: 10.1007/s13224-022-01622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/11/2022] [Indexed: 10/19/2022] Open
Abstract
Introduction Elective labour induction is associated with more pain, intrapartum interventions, cesarean deliveries, as compared with spontaneous labour, necessitating the use of labour analgesia. Epidural analgesia is one popular method for control of pain. This study was to determine the effect of epidural analgesia on the maternal and fetal outcomes in women undergoing induction of labour, as adequate data in this specific population is relatively sparse. Materials and Methods This was a cross-sectional study conducted over a period of 18 months which included mothers with singleton term gestation with cephalic presentation admitted for induction of labour. Result A sample of 238 mothers were included in the study. Among the study population, 52.7% opted for epidural analgesia. The pain score was less than 3/10 (VAS) in 81% of mothers who opted for epidural analgesia. The cesarean section rate was 20.5% and 34.3% in the epidural and non-epidural groups, respectively. After adjusting the confounding factors, there was a positive effect noted in the caesarean section rate among the epidural group, which was lesser than the non-epidural group. However, a higher instrumental delivery rate (18.8% vs. 10.5%, p-value < 0.05) was noted in the epidural group. There was no significant difference in the duration of labour and fetal outcome in the two groups. Conclusion Epidural analgesia providing good pain relief in the majority of the mothers was reinforced. In our study, epidural analgesia was associated with a reduction of caesarean section rate after adjusting the confounding factor. Epidural analgesia did not affect the duration of labour, cesarean section rate and fetal outcome independently, however, it was associated with increased risk of instrumental delivery. The outcomes mainly depend on the confounding factors. Therefore, mothers can be provided with an evidence-based information regarding the effect of epidural analgesia in induced labour and help those seeking epidural analgesia to make an informed choice. Supplementary Information The online version contains supplementary material available at 10.1007/s13224-022-01622-1.
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Maghalian M, Mirghafourvand M, Ghaderi F, Abbasalizadeh S, Pak S, Kamalifard M. Comparison the effect of Swedish massage and interferential electrical stimulation on labor pain and childbirth experience in primiparous women: a randomized controlled clinical trial. Arch Gynecol Obstet 2021; 306:37-47. [PMID: 34716820 DOI: 10.1007/s00404-021-06220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since mothers are more inclined toward non-pharmacological labor pain management methods, this study aimed to compare the effect of interferential electrical stimulation (IES) and Swedish massage (SM) on labor pain and childbirth experience (primary outcomes) and childbirth satisfaction, duration of active phase and side effects (secondary outcomes) in primiparous women. METHODS This randomized controlled trial was performed on 90 primiparous women. Participants were randomly assigned into three groups through the block randomization method. The SM group received two massage techniques of effleurage and petrissage, on T10-L1 and S2-S4 at cervical dilatation of 4 and 8-10 cm. The IES group received electrical stimulation in a similar way to SM group, with a base frequency of 4000 Hz and a pulse frequency of 80-120 Hz by a physiotherapist. Control group received only routine care. RESULTS The mean pain was significantly lower in the SM group (adjusted mean difference (AMD) - 0.86; 95% confidence interval (95% CI) - 1.60 to - 0.11) and the IES group (AMD - 0.95; 95% CI - 1.70 to - 0.21) compared to the control group. The mean score of childbirth experience was significantly higher in the SM (MD 5.63; 95% CI 2.15-9.11) and IES (MD 3.66; 95% CI 0.18-7.14) group compared to the control group. The mean childbirth satisfaction in the SM (p = 0.003) and IES (p = 0.046) groups was significantly higher than the control group; and duration of the active phase of labor was significantly lower (p < 0.001) than the control group. No serious side effects were occurred in none of the groups. CONCLUSION SM and IES are safe methods that can significantly reduce pain and duration of active phase and improve the experience and satisfaction of childbirth.
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Affiliation(s)
- Mahsa Maghalian
- Student Research Committee, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Centre, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Ghaderi
- Department of Physiotherapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shamsi Abbasalizadeh
- Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Pak
- Student Research Committee, Department of Physiotherapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahin Kamalifard
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Au-Yong PS, Tan CW, Tan WH, Tan KH, Goh Z, Sultana R, Sng BL. Factors associated with an increased risk of instrumental vaginal delivery in women with epidural analgesia for labour: A retrospective cohort study. Eur J Anaesthesiol 2021; 38:1059-1066. [PMID: 33443381 DOI: 10.1097/eja.0000000000001439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidural analgesia is the most effective form of labour analgesia, but is associated with an increased risk of instrumental delivery. OBJECTIVE To evaluate factors that are associated with an increased risk of instrumental delivery. DESIGN Retrospective cohort data study. SETTING Singapore's major public maternity institution. PATIENTS All obstetric patients who received labour epidural analgesia for vaginal delivery between January 2012 to December 2015. INTERVENTION None. MAIN OUTCOME MEASURES Our primary outcome was the incidence of instrumental delivery. RESULTS Out of 17 227 pregnant women who received labour epidural analgesia, 12% (n = 2069) had instrumental delivery. Independent factors associated with an increased risk of instrumental delivery included maternal factors [nulliparity (adjusted odds ratio (aOR) 2.97, 95% CI 2.61 to 3.39, P < 0.0001] and advanced maternal age (aOR 1.04, 95% CI 1.03 to 1.05, P < 0.0001)). Greater maternal height (aOR 0.18, 95% CI 0.08 to 0.40), P < 0.0001) was associated with a reduced risk of instrumental delivery. Significant labour-related factors increasing the risk of an instrumental delivery were the use of prostin (aOR 1.19, 95% CI 1.07 to 1.32, P = 0.0014), pre-epidural analgesia (aOR 1.16, 95% CI 1.05 to 1.28, P = 0.0040), a longer second stage of labour (aOR 1.23, 95% CI 1.20 to 1.26, P < 0.0001), higher infant birth weight (aOR 1.27, 95% CI 1.12 to 1.43, P = 0.0002) and an epidural performed by a senior anaesthetist (aOR 1.94, 95% CI 1.72 to 2.18, P < 0.0001). Labour epidural-related factors for an increased risk of instrumental delivery were the occurrence of breakthrough pain (aOR 1.55, 95% CI 1.37 to 1.76, P < 0.0001), a more dense motor block (aOR 1.14, 95% CI 1.03 to 1.25, P = 0.0097) and having an epidural infusion stopped at full cervical dilatation (aOR 1.18, 95% CI 1.05 to 1.32, P = 0.0048) [receiver operating characteristic (ROC) = 0.75]. CONCLUSIONS The multivariate model generated would help identify women at higher risk of instrumental delivery, which can help clinicians to address potentially modifiable factors and improve clinical care.
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Affiliation(s)
- Phui Sze Au-Yong
- From the Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital (PSA), Department of Women's Anaesthesia, KK Women's and Children's Hospital (CWT, BLS), Department of Anaesthesia, Tan Tock Seng Hospital (WHT), Department of Anaesthesia, Ng Teng Fong General Hospital (KHT), Duke-NUS Medical School (ZG), Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore (RS)
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Rinaldi L, Ghirardini AM, Troglio R, Bellini V, Donno L, Biondini S, Biagioni E, Baciarello M, Bignami E, Girardis M. Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2021; 1:2. [PMID: 37386624 DOI: 10.1186/s44158-021-00003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Automated continuous epidural administration of local anesthetics provides a more stable analgesic block with decreasing of healthcare staff compared to manual boluses administration (TOP-UP) but is associated to high rate of operative vaginal delivery. We hypothesized that the use of programmed intermittent automated boluses (PIEB) is able to provide a good quality of analgesia and decreasing of anesthesiologic workload without increasing the rate of instrumental vaginal birth in comparison with TOP-UP technique. Laboring nulliparous woman aged between 18 and 46 years were randomized to epidural analgesia with 0.0625% levobupivacaine and sufentanil administered by PIEB or by TOP-UP techniques. Primary outcome was instrumental vaginal delivery rate and secondary outcomes were quality of analgesia, total and time-related drugs doses used, motor block, newborn outcome, and anesthesiologic workload. RESULTS Six hundred twenty-nine were randomized, and 628 were included in the intention-to-treat analysis. The rate of instrumental vaginal delivery was similar in the PIEB and TOP-UP groups (13.2% vs 9.7%, OR 1.4 95% CI 0.8 to 2.5; p 0.21). There was no difference between groups regarding mode of delivery (cesarean section vs vaginal birth), newborn outcome, and motor block. Patients in the PIEB group received more total and time-related drugs doses and a better quality of analgesia. Anesthesiological workload was significantly reduced in the PIEB group. CONCLUSIONS Our study demonstrated that epidural anesthesia with programmed intermittent epidural boluses by an automated device provides an effective and safe management of labor analgesia with improvement of pain control and sparing of man workload compared to manual top-up protocols.
