1
|
Ji C, Zhao J, Nie Q, Wang S. The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials. J Psychosom Obstet Gynaecol 2024; 45:2291635. [PMID: 38146963 DOI: 10.1080/0167482x.2023.2291635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION The abundant functions of music and its effects on human's mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention. OBJECTIVE This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women. METHOD A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study. RESULT The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations. CONCLUSION Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.
Collapse
Affiliation(s)
- Chao Ji
- Department of Obstetrics, Qingdao Municipal Hospital, Qingdao, China
| | - Jing Zhao
- Department of Obstetrics, Qingdao Municipal Hospital, Qingdao, China
| | - Qiaole Nie
- Musical anesthesia, Beijing Yuedi Music Analgesia Labor Institute, China
| | - Shuo Wang
- Labor Union, Qingdao Women and Children's Hospital, Qingdao, China
| |
Collapse
|
2
|
Azeze GA, Asgedom YS, Efa AG, Haile KE, Woldegeorgis BZ, Gebeyehu NA, Gebrekidan AY, Kassie GA, Lombebo AA. Labor pain management practices and associated factors in Ethiopia: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 166:204-213. [PMID: 38009592 DOI: 10.1002/ijgo.15276] [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: 07/20/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The pain that women experience during labor and childbirth is the central feature of parturition in humans. Despite improvement in the development of standards for pain assessment and treatment, labor pain is mostly ignored especially in low- and middle-income countries resulting in unmeasured suffering from childbirth for mothers. OBJECTIVES We aimed to provide a comprehensive estimation of the pooled magnitude and associated factors of labor pain management practices in Ethiopian public health facilities. SEARCH STRATEGY A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Electronic databases including Google Scholar, Web of Science, Excerpta Medica Database (EMBASE), PubMed/MEDLINE, and Scopus were searched from database inception to June 30, 2023. SELECTION CRITERIA The inclusion criteria were established prior to article review and follows the population, intervention, comparison and outcome criterions. DATA COLLECTION AND ANALYSIS We evaluated publication bias by means of funnel plots and Egger's test. Heterogeneity between studies was assessed using I2 statistics. For each associated factors in meta-regressions, the pooled odds ratio (OR) and its 95% confidence interval (CI) were extracted. A P value of 0.05 was used to determine the significance of the small study effect. MAIN RESULTS Our search terms yielded 17 studies with 5735 participants. The pooled prevalence of labor pain management practices in Ethiopia was 45.73% (95% CI: 39.13, 52.32; I2 = 96.4). Having adequate knowledge regarding labor pain management (OR: 3.74; 95% CI: 2.74, 5.11; I2 = 53.8%), a favorable attitude toward labor pain management (OR: 2.90; 95% CI: 2.03, 4.14; I2 = 63.8%), availability of labor analgesics (OR: 3.23; 95% CI: 2.18, 4.79; I2 = 46.2%), and clinical experience of 10 or more years (OR: 3.45; 95% CI: 2.06, 5.78; I2 = 19.0%) were factors that were statistically associated with the use of labor pain management practices. CONCLUSION We concluded that the routine practices of labor pain management by obstetric health providers in Ethiopia are still low. Therefore, it remains important to call for holistic and inclusive interventions targeting maternity health providers and hospital officials to update their long-standing practices. REGISTRATION Registered in PROSPERO under protocol number CRD42023429140.
Collapse
Affiliation(s)
- Gedion Asnake Azeze
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amelework Gonfa Efa
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu Haile
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Beshada Zerfu Woldegeorgis
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
3
|
Videbech P. Kan vi optimere smertelindring under fødsel? Ugeskr Laeger 2024; 186:V205168. [PMID: 38808761 DOI: 10.61409/v205168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Poul Videbech
- Center for Neuropsykiatrisk Depressionsforskning, Psykiatrisk Center Glostrup
| |
Collapse
|
4
|
Wootton SH, Rysavy M, Davis P, Thio M, Romero-Lopez M, Holzapfel LF, Thrasher T, Wade JD, Owen L. Practical approaches for supporting informed consent in neonatal clinical trials. Acta Paediatr 2024; 113:923-930. [PMID: 38389165 PMCID: PMC11006570 DOI: 10.1111/apa.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
The survival and health of preterm and critically ill infants have markedly improved over the past 50 years, supported by well-conducted neonatal research. However, newborn research is difficult to undertake for many reasons, and obtaining informed consent for research in this population presents several unique ethical and logistical challenges. In this article, we explore methods to facilitate the consent process, including the role of checklists to support meaningful informed consent for neonatal clinical trials. CONCLUSION: The authors provide practical guidance on the design and implementation of an effective consent checklist tailored for use in neonatal clinical research.