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Affiliation(s)
- Laura Rinaldi
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy.
| | - Anna Maria Ghirardini
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
| | - Raffaella Troglio
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Valentina Bellini
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Lara Donno
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
| | - Susanna Biondini
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Emanuela Biagioni
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
| | - Marco Baciarello
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Elena Bignami
- Anesthesiology and Critical Care Division, Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126, Parma, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, University Hospital of Modena, L.go del Pozzo 71, 41125, Modena, Italy
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Uzunlar Ö, Sert ÜY, Kadıoğlu N, Çandar T, Engin Üstün Y. The effects of water immersion and epidural analgesia on cellular immune response, neuroendocrine, and oxidative markers. Turk J Med Sci 2021; 51:1420-1427. [PMID: 33600095 PMCID: PMC8283481 DOI: 10.3906/sag-2009-181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background/aim Water immersion and epidural analgesia are the most preferred pain relief methods during the labor process. Adverse effects related to these methods, impact on the labor, and perception of pain is well studied in the literature. We aimed to investigate the cord blood level of copeptin, total serum oxidant (TOS), antioxidant (TAS), interleukin (IL)-1, IL-6, and oxytocin after the labor with water immersion, epidural analgesia, and vaginal birth without pain relief. Materials and methods The study was conducted with 102 healthy pregnant women admitted to the obstetric delivery unit for noncomplicated term birth. Copeptin, oxytocin, TAS, TOS, IL-1, and IL-6 levels of cord blood and obstetric and neonatal results after vaginal birth were compared. Results The study included a total of 102 patients (group 1 = 30, group 2 = 30, and group 3 = 42). We found no significant difference between the three groups in terms of BMI, age, gravidity, parity, birth week, birth weight, interventional birth, perineal trauma, breastfeeding, duration of labor, oxytocin, IL-1 and IL-6 levels (p > 0.05). Neonatal intensive care unit (NICU) need, TAS, TOS, and copeptin levels were higher. Apgar scores were lower in the epidural group (p = 0.011, p = 0.036, p = 0.027, p < 0.001, and p < 0.001 respectively). Conclusion Epidural analgesia has deteriorated oxidative stress status and lower neonatal Apgar scores with higher NICU administration compared with water birth and vaginal birth without pain relief.
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Affiliation(s)
- Özlem Uzunlar
- Department of Obstetrics and Gynecology, Ankara City Hospital, University of Health Science, Ankara, Turkey
| | - Ümit Yasemin Sert
- Department of Obstetrics and Gynecology, Ankara City Hospital, University of Health Science, Ankara, Turkey
| | - Nezaket Kadıoğlu
- Department of Obstetrics and Gynecology, Liv Hospital, Ankara, Turkey
| | - Tuba Çandar
- Department of Biochemistry, Ufuk University, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanım Education and Research Hospital, University of Health Science, Ankara, Turkey
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14
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Lang Ben Nun E, Sela HY, Ioscovich A, Rotem R, Grisaru-Granovsky S, Rottenstreich M. Epidural analgesia and vacuum-assisted delivery in primiparous women: maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2021; 35:6906-6913. [PMID: 34039246 DOI: 10.1080/14767058.2021.1929161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aimed to evaluate the effect of epidural analgesia (EA) on maternal and neonatal outcomes. METHODS We conducted a retrospective cohort database study on primiparous women who underwent a vacuum-assisted delivery (VAD) trial between 2005 and 2019 at a university-affiliated tertiary medical center. We compared women with and without the standard "one protocol" patient-controlled EA. The primary outcome was VAD failure. Secondary outcomes were maternal and neonatal morbidities. We performed univariate analysis, followed by multivariable logistic regression analysis to control for potential confounders. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS Overall, 7042 primiparous women attempted VAD during the study period; 6238 (88.3%) and 804 (11.7%) women used and did not use EA, respectively. The VAD failure rate was significantly lower among women with than without EA use (2.5% vs. 4.2%, respectively, p < .01). On multivariable analysis, EA use was found to reduce the VAD failure rate (aOR, 0.05; 95% CI [0.01-0.49], p = .01). Notably, EA use was not associated with an increased rate of any maternal or neonatal adverse outcome (aOR, 1.01; 95% CI [0.8-1.27], p = .95 or aOR, 1.14 95% CI [0.89-1.45], p = .3, respectively). CONCLUSIONS EA use in primiparous women is associated with lower rates of VAD failure without an increase in adverse maternal or neonatal outcomes.
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Affiliation(s)
- Eyal Lang Ben Nun
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Alexander Ioscovich
- Department of Anesthesiology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.,Department of Anesthesiology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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15
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Akyıldız D, Çoban A, Gör Uslu F, Taşpınar A. Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2021; 29:9-21. [PMID: 34263219 PMCID: PMC8137733 DOI: 10.5152/fnjn.2021.19093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to investigate the effects of the interventions in the delivery room on the delivery process and the newborn health. METHOD The analytical-cross-sectional study was carried out with 354 puerperal women who gave birth in hospital between December 2016 and June 2017 in a public hospital. The data were collected by the data collection form developed by the researchers. Data analysis was done by using descriptive statistics and chi-square test in SPSS 21.00 program. RESULTS The interventions were determined in continuous electro fetal monitoring (80.5%), oxytocin induction (79.9%), restriction of free movement (56.8%), amniotomy (49.7%), enema (44.1%), and movement restriction (56.8%). The intervention period of the second phase of delivery was longer and the rate of cesarean section was higher, and the need for NICU, suction difficulty, 5th APGAR score less than 7, trauma development, difficulty in suction, and higher trauma rates were found in infants. It was determined that the rate of oxygen need in puerperals admitted to the delivery room with cervical dilatation below five cm, vacuum and episiotomy applications in those who underwent amniotomy, and vacuum application rates in those undergoing oxytocin inductions were found to be high. In addition, the rate of fundal compression and episiotomy was significantly higher in patients who used continuous electro fetal monitoring, fundal compression and vacuum rate in patients who were administered analgesic drugs, and episiotomy rates in patients using analgesic drugs. CONCLUSION It has been concluded that interventions in the first phase of labor negatively affect the delivery process and neonatal health and increase the need for intervention in the second phase.
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Affiliation(s)
- Deniz Akyıldız
- Department of Midwifery, Kahramanmaras Sütçü İmam University, Faculty of Health Sciences, Kahramanmaraş, Turkey
| | - Ayden Çoban
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | | | - Ayten Taşpınar
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
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Pandya S, Mikkilineni J, Madapu M. Conversion of labour epidural analgesia to anaesthesia for emergency caesarean section: A retrospective audit. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_91_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Silva YAP, Araújo FG, Amorim T, Martins EF, Felisbino-Mendes MS. Obstetric analgesia in labor and its association with neonatal outcomes. Rev Bras Enferm 2020; 73:e20180757. [PMID: 32609198 DOI: 10.1590/0034-7167-2018-0757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
OBJETIVE To investigate the association between analgesia during labor and occurrence of neonatal outcomes. METHOD Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. RESULTS Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. CONCLUSION The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.
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Affiliation(s)
| | | | - Torcata Amorim
- Universidade Federal de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
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Høtoft D, Maimburg RD. Epidural analgesia during birth and adverse neonatal outcomes: A population-based cohort study. Women Birth 2020; 34:e286-e291. [PMID: 32563571 DOI: 10.1016/j.wombi.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In general, epidural analgesia is considered a safe and efficient way to relieve pain during active labour and is increasingly used in childbirth. It is well documented that epidural analgesia during birth has benefits but also adverse effects. However, evidence is limited on how epidural analgesia influences neonatal outcome in a low-risk population of birthing women. AIM To examine low Apgar score, foetal hypoxia and admission to the neonatal intensive care unit in neonates of low-risk women receiving epidural analgesia during birth. METHODS A cohort study using registry data to investigate a population of 23,272 low-risk women giving birth at a university hospital. RESULTS Epidural analgesia was used in 21.6% of low-risk women during birth. Low Apgar score, foetal hypoxia, and admission to the neonatal intensive care unit were found in 0.6%, 0.6%, and 10.0%, respectively in neonates of mothers receiving epidural analgesia during birth compared to 0.3%, 0.6%, and 5.6%, respectively in the non-exposed group. Epidural analgesia was associated with low Apgar score, adjusted odds ratio 1.76 (95% CI 1.07-2.90) and admission to the neonatal intensive care unit, adjusted odds ratio 1.43 (95% CI 1.26-1.62). A mediation analysis indicates the impact of epidural analgesia on adverse neonatal outcomes was mediated by obstetric complications like maternal fever, labour augmentation, and foetal malpresentation. CONCLUSION This study found use of epidural analgesia during birth in low-risk pregnant women was associated with infant low Apgar score and admission to the neonatal intensive care unit.
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Affiliation(s)
- Diana Høtoft
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Rikke Damkjær Maimburg
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia
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19
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Grizhimalsky Y, Harha A. Patient-controlled epidural analgesia for labor – a step forward in Ukrainian obstetrics. PAIN MEDICINE 2019. [DOI: 10.31636/pmjua.v4i3.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Labour pain is recognized by some women as the most severe pain that they have ever felt in their life. Epidural analgesia is an effective method of pain relief in labour and is considered as the gold standard of analgesia for delivery. Traditionally, epidural analgesia in Ukraine is performed without the ability for the patient to control the process of anesthesia. The authors became interested in the delivery of local anesthetics by patientcontrolled epidural analgesia instead of the traditional physician methods. In randomized controlled studies there is an evidence that the PCEA method tends to improve the quality of pain relief and increase the patient satisfaction.
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20
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Ludvigsen E, Skjeldestad FE. Station of the fetal head at complete cervical dilation impacts duration of second stage of labor. Eur J Obstet Gynecol Reprod Biol X 2019; 7:100100. [PMID: 32715290 PMCID: PMC7379142 DOI: 10.1016/j.eurox.2019.100100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To examine the association between station of the fetal head at complete cervical dilation and duration of second stage of labor, as well as prolonged second stage of labor, without and with the use of analgesia (EA). Study design We conducted a population-based retrospective cohort study of 3311 women with a singleton pregnancy, gestational age ≥ 370 weeks, and cephalic presentation. Station of the fetal head at complete cervical dilation was categorized as at the pelvic floor, beneath the ischial spines, but above the pelvic floor, and at or above the ischial spines. In logistic regression analysis, we defined prolonged second stage of labor as > 2 h without and > 3 h with EA in nulliparous women, and > 1 h and > 2 h, respectively, in parous women. Results Survival curves demonstrated longer durations of second stage of labor in nulliparous women and women with EA in each category of station of fetal head. The adjusted odds ratio of prolonged second stage of labor was 13.1 (95% confidence interval (CI): 8.5-20.1) times higher when the fetal head was beneath the ischial spines, but above the pelvic floor, and 32.9 (95% CI: 21.5-50.2) times higher when the fetal head was at or above the ischial spines compared to at the pelvic floor. Conclusion Station of the fetal head at complete cervical dilation was significantly associated with duration of second stage of labor.
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Affiliation(s)
- Elisabeth Ludvigsen
- Division of Surgery, Oncology and Women’s Health, University Hospital of North Norway, Norway
- Research Group Epidemiology of Chronic Diseases, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Finn Egil Skjeldestad
- Research Group Epidemiology of Chronic Diseases, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Corresponding author at: Department of Community Medicine, Research Group Epidemiology of Chronic Diseases, UiT, The Arctic University of Norway, Tromsø, N 7037, Norway.
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Rodríguez González IP, Espinosa Domínguez E, Quesada García C, Rodríguez Chimeno Á, Borges R. Comparison between different epidural analgesia modalities for labor. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2019; 66:417-424. [PMID: 31138442 DOI: 10.1016/j.redar.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION In recent years new modalities of epidural analgesia maintenance (EA) have been introduced. OBJECTIVE The objective of this study is to compare different modalities of EA maintenance for childbirth relating the time of expulsive and dilatation, motor blockade and delivery instrumentation (caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery). MATERIAL AND METHODS Patients admitted for labor in the University Hospital Nuestra Señora de Candelaria between January 2013 and December 2015 were included. Independent modalities of EA, continuous infusion (CI), continuous infusion plus analgesia patient controlled epidural analgesia were determined as independent variables (CI+PCEA) and intermittent programmed epidural boluses plus patient controlled epidural analgesia (PIEB+PCEA). RESULTS There are no differences in expulsive time or dilation. There is a difference in the type of instrumentation, caesarean section, sucker, forceps, eutocic delivery or non-instrumented delivery (P>.05), with the percentage of eutocic deliveries in PIEB+PCEA of 66 versus 60 in CI and 65 in CI+PCEA. The percentage of caesarean sections was 23 in CI, in CI+PCEA and PIEB+PCEA of 17. CI increases by 27% the possibility of instrumented deliveries respect to PIEB+PCEA, there is no difference between CI+PCEA and PIEB+PCEA. The motor blockade at 60 and 90minutes reaches lower values with PIEB+PCEA with an average of 0 and a range of 0-1, compared to CI+PCEA 0 (0-4). Satisfaction with CI+PCEA ranges from 2-10 and with PIEB+PCEA 0-10. CONCLUSION It is possible to say that PIEB+PCEA is associated with higher frequency of non-instrumented deliveries. The possibility of instrumented deliveries increases with CI versus PIEB+PCEA. There is less motor block with PIEB+PCEA than with CI+PCEA. There are no differences in time of dilatation, expulsion, or patient satisfaction.
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Affiliation(s)
- I P Rodríguez González
- Servicio de Anestesiología y Reanimación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España.
| | - E Espinosa Domínguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España
| | - C Quesada García
- Servicio de Anestesiología y Reanimación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España
| | - Á Rodríguez Chimeno
- Servicio de Anestesiología y Reanimación, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, España
| | - R Borges
- Cátedra de Farmacología, la Universidad de la Laguna, Tenerife, España
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Garcia-Lausin L, Perez-Botella M, Duran X, Mamblona-Vicente MF, Gutierrez-Martin MJ, Gómez de Enterria-Cuesta E, Escuriet R. Relation between Length of Exposure to Epidural Analgesia during Labour and Birth Mode. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162928. [PMID: 31443209 PMCID: PMC6720813 DOI: 10.3390/ijerph16162928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
Objective: To appraise the relationship between the length of exposure to epidural analgesia and the risk of non-spontaneous birth, and to identify additional risk factors. This study is framed within the MidconBirth project. Study design: A multicentre prospective study was conducted between July 2016 and November 2017 in three maternity hospitals in different Spanish regions. The independent variable of the study was the length of exposure to epidural analgesia, and the dependent variable was the type of birth in women with uncomplicated pregnancies. The data was analyzed separately by parity. A multivariate logistic regression was performed. The odds ratios (OR), using 95% confidence intervals (CI) were constructed. Main outcome measures: During the study period, 807 eligible women gave birth. Non-spontaneous births occurred in 29.37% of the sample, and 75.59% received oxytocin for augmentation of labour. The mean exposure length to epidural analgesia when non-spontaneous birth happened was 8.05 for primiparous and 6.32 for multiparous women (5.98 and 3.37 in spontaneous birth, respectively). A logistic regression showed the length of exposure to epidural during labour was the major predictor for non-spontaneous births in primiparous and multiparous women followed by use of oxytocin (multiparous group). Conclusions: The length of exposure to epidural analgesia during labour is associated with non-spontaneous births in our study. It highlights the need for practice change through the development of clinical guidelines, training programs for professionals and the continuity of midwifery care in order to support women to cope with labour pain using less invasive forms of analgesia. Women also need to be provided with evidence-based information.