Collapse
Affiliation(s)
- Susan H. Wootton
- Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Matthew Rysavy
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Peter Davis
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Marta Thio
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Gandel Simulation Service, Royal Women's Hospital, Melbourne, Australia
| | - Mar Romero-Lopez
- Institute for Clinical Research and Learning Health Care, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Lindsay F. Holzapfel
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Tamara Thrasher
- Children's Memorial Hermann Hospital, Houston, Texas, USA
- March of Dimes NICU Family Support Program, Houston, Texas, USA
| | - Jaleesa D. Wade
- Division of Neonatology, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Louise Owen
- Newborn Research, Neonatal Services, Royal Women's Hospital, Melbourne, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
5
|
Germeshausen K, Linzbach A, Zöllkau J, Heimann Y, Schleussner E, Groten T, Weschenfelder F. SPAM-sub partual analgesia with meptazinol: a prospective cohort study comparing intramuscular with intravenous administration. Arch Gynecol Obstet 2024; 309:1873-1881. [PMID: 37160471 PMCID: PMC11018690 DOI: 10.1007/s00404-023-07056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Safe and effective analgesia sub partu is one of the central issues in optimizing vaginal delivery birth experiences. Meptazinol is a common opiate approved for treating labor pain in the first stage of labor. According to the manufacturer, manual meptazinol can be applied intramuscularly or intravenously. The aim of this study was to compare the two application methods in terms of efficacy in pain relief, occurrence of side effects and treatment satisfaction. METHODS 132 patients with singleton term pregnancies and intended vaginal delivery, receiving meptazinol during first stage of labor were included in this prospective cohort study from 05/2020 to 01/2021. We evaluated effectiveness in pain relief and treatment satisfaction using numeric rating scales (NRS) and documented the occurrence of adverse effects. Chi-square test or Fisher exact test were used to compare categorical data and Mann-Whitney U test to compare continuous data between the two treatment groups. Statistical analysis was done by SPSS 27.0. A p value < 0.05 was considered to indicate statistical significance (two tailed). RESULTS Meptazinol decreased labor pain significantly from a NRS of 8 (IQR 8-10) to 6 (IQR 4.75-8) in both treatment groups with no difference in effectiveness between the groups. Frequency of effective pain reduction of a decrease of 2 or more on the NRS did not differ between groups (39.4% vs 54.5%, p = 0.116), as the occurrence of adverse effects. 12% of the newborns were admitted to NICU, the median NApH was 7.195. CONCLUSION Meptazinol significantly reduces labor pain regardless of the method of application: intramuscular or intravenous. According to our data, no preferable route could be identified. The comparably poorer perinatal outcome in our study cohort hinders us to confirm that meptazinol is safe and can be recommended without restrictions.
Collapse
Affiliation(s)
| | - Aissa Linzbach
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Janine Zöllkau
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Schleussner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | | |
Collapse
|
6
|
Parkies LE, Murray D, Okafor UB. Pharmacological labour pain interventions: South African midwives' perspective. BMC Nurs 2024; 23:176. [PMID: 38486184 PMCID: PMC10938825 DOI: 10.1186/s12912-024-01844-w] [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: 12/17/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives' perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch's open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician's prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives' ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.
Collapse
Affiliation(s)
- L E Parkies
- Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa
| | - D Murray
- Department of Public Health, University of Fort Hare, 5 Oxford Street, 5201, East London, South Africa
| | - U B Okafor
- Faculty of Health Sciences, University of Fort Hare, 5 Oxford Street, 5201, East London, South Africa.
| |
Collapse
|
7
|
Yu M, Qian H, Gan M. Comparison of different interventions for the reduction of labor pain: A systematic review and network meta-analysis. Medicine (Baltimore) 2024; 103:e37047. [PMID: 38457589 PMCID: PMC10919462 DOI: 10.1097/md.0000000000037047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE This systematic review and network meta-analysis were performed to compare different interventions for the reduction of labor pain. METHODS PubMed, Embase, Cochrane Library, Web of Science and ScienceDirect databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to January, 2023. Interventions including electrical acupoint stimulation (TEAS), epidural analgesia (EA) and control treatments. The primary outcomes included pain scores, failure rate of natural delivery, adverse events and Apgar scores. The methodological quality was assessed by the Cochrane risk of bias tool. Meta-analysis was performed by R software with gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the intervention. RESULTS Twelve studies met the inclusion criteria and were included in the network meta-analysis. TEAS (WMD -3.1, 95% CrI -3.8, -2.5) and EA (WMD -2.1, 95% CrI -2.8, -1.3) was more effective than the control in decreasing VAS. TEAS ranked first (SUCRA, 90.9%), EA ranked second (SUCRA, 74.0%) and control ranked last (SUCRA, 35.0%) for reducing VAS. For patients with labor pain, with respect to the most effective treatment for reducing failure rate of natural delivery, TEAS ranked first (SUCRA, 96.6%), EA ranked second (SUCRA, 50.4%) and control ranked last (SUCRA, 3.0%). With regard to the Apgar scores, there was high probability that TEAS ranked first (SUCRA, 80.7%), compared to control (SUCRA, 41.4%) and EA (SUCRA 27.9%). With regard to the adverse events, there was high probability that TEAS ranked first (SUCRA, 99.9%), compared to control (SUCRA, 33.2%) and EA (SUCRA 17.6%). CONCLUSION TEAS has the potential to serve as a viable alternative for women in labor, offering a simple, noninvasive, and non-pharmacological intervention that surpasses EA in terms of both analgesic effectiveness and safety for both mothers and neonates.