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Affiliation(s)
- Laura Garcia-Lausin
- Department of Experimental and Health Science, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
- Parc de Salut Mar, 08003 Barcelona, Spain.
| | - Mercedes Perez-Botella
- Department of Experimental and Health Science, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Research in Childbirth and Health Unit (ReaRH), University of Central Lancashire, 100, Picketlaw Road, G76 0BF Glasgow, UK
| | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain
| | | | | | | | - Ramon Escuriet
- Centre for Research in Health and Economics, University Pompeu Fabra, 08005 Barcelona, Spain
- Catalan Health Service, Government of Catalonia, 08028 Barcelona, Spain
- Faculty of Health Sciences, University Ramon Llull-Blanquerna, 08025 Barcelona, Spain
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23
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Naito Y, Ida M, Yamamoto R, Tachibana K, Kinouchi K. The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute. JA Clin Rep 2019; 5:40. [PMID: 32026970 PMCID: PMC6967033 DOI: 10.1186/s40981-019-0260-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/11/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Lumbar epidural analgesia (LEA) is the most widely used method in reducing labor pain. Previous RCTs have shown that LEA does not increase cesarean section rates; however, the results are inconsistent and may vary depending on the different backgrounds. Therefore, we aimed to study whether LEA would affect the course of labor in our institute. Methods Delivery records from October 2013 to April 2016 were collected. Deliveries at gestational age < 36 weeks and multiple pregnancies were excluded. All cases were divided into the non-epidural labor (NEL) group or the epidural labor (EL) group. We performed a propensity score matching analysis to balance intergroup differences. Our primary outcome was a mode of delivery (spontaneous, assisted vaginal, cesarean). Secondary outcomes were lengths of labor and outcomes of the neonates. Results During the study period, 2632 cases met the inclusion criteria. All analyses were performed after propensity score matching (218 pairs). The percentage of assisted vaginal delivery increased by the use of LEA (11.5% in NEL group vs 25.7% in EL group; p < 0.001), but the rate of cesarean section was similar (12.8% vs 17.0%; p = 0.23). The durations of the first and second stages of labor were prolonged by the use of LEA in both primipara and multipara women. Outcomes of the neonates were similar in both groups. Conclusion Use of LEA did not increase the rate of cesarean section when analyzed by propensity score-matched analysis in our institute.
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Affiliation(s)
- Yusuke Naito
- Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi-shi, Osaka, Japan.
| | - Mitsuru Ida
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Ryo Yamamoto
- Department of Obstetrics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi-shi, Osaka, Japan
| | - Keiko Kinouchi
- Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi-shi, Osaka, Japan
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Ortiz JU, Hammerl T, Wasmaier M, Wienerroither V, Haller B, Hamann M, Kuschel B, Lobmaier SM. Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome. Geburtshilfe Frauenheilkd 2019; 79:389-395. [PMID: 31000884 PMCID: PMC6461463 DOI: 10.1055/a-0774-8617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 12/14/2022] Open
Abstract
Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p < 0.001, respectively) and epidural analgesia (90 [92] vs. 44 [55] min, p = 0.004, and 22.5 [73] vs. 10 [11] min, p = 0.003, respectively) compared with the controls. The length of the pushing stage was similar among primiparas in all groups but prolonged compared with the controls in multiparas with patient-controlled intravenous analgesia with remifentanil (15 [17] vs. 5 [7] min, p = 0.001) and epidural analgesia (10 [15] vs. 5 [7] min, p = 0.006). The Apgar, umbilical arterial pH and base excess values were similar between the groups, as were the rates of acidosis and neonatal intensive care unit admission. Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.
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Affiliation(s)
- Javier U Ortiz
- Sektion für Geburtshilfe und Perinatalmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Thomas Hammerl
- Sektion für Geburtshilfe und Perinatalmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Maria Wasmaier
- Klinik für Anästhesiologie, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Valerie Wienerroither
- Sektion für Geburtshilfe und Perinatalmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Bernhard Haller
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Klinikum rechts der Isar, Technische Universität München, München, München
| | - Moritz Hamann
- Sektion für Geburtshilfe und Perinatalmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Bettina Kuschel
- Sektion für Geburtshilfe und Perinatalmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Silvia M Lobmaier
- Sektion für Geburtshilfe und Perinatalmedizin, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Penuela I, Isasi-Nebreda P, Almeida H, López M, Gomez-Sanchez E, Tamayo E. Epidural analgesia and its implications in the maternal health in a low parity comunity. BMC Pregnancy Childbirth 2019; 19:52. [PMID: 30700256 PMCID: PMC6354357 DOI: 10.1186/s12884-019-2191-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background In regard to obstetrical analgesia management there are different results related to the use of epidural analgesia versus mechanical adverse outcomes at delivery. Methods Cohort study of 23,183 consecutive, term, singleton vaginal deliveries, including spontaneous and induced labours, at a single institution from January 2004 to June 2016 to determine the association between epidural analgesia and different mechanical complications affecting maternal health such as severe perineal tears (SPT), abnormal foetal head position at delivery, instrumental delivery and caesarean section (CS). Multivariate logistic regression models were constructed to evaluate the risk factors of these mechanical complications with respect to possible cofounders. Results Epidural analgesia was used in 15,821 (68.24%) women. The logistic regression model showed a non-significant association between the use of epidural analgesia and SPT (odds ratio [OR], 078; 95% confidence interval [CI], 0.48–1.26; p = 0.310). Instrumental delivery and CSs were more frequently performed in cases than controls (p = < 0.001), with OR of 1.19 (95% CI: 1.10–1.29) for CS and with OR of 3.27 (95% CI: 2.93–4.61) for instrumental delivery. The abnormal foetal position head at delivery were significantly lower in the neonates delivered without epidural analgesia compared with those in which epidural analgesia was used (p < 0.001) with OR of 1.43 (95% CI:1.27–1.72). Conclusions Epidural analgesia is not associated with an increase of SPT, but it was an independent risk factor for instrumental delivery, CS and abnormal foetal head position at delivery.
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Affiliation(s)
- Ivan Penuela
- Unit of Anesthesiology, Resuscitation and Pain Treatment, University Hospital Joan XXIII, Carrer Dr. Mallafré Guasch, 4, Tarragona, Spain.
| | - Pilar Isasi-Nebreda
- Unit of Anesthesiology, Resuscitation and Pain Treatment, University Hospital of Burgos, Burgos, Spain
| | - Hedylamar Almeida
- Unit of Anesthesiology, Resuscitation and Pain Treatment, University Hospital of Burgos, Burgos, Spain
| | - Mario López
- Unit of Anesthesiology, Resuscitation and Pain Treatment, Clinic University Hospital, Valladolid, Spain
| | - Esther Gomez-Sanchez
- Unit of Anesthesiology, Resuscitation and Pain Treatment, Clinic University Hospital, Valladolid, Spain
| | - Eduardo Tamayo
- Unit of Anesthesiology, Resuscitation and Pain Treatment, Clinic University Hospital, Valladolid, Spain
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26
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Polónia Valente R, Santos P, Ferraz T, Montenegro N, Rodrigues T. Effect of obesity on labor duration among nulliparous women with epidural analgesia. J Matern Fetal Neonatal Med 2019; 33:2195-2201. [PMID: 30394154 DOI: 10.1080/14767058.2018.1543655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: The aim of this study was to describe the effect of obesity on the duration of labor, specifically latent and active phases of labor, and on mode of delivery, among nulliparous women with epidural analgesia.Study design: We conducted a retrospective cohort study, comparing a sample of nulliparous obese women (body mass index ≥30 kg/m2, n = 121) with a random sample of normal weight nulliparous (18.5 kg/m2 ≤body mass index ≤25 kg/m2, n = 161). Analysis included all obese women delivered at the Department of Obstetrics and Gynecology of Centro Hospitalar, São João, Porto, Portugal between 1 January and 31 December, 2016. Only women submitted to epidural analgesia were included. Information on maternal age, obstetric history, current pregnancy and labor characteristics (gestational age, birthweight, mode of delivery, total duration of labor, latent and active phases duration) was retrieved from electronic obstetrical databases and labor charts.Results: In our department, the prevalence of maternal obesity was 12.0%. Obese women had a significantly higher rate of cesarean delivery (47.1 versus 27.3%), fewer normal vaginal deliveries (28.9 versus 32.9%) and fewer instrumental vaginal deliveries (24.0 versus 39.8%). Labor induction was significantly more frequent among obese women (51.2 versus 29.2%; p = 0.001). The median (interquartile range) for length of latent phase when labor was induced with prostaglandins in the obese group was 23.3 hours (20.9). This was significantly longer than in normal weight women -15.6 hours (13.15) (p = 0.001). However, there was no significant difference in latent phase duration when labor was induced with oxytocin (12.4 versus 9.4 hours; p = 0.150). The medians (interquartile range) for length of latent phase in spontaneous delivery -6.5 hours (6.8) versus 6.6 hours (6.5) did not differ (p = 0.992). The duration of active phase was not significantly different between obese and normal weight (5.1 versus 5.1 hours; p = 0.784). For spontaneous labor, there was no difference between the two groups in the total duration of labor (11.9 versus 11.3 hours; p = 0.573). But for induced labor, the total duration was significantly higher among obese women (31.1 versus 21.4 hours; p = 0.001).Conclusion: Latent phase was longer in obese than normal weight women undergoing labor induction with prostaglandins. Obesity had no effect on duration of active phase. Obese women undergoing labor induction had a longer total duration of labor, compared to normal weight women mainly due to prolonged latent phase.
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Affiliation(s)
- Rita Polónia Valente
- Department of Obstetrics and Gynecology of Centro Hospitalar de São João, Porto, Portugal
| | | | - Tiago Ferraz
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Montenegro
- Department of Obstetrics and Gynecology of Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Teresa Rodrigues
- Department of Obstetrics and Gynecology of Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
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27
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Garcia-Lausin L, Perez-Botella M, Duran X, Rodríguez-Pradera S, Gutierrez-Martí MJ, Escuriet R. Relation between Epidural Analgesia and severe perineal laceration in childbearing women in Catalonia. Midwifery 2018; 70:76-83. [PMID: 30594059 DOI: 10.1016/j.midw.2018.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objectives were to study the association between epidural analgesia and risk of severe perineal laceration (SPL), and identify additional risk factors for SPL. This multicentre study consisted of an analysis of data from the MidconBirth Phase I Database, on the use of EA and perineal results during childbirth. (World Health Organization, International Clinical Trials Registry Platform, 2016: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN17833269). METHODS We conducted a prospective study of pregnant women at term between July 2016 and July 2017 in 30 public maternity hospitals in Catalonia, Spain. Inclusion criteria were an uncomplicated singleton pregnancy, in cephalic presentation and vaginal birth. Data was analysed separately for instrumental births and spontaneous vaginal births, as the former is more frequently associated with episiotomy and more perineal lacerations. Risk factors as well as protective factors in each cohort of women (instrumental and spontaneous vaginal birth), were identified. Multivariate logistic regression model was performed to study the association between epidural analgesia and SPL to identify potential confounders. Odds ratios (OR), using 95% confidence intervals (CI) were constructed. FINDINGS During the study period, 5497 eligible women gave birth, 77.46% of them received epidural analgesia. SPL occurred in 1.63% of births. The univariate analysis showed births with epidural analgesia had significantly higher rates of inductions, augmentation of labour, lithotomy position for birth and episiotomy. However, this association disappeared when the variable "type of vaginal birth" was introduced. In multivariate logistic regression, nulliparity was the major predictor for SPL (OR: 0.17; CI 95%: 0.08-0.34, p: 0.000). KEY CONCLUSIONS Epidural analgesia was not associated with SPL once confounding factors were included. Other interesting factors associated with SPL were identified. IMPLICATIONS FOR PRACTICE This paper identifies important practice areas which contribute to SPL and which have the potential to be rectified. It offers evidence on the role that EA plays on pelvic floor injuries and it adds to existing evidence about the disadvantages of using the lithotomy position for birth, especially in relation to SPL. It highlights the need for practice change in Catalonia from what can be considered a medical model of care to one more aligned with the midwifery philosophy of care through the development of clinical guidelines. It also signals the need to provide women with evidence base upon which to make informed choices on the use of EA, specifically in relation to SPL.
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Affiliation(s)
- L Garcia-Lausin
- Department of Experimental and Health Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Mar Health Park, Spain.
| | - M Perez-Botella
- Research in Childbirth and Health unit (ReaRH), University of Central Lancashire, United Kingdom
| | - X Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d´Investigacions Mèdiques (IMIM), Spain
| | | | | | - R Escuriet
- Innovation and Health Division, Catalan Health Service, Spain; Mar School of Nursing, Universitat Pompeu Fabra (UPF), Spain
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Kličan-Jaić K, Roso I, Pešić M, Djaković I, Bilić N. Conducting an epidural analgesia in University Hospital Center "Sisters of Mercy": Croatian experience. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2018. [DOI: 10.23736/s0393-3660.17.03670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Epidural Analgesia and Neonatal Morbidity: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102092. [PMID: 30249991 PMCID: PMC6210157 DOI: 10.3390/ijerph15102092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/20/2018] [Accepted: 09/22/2018] [Indexed: 11/16/2022]
Abstract
(1) Background: Epidural analgesia (EA), at the present time, is one of the most effective methods to reduce labor pain. In recent years its use has increased, being used between 20–70% of all deliveries; (2) Methods: Historical cohort on a total of 2947 deliveries during the years 2012–2016 at the “Mancha-Centro Hospital” of Alcázar de San Juan. The main outcome variables were four neonatal morbidity (NM) criteria: umbilical artery pH of <7.10, Apgar score at 5 min < 7, need for advanced resuscitation and composite morbidity. We used the multivariate analysis to control confounding bias. (3) Results: No statistical relationship between EA and the second stage of labor duration with none of the four criteria of NM used (p > 0.005). However, the type of delivery was associated with three criteria (pH, resuscitation, and composite morbidity). The instrumental delivery presented an OR of pH < 7.10 of 2.68 95% CI [1.15, 6.27], an OR of advanced resuscitation of 2.44 95% CI [1.17, 5.08] and OR of composite morbidity of 2.86 95% CI [1.59, 5.12]; (4) Conclusions: The EA and the second stage of labor duration are not related to the NM. While the instrumental delivery doubles the risk of NM compared to the normal vaginal delivery.
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Shiro M, Nakahata K, Minami S, Kawamata T, Ino K. Perinatal outcome of vaginal delivery with epidural analgesia initiated at the early or late phase of labor period: A retrospective cohort study in the Japanese population. J Obstet Gynaecol Res 2018; 44:1415-1423. [PMID: 29888832 DOI: 10.1111/jog.13671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/06/2018] [Indexed: 11/30/2022]
Abstract
AIM We compared the perinatal outcomes of vaginal delivery with epidural analgesia initiated at the early versus late phase in a Japanese population. METHODS Women enrolled in this retrospective cohort study received intrapartum analgesia via combined spinal epidural analgesia after labor onset between May 2010 and August 2015. We compared the perinatal outcomes between two different timings of epidural analgesia: at the early phase (≤3 cm cervical dilatation) and the late phase (≥4 cm) or at the new definition-based early phase (≤5 cm) and late phase (≥6 cm). RESULTS One hundred twenty-eight singleton pregnant women were eligible. In nulliparous women, there was no marked difference in perinatal outcomes between the early and late phase except for in the first-stage labor period (13.7 h vs 10.1 h, P = 0.016). In multiparous women, there was no marked difference in perinatal outcomes between the early and late phase except for a higher proportion of Apgar score ≤7 at 1 min in the early phase (20.0% vs 0.0%, P = 0.033). In nulliparous women, the first-stage labor period in the new early phase was significantly longer than in the new late phase (13.3 h vs 6.9 h, P = 0.035). Other variables for nulliparous women and all for multiparous women were not different between the new early and late phases. CONCLUSION Most perinatal outcomes between the early and late phases of initiated epidural analgesia were not markedly different in our Japanese population, even when using a new definition of labor phase.