Collapse
Affiliation(s)
- Mengxian Yu
- Anesthesiology Department, Chongqing KangHuaZhongLian Cardiovascular Hospital, Chongqing, China
| | - Haiyan Qian
- Anesthesiology Department, Chongqing KangHuaZhongLian Cardiovascular Hospital, Chongqing, China
| | - Miao Gan
- Anesthesiology Department, Chongqing KangHuaZhongLian Cardiovascular Hospital, Chongqing, China
| |
Collapse
|
8
|
Yang JM, Li ZQ, Ye H, Wu YL, Long Y, Zhong YB, Luo Y, Wang MY. Effects of foot reflexology massage on pregnant women: a systematic review and meta-analysis of randomized controlled studies. Sci Rep 2024; 14:1012. [PMID: 38200035 PMCID: PMC10781947 DOI: 10.1038/s41598-023-51107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
To explore the effects of foot reflexology massage on anxiety, pain, duration of labor, labor satisfaction, blood pressure, pulse rate and respiratory rate in pregnant women. We systematically searched eight databases for randomized controlled studies on the effects of foot reflexology massage on pregnant women. The inclusion criteria were as follow: participants were pregnant woman; the intervention is foot reflexology or foot massage; the control intervention is placebo, usual care, or no intervention; outcome indicators included pain, anxiety, birth satisfaction, duration of labor, blood pressure, pulse, and respiration; and study type was randomized controlled study. Studies that did not meet the above requirements were excluded. We assessed the quality of the included studies using the Physiotherapy Evidence Database scale, the risk of bias using the Risk of Bias 2.0 tool, and the level of evidence for the outcomes using the Grading of Recommendations Assessment Development and Evaluation. We used Review Manager 5.3 for data analysis and generated funnel plots to assess publication bias. In addition, sensitivity analysis was used to test the stability of the results. A total of 13 randomized controlled studies with 1189 participants were included in this study. Compared to the control group, foot reflexology massage reduced anxiety and pain in pregnant women, shortened the three stages of labor, and increased birth satisfaction. In addition, it also reduced the pulse rate and respiratory rate of pregnant women, but not for blood pressure. Foot reflexology massage can significantly reduce anxiety and pain, shorten the duration of labor, increase birth satisfaction, and stabilize vital signs in pregnant women. It is a safe and non-invasive form of complementary therapy.PROSPERO registered number: CRD42022359641. URL: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=359641 .
Collapse
Affiliation(s)
- Jia-Ming Yang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Ze-Qin Li
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Hua Ye
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Yan-Lin Wu
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Yi Long
- School of Rehabilitation Medicine, Gannan Medical University, Ganzhou, China
| | - Yan-Biao Zhong
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China
- Ganzhou Intelligent Rehabilitation Technology Innovation Center, Ganzhou, China
| | - Yun Luo
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China
| | - Mao-Yuan Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou, 341000, Jiangxi, China.
- Ganzhou Key Laboratory of Rehabilitation Medicine, Ganzhou, China.