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Affiliation(s)
- Michihisa Shiro
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
| | - Katsutoshi Nakahata
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan.,Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Sawako Minami
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University, Wakayama, Japan
| | - Kazuhiko Ino
- Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan
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The effect of labor epidural analgesia on maternal-fetal outcomes: a retrospective cohort study. Arch Gynecol Obstet 2018; 298:89-96. [PMID: 29777348 DOI: 10.1007/s00404-018-4777-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/19/2018] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the impact of labor epidural analgesia on maternal-fetal safety outcomes in a signal Chinese academic medical center. METHODS A single-intervention impact study was conducted at The Second Affiliated Hospital, Wenzhou Medical University. The study period was divided into three phases: (1) baseline phase: from January 1 and June 30, 2009 when no analgesic method was routinely employed during labor; (2) phase-in period: the epidural analgesia was implemented 8 a.m.-5 p.m. during weekdays; and (3) the post-No Pain Labor N'Delivery phase when the labor epidural was applied 24 h a day, 7 days a week, from June 1, 2010 and June 30, 2011. The maternal-fetal safety outcomes of delivery were compared between the different periods. RESULTS There were 15,415 deliveries with 42.3% of nulliparous parturients in the 31-month study period. As the primary outcomes, the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5% after full implementation. As the secondary outcomes, the rate of episiotomy and severe perineal injury after the implementation periods were significant decreased. The rate of postpartum oxytocin administration was decreased by 17.8%. No significant difference between the baseline and implementation periods was found in the rate of postpartum hemorrhage, Apgar scores less than 7 at both 1 and 5 min, 7-day mortality, and the overall neonatal intensive care unit admission rate. CONCLUSION Implementation of labor epidural analgesia increased the vaginal delivery rate and use of labor epidural analgesia is safe to parturients and fetus.
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Felisbino-Mendes MS, Santos LO, Amorim T, Costa IN, Martins EF. O uso de analgesia farmacológica influencia no desfecho de parto? ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia farmacológica durante o trabalho de parto e o desfecho classificado como parto vaginal, vaginal instrumentalizado e cesariana. Verificou-se a associação entre analgesia e os desfechos do parto por meio de regressão logística multinominal para obter as estimativas de Odds Ratio (OR) com seus respectivos intervalos de 95% de confiança, e o modelo final foi ajustado por idade da mulher, número de partos anteriores, presença de acompanhante ou doula e dilatação cervical no momento da analgesia. Resultados: Do total de nascimentos, 87,1% foram vaginais e 12,9% cesariana. A prevalência do uso de analgesia farmacológica foi 34,2% e do parto instrumentalizado de 8,4%. Cerca de 70% das mulheres tiveram gestação de risco habitual. Mesmo após ajuste por confundidores, o uso da analgesia aumentou em 3,5 vezes a chance de parto instrumentalizado (p<0,0001) e para as mulheres com gestação de alto risco esse aumento foi ainda superior (OR=4,62; p<0,0001). Não houve associação do uso da analgesia com a cesariana (p=0,320). Conclusão: O uso de analgesia farmacológica modifica o desfecho do parto, aumentando as chances de parto instrumentalizado, principalmente em mulheres com gravidez de alto risco. Nesse contexto considera-se importante orientar as mulheres quanto aos potenciais riscos e benefícios da analgesia para uma escolha segura.
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Sánchez-Migallón V, Sánchez E, Raynard M, Miranda A, Borràs RM. Analysis and evaluation of the effectiveness of epidural analgesia and its relationship with eutocic or dystocic delivery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:369-374. [PMID: 28089318 DOI: 10.1016/j.redar.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Numerous studies have demonstrated the difference in the verbal rating scale with regard to obstructed labour and induced labour, so that obstructed labour and foetal macrosomia have been related to a greater sensation of pain during labour, particularly in the first stage. Even the epidural analgesia is linked to the need for instrumented or caesarean section due to foetal obstruction. The goal of the study is to analyze and evaluate the effectiveness of epidural analgesia in normal versus obstructed labour. PATIENTS AND METHODS One hundred and eighty pregnant women were included in an observational, analytical, longitudinal and prospective study, that was performed in the Obstetrics Department of the Hospital Universitario Dexeus. All the nulliparous or multiparous over 36 weeks of pregnancy, after 3cm of cervical dilatation in spontaneous or induced labor were included. All the patients were given epidural analgesia according to protocol. RESULTS The basic descriptive methods were used for the univariate statistical analysis of the sample and the Mann-Whitney U test was used for the comparison of means between both groups. The correlations between variables were studied by means of the Spearman coefficient of correlation. The differences regarded as statistically significant are those whose P<.05. CONCLUSION In our population there were no statistically significant differences in the effectiveness of epidural analgesia in normal versus obstructed labour. Patients who got epidural analgesia and had obstructed labors have the same degree of verbal rating scale as patients that do not had obstructed labors (P>.05).
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Affiliation(s)
- V Sánchez-Migallón
- Departamento de Anestesiología y Reanimación, Hospital Universitario Dexeus, Barcelona, España.
| | - E Sánchez
- Departamento de Anestesiología y Reanimación, Hospital Universitario Dexeus, Barcelona, España
| | - M Raynard
- Departamento de Anestesiología y Reanimación, Hospital Universitario Dexeus, Barcelona, España
| | - A Miranda
- Departamento de Anestesiología y Reanimación, Hospital Universitario Dexeus, Barcelona, España
| | - R M Borràs
- Departamento de Anestesiología y Reanimación, Hospital Universitario Dexeus, Barcelona, España
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Herrera-Gómez A, De Luna-Bertos E, Ramos-Torrecillas J, Ocaña-Peinado FM, Ruiz C, García-Martínez O. Risk Assessments of Epidural Analgesia During Labor and Delivery. Clin Nurs Res 2017; 27:841-852. [PMID: 28754057 DOI: 10.1177/1054773817722689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidural analgesia (EA) is one of the methods of choice for labor pain relief, but its adverse effects on the mother and child remain controversial. The objective of this study was to determine whether there is an association between the use of EA and different aspects of labor. The author(s) analyzed the effect of EA on different aspects of labor in a retrospective cohort observational study of deliveries in a public Spanish hospital during a 3-year period. Women with EA administration were found to increase the risk of stimulated labor, reduce the percentage of spontaneous deliveries, increase the risk of instrumental labor due to stalled labor or loss of fetal well-being, and increase the percentage of episiotomies. However, women with EA were not and increased risk for perineal laceration or the condition of the membranes at the delivery or with the type of placental expulsion. Thus, the administration of EA should be assessed in each case by the health care professional.
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Affiliation(s)
- Antonio Herrera-Gómez
- 1 Hospital "San Juan de la Cruz"-Servicio Sanitario Público Andaluz, Jaén, Spain.,2 Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
| | - Elvira De Luna-Bertos
- 2 Department of Nursing, Faculty of Health Sciences, University of Granada, Spain.,3 Instituto Investigación Biosanitaria, ibs.Granada University of Granada, Spain
| | - Javier Ramos-Torrecillas
- 2 Department of Nursing, Faculty of Health Sciences, University of Granada, Spain.,3 Instituto Investigación Biosanitaria, ibs.Granada University of Granada, Spain
| | - Francisco M Ocaña-Peinado
- 4 Department of Statistics and Operations Research, School of Pharmacy, University of Granada, Spain
| | - Concepción Ruiz
- 3 Instituto Investigación Biosanitaria, ibs.Granada University of Granada, Spain.,5 Institute of Neuroscience, University of Granada, Spain
| | - Olga García-Martínez
- 2 Department of Nursing, Faculty of Health Sciences, University of Granada, Spain.,3 Instituto Investigación Biosanitaria, ibs.Granada University of Granada, Spain
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Kelly A, Tran Q. The Optimal Pain Management Approach for a Laboring Patient: A Review of Current Literature. Cureus 2017; 9:e1240. [PMID: 28620569 PMCID: PMC5467776 DOI: 10.7759/cureus.1240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient’s labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Cesarean delivery rates are not affected by the early initiation of epidural analgesia. The use of various adjuvants such as opioids, clonidine, and neostigmine in conjunction with local anesthetics solution can significantly reduce the severity of motor blockade and the need for assisted vaginal delivery.
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Affiliation(s)
- Albert Kelly
- Anesthesiology, Riverside University Health System Medical Center, Moreno Valley, California, United States
| | - Quang Tran
- Anesthesiology, Riverside University Health System Medical Center, Moreno Valley, California, United States
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Herrera-Gómez A, Luna-Bertos ED, Ramos-Torrecillas J, Ocaña-Peinado FM, García-Martínez O, Ruiz C. The Effect of Epidural Analgesia Alone and in Association With Other Variables on the Risk of Cesarean Section. Biol Res Nurs 2017; 19:393-398. [DOI: 10.1177/1099800417706023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Epidural analgesia (EA) is the most widespread pharmacologic method of labor pain relief. There remains disagreement, however, regarding its adverse effects. The objective of this study was to determine the effect of EA administration on the risk of cesarean delivery and its causes (e.g., stalled labor, risk of loss of fetal well-being, among others) and the degree to which this effect may be modulated by mother-, newborn-, and labor-related variables. Method: A retrospective cohort observational study was conducted including all deliveries in a Spanish public hospital between March 2010 and March 2013 ( N = 2,450; EA = 562, non-EA = 1,888). Results: Risk of a cesarean section was significantly increased by EA administration (odds ratio [ OR] = 2.673; p < .0001). The percentage of cesarean deliveries due to the risk of loss of fetal well-being was significantly higher in the EA (47.8%) versus non-EA group (27.5%; OR = 1.739; p = 0.0012,). The EA-associated risk of cesarean section was not significantly modified as a function of maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration alone. However, these variables in combination may increase the risk. We present multivariate models for each group that account for these variables, allowing for estimation of the risk of a cesarean delivery if EA is administered. Conclusion: EA is associated with an increased risk of cesarean delivery. Other variables in combination (maternal age or parity, fetal position, newborn weight, weeks of gestation, or sedation administration) may increase this risk.
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Affiliation(s)
- Antonio Herrera-Gómez
- Hospital “San Juan de la Cruz”, Úbeda, Jaén, Spain
- Servicio Sanitario Público Andaluz, Junta de Andalucía, Úbeda, Jaén, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Elvira De Luna-Bertos
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, University of Granada, Granada, Spain
| | - Javier Ramos-Torrecillas
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, University of Granada, Granada, Spain
| | | | - Olga García-Martínez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, University of Granada, Granada, Spain
| | - Concepción Ruiz
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, University of Granada, Granada, Spain
- Institute of Neuroscience, Granada Health-Science Technology Park, University of Granada, Armilla, Granada, Spain
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Zhao S, Wen J, Niu J, Xia J, Zhou L, Zou W. The clinical research into the application of multifunctional airbag abdominal pressure belt in midwifery and in the prevention of postpartum hemorrhage. J Matern Fetal Neonatal Med 2017; 31:128-134. [PMID: 28140705 DOI: 10.1080/14767058.2016.1277699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Explore the effect of the multifunctional airbag abdominal pressure belt on midwifery and on the prevention of postpartum hemorrhage. METHODS Select 363 natural delivery cases of hospitalized primiparae and divide them randomly into two groups. In the observation group, 182 primiparae used the multifunctional airbag abdominal pressure belt during the second and third stages of labor, whereas the control group of 181 did not use the belt. Delivery outcomes of the primiparae and their fetus were then observed. RESULTS The average duration for the second stage of labor, from head emergence to delivery, placenta delivery and postpartum hemorrhage were all shorter in the observation group (p < 0.01). There was no statistical difference in episiotomy rate, maternal signs 2 h postpartum, neonatal Apgar score and neonatal cord blood gas analysis (p > 0.05). No statistical difference was found in primipara signs and no fetal heart rate change of the primiparae under different internal pressures of the belt during the second stage of labor in the observation group (p > 0.05). CONCLUSION By closely monitoring and appropriately adjusting the internal pressure of the belt, the multifunctional airbag abdominal pressure belt can speed up the second and third stages of labor, prevent postpartum hemorrhage and promote natural delivery.
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Affiliation(s)
- Shaofei Zhao
- a Guangdong Provincial Maternal and Child Health Hospital , Guangzhou , People's Republic of China
| | - Jiying Wen
- a Guangdong Provincial Maternal and Child Health Hospital , Guangzhou , People's Republic of China
| | - Jianmin Niu
- a Guangdong Provincial Maternal and Child Health Hospital , Guangzhou , People's Republic of China
| | - Jiaohong Xia
- a Guangdong Provincial Maternal and Child Health Hospital , Guangzhou , People's Republic of China
| | - Liping Zhou
- a Guangdong Provincial Maternal and Child Health Hospital , Guangzhou , People's Republic of China
| | - Wenxia Zou
- a Guangdong Provincial Maternal and Child Health Hospital , Guangzhou , People's Republic of China
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The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series. Obstet Gynecol Int 2016; 2016:5740534. [PMID: 27990163 PMCID: PMC5136389 DOI: 10.1155/2016/5740534] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/09/2016] [Accepted: 10/30/2016] [Indexed: 12/31/2022] Open
Abstract
Objective. To investigate whether the use of epidural analgesia during induced labour was a risk factor for instrumental vaginal delivery and caesarean section (CS) delivery. Study Design. This was a retrospective case series of primigravidae women being induced at term for all indications with a normal body mass index (BMI) at booking and under the age of 40 years. Results. We identified 1,046 women who fulfilled the inclusion criteria of which 31.2% had an epidural analgesia. Those with an epidural analgesia had significantly greater maternal age, higher BMI, greater percentage of oxytocin usage, and a longer first and second stage of labour. Women with an epidural analgesia had a higher instrumental delivery (37.9% versus 16.4%; p < 0.001) and CS delivery rate (26% versus 10.1%; p < 0.001). Multivariable analysis indicated that the use of an epidural was not a risk factor for a CS delivery but was a risk factor for an instrument-assisted delivery (adjusted OR = 3.63; 95% CI: 2.51–5.24; p < 0.001). Conclusion. Our study supports the literature evidence that the use of an epidural increases the instrumental delivery rates. It has also added that there is no effect on CS delivery and the observed increase is due to the presence of confounding factors.
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Djaković I, Sabolović Rudman S, Košec V. Effect of epidural analgesia on mode of delivery. Wien Med Wochenschr 2016; 167:390-394. [DOI: 10.1007/s10354-016-0511-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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French CA, Cong X, Chung KS. Labor Epidural Analgesia and Breastfeeding: A Systematic Review. J Hum Lact 2016; 32:507-20. [PMID: 27121239 DOI: 10.1177/0890334415623779] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
Despite widespread use of epidural analgesia during labor, no consensus has been reached among obstetric and anesthesia providers regarding its effects on breastfeeding. The purpose of this review was to examine the relationship between labor epidural analgesia and breastfeeding in the immediate postpartum period. PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature were searched for articles published in 1990 or thereafter, using the search term breastfeeding combined with epidural, labor epidural analgesia, labor analgesia, or epidural analgesia Of 117 articles, 23 described empirical studies specific to labor epidural analgesia and measured a breastfeeding outcome. Results were conflicting: 12 studies showed negative associations between epidural analgesia and breastfeeding success, 10 studies showed no effect, and 1 study showed a positive association. Most studies were observational. Of 3 randomized controlled studies, randomization methods were inadequate in 2 and not evaluable in 1. Other limitations were related to small sample size or inadequate study power; variation and lack of information regarding type and dosage of analgesia or use of other intrapartum interventions; differences in timing, definition, and method of assessing breastfeeding success; or failure to consider factors such as mothers' intention to breastfeed, social support, siblings, or the mother's need to return to work or school. It is also unclear to what extent results are mediated through effects on infant neurobehavior, maternal fever, oxytocin release, duration of labor, and need for instrumental delivery. Clinician awareness of factors affecting breastfeeding can help identify women at risk for breastfeeding difficulties in order to target support and resources effectively.