| |
Collapse
|
9
|
Zhang D, Sun Y, Li J. Application of Dexmedetomidine in Epidural Labor Analgesia: A Systematic Review and Meta-Analysis on Randomized Controlled Trials. Clin J Pain 2024; 40:57-65. [PMID: 37855310 PMCID: PMC10712998 DOI: 10.1097/ajp.0000000000001166] [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: 02/24/2023] [Revised: 09/16/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To summarize and appraise the use of dexmedetomidine in epidural labor analgesia, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We conducted the literature search about the RCTs of epidural labor analgesia with or without dexmedetomidine from inception until November 1, 2022, in the following databases: PubMed, Cochrane Library, and Embase. The primary outcome was visual analog scale (VAS) within 2 hours after epidural intubation. The secondary outcomes included the duration of the first and second labor stages, Apgar score, umbilical blood pH, dosage of analgesics, and side effects. RESULTS Eight RCTs including 846 parturients were included. The VAS score of the dexmedetomidine group was significantly lower than that of the control group at the time of 15 minutes (mean difference [MD] -1.41, 95% confidence interval [CI] -2.23, -0.59), 30 minutes (MD -1.02, 95% CI -1.70, -0.33), 60 minutes (MD -0.90, 95% CI -1.36, -0.44), and 90 minutes (MD -0.70, 95% CI -1.16, -0.23). The incidence of pruritus in the dexmedetomidine group was lower than that of the control group (MD 0.28, 95% CI 0.11, 0.74), but the incidence of maternal bradycardia was higher (MD 6.41, 95% CI 1.64, 25.04). There were no significant difference in other outcomes. DISCUSSION Dexmedetomidine combined with local anesthetic for epidural labor analgesia can improve the VAS score of parturients. Except for the increased incidence of maternal bradycardia, it seems to be safe for the parturients and fetuses.
Collapse
Affiliation(s)
- Di Zhang
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Yanxia Sun
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Junfeng Li
- Department of Anesthesiology, Beijing Hospital, National Center of Gerontology
- Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P.R. China
| |
Collapse
|
10
|
Yang J, Li X. A Qualitative Study on Postpartum Women Experienced Various Pain Throughout the Perinatal Period Based on the Thrive Model. Patient Prefer Adherence 2023; 17:3577-3587. [PMID: 38164225 PMCID: PMC10758158 DOI: 10.2147/ppa.s437901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Aim This study aims to thoroughly explore to comprehensively examine the diverse types and subjective experiences of pain in postpartum women throughout perinatal period, aiming to deepen understanding and support the development of precise pain management strategies in nursing care. Design A descriptive qualitative study. Methods Between August and November 2022, postpartum women attending outpatient clinics at a tertiary level A hospital were selected as participants. The study followed the framework of the THRIVE model and utilized a phenomenological method for qualitative research. In-depth semi-structured interviews were conducted with 21 postpartum women, and the data were analyzed using the Colaizzi 7-step analysis method. Results Thematic analysis revealed that different postpartum women exhibited diverse perceptions of their own pain experiences. Three themes were identified to describe the pain encountered by postpartum women: (1) Experiencing pain is complex (including experiencing multiple kinds of pain, individual differences in pain, and pain is variable), (2) Double perceptions of pain (negative effects of pain and positive energy for perceiving pain), and (3) Fighting pain requires active support (active outside support and construct a positive self-coping style). Conclusion This study provides a comprehensive overview of perinatal pain management in postpartum women, offering recommendations for accurate pain understanding and management. Healthcare professionals should be vigilant about maternal pain changes and individual experiences, implement targeted measures and support, aid in alleviating psychological burdens, boost maternal confidence in childbirth, and enhance postpartum quality of life. Patient or Public Contribution In this study, interviews were conducted in the hospital outpatient department, and the participants included in this study participated in the interviews to provide support for the implementation of this subject.
Collapse
Affiliation(s)
- Jie Yang
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Nursing, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xue Li
- Department of Nursing, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| |
Collapse
|
11
|
Hu X, Xiong D, Luo M, Ling C, Liu X, Yang K, Wen X. Retrospective analysis on the efficacy of epidural labor analgesia on early breast feeding after vaginal delivery. BMC Anesthesiol 2023; 23:413. [PMID: 38097947 PMCID: PMC10720227 DOI: 10.1186/s12871-023-02373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Breastfeeding is essential for infants and mothers. Epidural labor analgesia is used frequently to alleviate pain during vaginal delivery. Studies have found that epidural labor analgesia potentially have negative effects on postpartum breastfeeding. However, the efficacy of epidural labor analgesia on early breastfeeding after vaginal delivery is unclear. Therefore, a retrospective analysis was performed to illuminate the efficacy of epidural labor analgesia on postpartum breast feeding. METHODS A total of 392 women who received vaginal delivery in the Second People's Hospital of Foshan from July 2022 to June 2023 were selected for this study, and all women received epidural labor analgesia and were divided into three groups according to the efficacy of labor analgesia. There were three groups: parturients with VAS scores < 3 were divided into Group E (n = 192), parturients with VAS scores 4-6 were divided into Group M (n = 127), and parturients with VAS scores > 7 were divided into Group P (n = 73). The labor process, lactation initiation time, and incidence of delayed onset of lactation were analyzed. The lactation volume and time and LATCH score at 24, 48 and 72 h after vaginal delivery were also analyzed. RESULTS There was no significant difference in labor process times among the three groups (P > 0.05). The cases of prolactin use in Group M were less than those in Group E and Group P, with a significant difference (all P < 0.05). There was no significant difference in cases of prolactin use between Group E and Group P (P > 0.05). The lactation initiation time in Group M was significantly shorter than those in Group E and Group P (all P>0.05). There was no significant difference in lactation initiation time after vaginal delivery between Group E and Group P (P>0.05). The incidence of delayed onset of lactation in Group M was significantly lower those that in Group E and Group P (all P < 0.05). There was no statistically significant difference in the incidence of delayed onset of lactation between Group E and Group P (P > 0.05). The lactation volumes at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P < 0.05). There was no significant difference in lactation volume at 24, 48 and 72 h after vaginal delivery between Group E and Group P (P > 0.05). The lactation times at 24, 48 and 72 h after vaginal delivery in Group M were significantly higher than those in Group E and Group P (all P < 0.05). There was no significant difference in lactation times at 24, 48 and 72 h after vaginal delivery between Group E and Group P (P > 0.05). There was no significant difference in LATCH scores at 24, 48 and 72 h after vaginal delivery among the three groups (all P > 0.05). CONCLUSIONS Compared with labor analgesia with excellent and poor analgesia efficacy, labor analgesia with moderate analgesia efficacy has fewer cases of prolactin use, more lactation volume and time, a shorter lactation initiation time, a lower incidence of delayed onset of lactation and no effect on the LATCH score of breastfeeding.
Collapse
Affiliation(s)
- Xudong Hu
- Department of Anesthesiology, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000
| | - Dongqin Xiong
- Department of Obstetrics, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000
| | - Meifang Luo
- Department of Obstetrics, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000
| | - Chen Ling
- Department of Anesthesiology, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000
| | - Xingqing Liu
- Department of Anesthesiology, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000
| | - Kai Yang
- Department of Anesthesiology, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000
| | - Xianjie Wen
- Department of Anesthesiology, The Second People's Hospital of Foshan, Weiguo Road NO78, Destrict of Chancheng, Foshan City, Guangdong Province, China, 528000.
| |
Collapse
|
12
|
Hunter AR, Heiderscheit A, Galbally M, Gravina D, Mutwalli H, Himmerich H. The Effects of Music-Based Interventions for Pain and Anxiety Management during Vaginal Labour and Caesarean Delivery: A Systematic Review and Narrative Synthesis of Randomised Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7120. [PMID: 38063550 PMCID: PMC10706633 DOI: 10.3390/ijerph20237120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/04/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023]
Abstract
Music-based interventions are not physically invasive, they usually have minimal side effects, and they are increasingly being implemented during the birthing process for pain and anxiety relief. The aim of this systematic review is to summarise and evaluate published, randomised controlled trials (RCTs) assessing the effects of music-based interventions for pain and anxiety management during vaginal labour and caesarean delivery. Following the PRISMA guidelines, a systematic search of the literature was conducted using: PsychInfo (Ovid), PubMed, and Web of Science. Studies were included in the review if they were RCTs that assessed the effects of music on pain and anxiety during vaginal and caesarean delivery by human mothers. A narrative synthesis was conducted on 28 identified studies with a total of 2835 participants. Most, but not all, of the included studies assessing music-based interventions resulted in reduced anxiety and pain during vaginal and caesarean delivery. Music as part of a comprehensive treatment strategy, participant-selected music, music coupled with another therapy, and relaxing/instrumental music was specifically useful for reducing light to moderate pain and anxiety. Music-based interventions show promising effects in mitigating pain and anxiety in women during labour. However, the long-term effects of these interventions are unclear.
Collapse
Affiliation(s)
- Amy Rose Hunter
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Mental Health Studies Programme, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AB, UK
| | - Annie Heiderscheit
- Cambridge Institute for Music Therapy Research, Anglia Ruskin University, Cambridge CB1 2LZ, UK
| | - Megan Galbally
- School of Clinical Sciences, Department of Psychiatry, Monash University, Clayton, VIC 3168, Australia
| | - Davide Gravina
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy
| | - Hiba Mutwalli
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK
| |
Collapse
|
13
|
Nori W, Kassim MAK, Helmi ZR, Pantazi AC, Brezeanu D, Brezeanu AM, Penciu RC, Serbanescu L. Non-Pharmacological Pain Management in Labor: A Systematic Review. J Clin Med 2023; 12:7203. [PMID: 38068274 PMCID: PMC10707619 DOI: 10.3390/jcm12237203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 04/22/2024] Open
Abstract
Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.