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Affiliation(s)
- Cynthia A French
- Columbia University, Graduate Program in Nurse Anesthesia, New York, NY, USA Yale New Haven Hospital, New Haven, CT, USA
| | - Xiaomei Cong
- University of Connecticut, School of Nursing, Storrs, CT, USA
| | - Keun Sam Chung
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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Zondag DC, Gross MM, Grylka-Baeschlin S, Poat A, Petersen A. The dynamics of epidural and opioid analgesia during labour. Arch Gynecol Obstet 2016; 294:967-977. [DOI: 10.1007/s00404-016-4110-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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Dior UP, Kogan L, Eventov-Friedman S, Gil M, Bahar R, Ergaz Z, Porat S, Calderon-Margalit R. Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes. Neonatology 2016; 109:62-8. [PMID: 26536344 DOI: 10.1159/000440938] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrapartum fever is a well-known risk factor for adverse perinatal outcomes. Maternal intrapartum fever ≥39.0°C at term is a rare event during labor, and there is scarce evidence regarding its implications. OBJECTIVES To investigate the association between very high intrapartum maternal fever and perinatal outcomes in term pregnancies. METHODS A retrospective cohort analysis including 43,560 term, singleton live births in two medical centers between the years 2003 and 2011 was performed. We compared parturients who experienced a maximal intrapartum fever of <38.0°C with two subgroups of parturients who experienced respective maximal fevers of 38.0-38.9°C and ≥39°C. Adjusted risks for adverse perinatal outcomes were calculated by using multiple logistic regression models to control for confounders. RESULTS Compared with normal intrapartum temperature, intrapartum fever ≥39.0°C was associated with an extremely elevated risk for neonatal sepsis 16.08 (95% CI: 2.15, 120.3) as well as with low Apgar scores and neonatal intensive care unit admissions (p < 0.001). Additionally, very high intrapartum fever was related to significantly higher risk for operative delivery (p < 0.001). CONCLUSIONS Extremely elevated intrapartum fever is an important indicator of severe neonatal morbidity and operative delivery.
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Affiliation(s)
- Uri P Dior
- Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Lalooei A, Hashemi SR, Khosravi MH. Comparing the Effect of Painless Labor Methods on the Duration of Active Phase of Labor. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2015. [DOI: 10.17795/rijm30834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hung TH, Hsieh TT, Liu HP. Differential effects of epidural analgesia on modes of delivery and perinatal outcomes between nulliparous and multiparous women: a retrospective cohort study. PLoS One 2015; 10:e0120907. [PMID: 25807240 PMCID: PMC4373716 DOI: 10.1371/journal.pone.0120907] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/27/2015] [Indexed: 11/19/2022] Open
Abstract
Background Epidural analgesia is considered one of the most effective methods for pain relief during labor. However, it is not clear whether similar effects of epidural analgesia on the progression of labor, modes of delivery, and perinatal outcomes exist between nulliparous and multiparous women. Methodology/Principal Findings A retrospective cohort study was conducted to analyze all deliveries after 37 weeks of gestation, with the exclusion of pregnancies complicated by multiple gestations and fetal anomalies and deliveries without trials of labor; these criteria produced a study population of n=16,852. A multivariable logistic regression model was constructed to control for confounders. In total, 7260 of 10,175 (71.4%) nulliparous and 2987 of 6677 (44.7%) multiparous parturients were administered epidural analgesia. The independent factors for intrapartum epidural analgesia included a low prepregnancy body mass index, genetic amniocentesis, group B streptococcal colonization of the genito-rectal tract, and augmentation and induction of labor. In the nulliparous women, epidural analgesia was a significant risk factor for operative vaginal delivery (adjusted odds ratio [OR] 2.14, 95% confidence interval [CI] 1.80-2.54); however, it was a protective factor against Caesarean delivery (adjusted OR 0.62, 95% CI 0.55-0.69). Epidural analgesia remained a significant risk factor for operative vaginal delivery (adjusted OR 2.17, 95% CI 1.58-2.97) but not for Caesarean delivery (adjusted OR 1.09, 95% CI 0.77-1.55) in the multiparous women. Furthermore, the women who were administered epidural analgesia during the trials of labor had similar rates of adverse perinatal outcomes compared with the women who were not administered epidural analgesia, except that a higher rate of 1-minute Apgar scores less than 7 was noted in the nulliparous women who were administered epidural analgesia. Conclusions/Significance Intrapartum epidural analgesia has differential effects on the modes of delivery between nulliparous and multiparous women, and it is not associated with adverse perinatal outcomes.
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Affiliation(s)
- Tai-Ho Hung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - T’sang-T’ang Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Hung-Pin Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
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Rimaitis K, Klimenko O, Rimaitis M, Morkūnaitė A, Macas A. Labor epidural analgesia and the incidence of instrumental assisted delivery. MEDICINA-LITHUANIA 2015; 51:76-80. [PMID: 25975875 DOI: 10.1016/j.medici.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the influence of labor epidural analgesia on the course of labor and to determine its association with instrumental assisted delivery rate. MATERIALS AND METHODS A retrospective case-control study was performed during 2007-2011 aiming to identify the relation between epidural analgesia (EA) and instrumental assisted delivery (IAD) rate. All patients in whom instrumental assistance for delivery was applied were allocated into either case (parturients who received EA and had IAD) or control (parturients who did not receive EA but had IAD) groups. Maternal demographic data, pregnancy and delivery characteristics as well as neonatal short-term outcome were studied. RESULTS A total of 7675 vaginal deliveries occurred during the study period and 187 (2.43%) patients had IAD. Vacuum extraction was applied to 67 (2.16%) parturients who received EA, and to 120 (2.61%) who did not. The median duration of the first stage of labor was 510 min in the EA group as compared to 390 min in the control group (P=0.001). The median duration of the second stage of labor among cases and controls was 60 and 40 min, respectively (P<0.0005). Cases more often had their labor induced by oxytocin 80.3% as compared to 58.3% among controls (P=0.003). There was no significant association between the use of EA and increased IAD rate (OR=0.81; 95% CI, 0.60-1.09). CONCLUSIONS Labor EA did not increase the incidence of IAD and the risk of adverse neonatal outcomes, but was associated with prolonged first and second stages of labor.
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Affiliation(s)
- Kęstutis Rimaitis
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Olga Klimenko
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Marius Rimaitis
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Andrius Macas
- Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Update on best available options in obstetrics anaesthesia: perinatal outcomes, side effects and maternal satisfaction. Fifteen years systematic literature review. Arch Gynecol Obstet 2014; 290:21-34. [PMID: 24659334 DOI: 10.1007/s00404-014-3212-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/04/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE In modern obstetrics, different pharmacological and non-pharmacological options allow to obtain pain relief during labour, one of the most important goals in women satisfaction about medical care. The aim of this review is to compare all the analgesia administration schemes in terms of effectiveness in pain relief, length of labour, mode of delivery, side effects and neonatal outcomes. METHODS A systematic literature search was conducted in electronic databases in the interval time between January 1999 and March 2013. Key search terms included: “labour analgesia”, “epidural anaesthesia during labour” (excluding anaesthesia for Caesarean section), “epidural analgesia and labour outcome” and “intra-thecal analgesia”. RESULTS 10,331 patients were analysed: 5,578 patients underwent Epidural-Analgesia, 259 patients spinal analgesia, 2,724 combined spinal epidural analgesia, 322 continuous epidural infusion (CEI), 168 intermittent epidural bolus, 684 patient-controlled infusion epidural analgesia and 152 intra-venous patient-controlled epidural analgesia. We also considered 341 women who underwent patient-controlled infusion epidural analgesia in association with CEI and 103 patients who underwent patient-controlled infusion epidural analgesia in association with automatic mandatory bolus. CONCLUSION No significant differences occurred among all the available administration schemes of neuraxial analgesia. In absence of obstetrical contraindication, neuraxial analgesia has to be considered as the gold standard in obtaining maternal pain relief during labour. The options available in the administration of analgesia should be known and evaluated together by both gynaecologists and anaesthesiologists to choose the best personalized scheme and obtain the best women satisfaction. Since it is difficult to identify comparable circumstances during labour, it is complicate to standardize drugs schemes and their combinations.
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Abstract
Obstetric anesthesia has become a widely evidence-based practice, with an increasing number of specialized anesthesiologists and a permanent research production. We believe that with the review of commonly discussed and controversial points the reader will be able to incorporate an evidence-based practice into their routine and offer to parturients and their babies a safe, reliable and consistent anesthesia care.
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