Collapse
Affiliation(s)
- Wassan Nori
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Mustafa Ali Kassim Kassim
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Zeena Raad Helmi
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Alexandru Cosmin Pantazi
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Dragos Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ana Maria Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Roxana Cleopatra Penciu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Lucian Serbanescu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| |
Collapse
|
14
|
Bohsas H, Alibrahim H, Swed S, Abouainain Y, Nasif MN, Jawish N, Almarja MB, Aldarwish S, Ghareeb C, Sawaf B, Hafez W. Knowledge, attitudes and intentions of the Syrian pregnant women toward labour analgesia, and its associated factors: a cross sectional study in Syria (2022). BMC Health Serv Res 2023; 23:1229. [PMID: 37946222 PMCID: PMC10636948 DOI: 10.1186/s12913-023-10268-2] [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: 12/11/2022] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND During the reproductive period among pregnant women, the worst pain a woman can experience is labour pain. Untreated labour pain has many detrimental effects on the mother and the fetus. Then, the inadequate levels of awareness and attitudes toward labour analgesia among pregnant women are considered a serious concern that influences no-healthy results for both the mother and the baby. Therefore, this research aimed to define the degree of Awareness, Attitude, and intent to use labour analgesia among pregnant women in Syria. METHODS We conducted a cross-sectional study from 7 September to 23 October 2022, in which we included Pregnant Syrian women aged 18 and above. The questionnaire was based on a prior study that included verified and validated scales, which consisted of 23 questions separated into four sections. The sample size was calculated using Fisher's formula; however, our study included 638 participants. The data was analyzed using IBM SPSS Version 28.0, using descriptive and binary logistic regression methods. RESULTS Among those who had previous deliveries, 39.4% performed a caesarian delivery, and only 1.9% had a delivery at home. Nearly half of the study participants (50.4%) reported adequate knowledge about analgesia for obstetric pain. The inquired pregnant women who had children had more odds of knowledge than participants who had not. Respondents who were childbearing at the health center were more likely to have a good attitude (Adjusted Odds ratio = 4.728, P-value < 0.05, 95%CI: 1.035-21.589) than those who were childbearing at a national referral hospital. Also, the respondents above 31 years were less likely to desire labour analgesia than those aged 18-24. CONCLUSION Our results revealed that Syrian pregnant women have a moderated awareness, attitudes, and desire regarding labour analgesia, indicating a serious health problem among this population group. It is recommended that local and global health organizations address the current condition relevant to this issue by implementing healthy educational programmes for Syrian women through coordination with obstetric and gynaecological professionals.
Collapse
Affiliation(s)
| | | | - Sarya Swed
- Faculty of medicine, Aleppo University, Aleppo, Syria.
| | | | | | - Nagham Jawish
- Damascus university Faculty of medicine, Damascus, Syria
| | | | - Sara Aldarwish
- Damascus university Faculty of medicine, Damascus, Syria
| | - Carol Ghareeb
- Damascus university Faculty of medicine, Damascus, Syria
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wael Hafez
- NMC Royal Hospital, 16th Street, Khalifa City, Abu Dhabi, UAE
- Medical Research Division, Department of Internal Medicine, The National Research Centre, Cairo, Egypt
| |
Collapse
|
15
|
Calineata M, Jennewein L, Neef V, Flinspach AN, Louwen F, Zacharowski K, Raimann FJ. Safety and Efficiency of Low-Dose Spinal Analgesia Compared to Epidural Analgesia in Treatment of Pain during Labour: A Case Control Study. J Clin Med 2023; 12:5770. [PMID: 37762712 PMCID: PMC10532051 DOI: 10.3390/jcm12185770] [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: 07/16/2023] [Revised: 08/23/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The epidural catheter for analgesia has been used for decades and has become the gold standard in pain therapy for pregnant women in labour. However, procedural parameters such as time to pain relief and duration to implementation pose hurdles for patients shortly before delivery. Low-dose spinal analgesia (LDSA) is an alternative procedure that was investigated in the study with regard to patient satisfaction and complication rates compared to epidural catheter. METHODS In a retrospective monocentric study, a total of 242 patients receiving low-dose spinal analgesia or epidural catheters were evaluated using propensity score matching. Subjective patient satisfaction as well as complication rates were primarily analysed. We hypothesise that LDSA is a safe procedure and provides a similar level of satisfaction compared with the epidural catheter. For this purpose, both procedures were performed according to in-house standards and the patients were interviewed afterwards. Patients who required surgical delivery were excluded to prevent bias. RESULTS The LDSA was rated on average as very good [1.09 ± 0.311 vs. 1.07 ± 0.431] in terms of satisfaction by the patients compared to the epidural catheter without showing a significant difference (p = 0.653). Complications were in the low single-digit non-significant range for both procedures [6 (5%) vs. 7 (6%); p = 0.776]. The evaluation showed more perineal tears I° and II° in the low-dose spinal analgesia group [I°: 28 (23%) vs. 3 (2%); p < 0.001-II°: 30 (25%) vs. 2 (2%); p < 0.001]. Neonatal parameters differed significantly only in umbilical cord base excess and umbilical cord venous pH [-5.40 vs. -6.40; p = 0.005]. CONCLUSIONS LDSA represents a low complication procedure for patients at the end of labour with a high satisfaction level. With the LDSA in the repertoire of pain relief during childbirth, it is possible to also achieve pain reduction for women with deliveries of high velocity without compromising patient satisfaction or perinatal morbidity.
Collapse
Affiliation(s)
- Martin Calineata
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Lukas Jennewein
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Vanessa Neef
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Armin Niklas Flinspach
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Frank Louwen
- Goethe University Frankfurt, University Hospital, Department of Gynaecology and Obstetrics, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Florian Jürgen Raimann
- Goethe University Frankfurt, University Hospital, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| |
Collapse
|
16
|
Ezezew M, Yehualaw A, Demsie DG. Assessment of availability and challenges of WHO recommended priority life-saving medicines for under five-year children in primary public health facilities of Amhara region. BMC Pediatr 2023; 23:395. [PMID: 37558993 PMCID: PMC10413804 DOI: 10.1186/s12887-023-04216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The world health organization (WHO) priority lifesaving medicines are medicines recommended for the prevention and treatment of leading causes of under-five morbidity and mortality. They should be available in all health systems and at all times. However, the availability of these medicines and its determinants is not well studied in Ethiopia in general and in primary public health facilities Amhara region in particular. OBJECTIVE The study aimed to assess the availability and challenges of the WHO-recommended priority lifesaving medicines for under-five children in primary public health facilities of the Amhara region. METHODS A cross-sectional study design was conducted from February to December 2020 in 98 health centers and 22 primary hospitals in the Amhara region, Ethiopia. Facilities were selected with a simple random sampling technique. The data were collected through a pretested and structured questionnaire. Binary logistic regression was used to identify predictors associated with availability of WHO-recommended priority lifesaving medicines for under-five children. RESULTS The availability of oral rehydration salt was high (82.5%) and the availability of vitamin A (47.5%), morphine tablet (13.3%), and artesunate rectal suppository (7.5%) were within low and very low WHO range respectively. Budget adequacy (AOR = 12.9 CI= (2.1-78.2)), periodic review of stock level ((AOR = 13.4,CI=(1.9-92.0)), training on integrated pharmaceutical logistic system ((AOR = 4.5,CI=(1.0-20.5)), inclusion of WHO priority under five children facility specific medicine list (AOR = 12.4,CI=(2.3-66.4)), lead time for EPSA(Ethiopia Pharmaceutical Supply Agency) procurement (AOR = 7.9,CI=(1.3-44.8)) were significantly associated with availability of all WHO priority lifesaving medicines for under- five children. CONCLUSION The average availability of WHO-recommended priority lifesaving medicines for under-five children was low. The habit of updating bincard and adoption of the life-saving medicine list were the independent predictors of medication availability.
Collapse
Affiliation(s)
| | - Adane Yehualaw
- College of Medicine and Health Sciences, Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia
| | - Desalegn Getnet Demsie
- College of Medicine and Health Sciences, Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia.
| |
Collapse
|
17
|
Mingote Á, Zamora Moreno E, García Díaz A, Chiara Graciani G, Elbal Sánchez C, Guadalix Sánchez C, Gutiérrez Martínez D, García-Fernández J, Fornet Ruiz I. 'Walking epidural': comparison of the analgesic efficacy of levobupivacaine 0.0625% + fentanyl 2mcg/mL versus ropivacaine 0.075% + fentanyl 2mcg/mL. BMC Anesthesiol 2023; 23:259. [PMID: 37528373 PMCID: PMC10392001 DOI: 10.1186/s12871-023-02222-w] [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: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Epidural infusion with low local anesthetic concentrations with opiates decrease the severity of the motor blockade associated. The present study aims to compare the analgesic efficacy and the motor blockade between two local anesthetic epidural infusions: levobupivacaine 0.0625% + fentanyl 2mcg/mL versus ropivacaine 0.075% + fentanyl 2mcg/mL. MATERIALS AND METHODS In a single-blind prospective randomized study, 60 laboring parturient had continuous epidural analgesia as follows: 30 of them received levobupivacaine 0.0625% + fentanyl 2mcg/mL and 30 of them received ropivacaine 0.075% + fentanyl 2mcg/mL and rates of infusion were adjusted to the height. Analgesic, motor blockade and satisfaction records were collected as well as maternal and neonate adverse events. RESULTS After 2 h of the catheter placement, patients who received levobupivacaine showed a mean VAS of 3.2 [1.8-4.6] versus 1.8 [1.2-2.5] (p = 0.05) in patients who received ropivacaine. In addition, patients who received levobupivacaine showed a punctuation in Bromage scale of 0.0 [0.0-1.0] versus 0.0 [0.0-0.0] (p = 0.04) in patients who received ropivacaine. Finally, the parturient who received levobupivacaine scored a mean satisfaction index of 8.1 [7.3-8.9] versus 9.3 [8.7-9.8] (p = 0.02) in those who received ropivacaine. We did not register maternal nor neonate adverse events. CONCLUSION Both infusions (levobupivacaine 0.0625% + fentanyl 2mcg/mL and ropivacaine 0.075% + fentanyl 2mcg/mL) are effective for labor analgesia. However, ropivacaine would present a better pharmacodynamic profile with less motor blockade and decreased need for analgesic rescue hence improving patient's satisfaction.
Collapse
Affiliation(s)
- Álvaro Mingote
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain.
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
| | - Eloísa Zamora Moreno
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| | - Andrés García Díaz
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| | - Guillermo Chiara Graciani
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| | - Carlos Elbal Sánchez
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| | - Cristina Guadalix Sánchez
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| | - Diego Gutiérrez Martínez
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| | - Javier García-Fernández
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Inocencia Fornet Ruiz
- Anesthesia, Critical Care Department and Pain Unit, Puerta de Hierro Universitary Hospital, Majadahonda. c/Manuel de Falla, 1, Madrid, 28222, Spain
| |
Collapse
|
18
|
Matthews L, Lim G. Analgesia in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:151-161. [PMID: 36822700 DOI: 10.1016/j.ogc.2022.10.016] [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] [Indexed: 02/25/2023]
Abstract
Pain management during labor and delivery is complex and must balance efficacy and toxicity to both the pregnant person and the fetus. There are numerous ways to achieve safe and effective analgesia and anesthesia during labor and delivery, including neuraxial and nonneuraxial techniques. This review describes important anesthetic considerations that should be made when formulating a pain management plan and an overview of common anesthesia-related complications encountered in the obstetric population.
Collapse
Affiliation(s)
- Leslie Matthews
- Department of Anesthesiology & Perioperative Medicine, Division of Obstetric & Women's Anesthesiology, University of Pittsburgh School of Medicine, 300 Halket Street Suite 3510, Pittsburgh, PA 15215, USA.
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, Division of Obstetric & Women's Anesthesiology, University of Pittsburgh School of Medicine, 300 Halket Street Suite 3510, Pittsburgh, PA 15215, USA; Department of Obstetrics Gynecology and Reproductive Sciences University of Pittsburgh School of Medicine, 300 Halket Street Suite 3510, Pittsburgh, PA 15215, USA
| |
Collapse
|
19
|
Rosvig L, Steffensen E, Brogaard L, Hvidman L, Kierkegaard O, Kjeldsen AC, Taastrøm K, Uldbjerg N, Lou S. Women and partners' experience of major postpartum haemorrhage: a qualitative study. BJOG 2023. [PMID: 36852514 DOI: 10.1111/1471-0528.17440] [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: 10/05/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To examine women and their partners' experience of major postpartum haemorrhage (PPH). DESIGN A qualitative interview study. SETTING Two Labour and Delivery Units in Denmark. POPULATION Women who experienced major PPH (≥1 litre within 2 hours after vaginal birth). METHODS Semi-structured interviews were conducted with 15 women and nine partners (nine joint interviews, six individual interviews). Interviews were analysed using thematic analysis. MAIN OUTCOME MEASURES A qualitative description of women and their partners' experiences. RESULTS Three major themes were identified. (1) 'From birth to emergency' included factors that increased concern in women and their partners, such as 'incomprehensible' medical terminology, a tense atmosphere, and alarm call. Transfer to the operating theatre was experienced as the most devastating part of major PPH. (2) 'Feeling safe during an emergency' described factors that supported the women and their partners' management of the situation such as brief explanations from a few healthcare professionals and reassurance that the healthcare professionals were in control of the situation. The pain was experienced as severe, but acceptable. (3) 'Family unity challenged' described how family bonding was supported by positioning the partner at the head of the bed and by keeping the baby on the woman's chest. CONCLUSIONS Several factors such as small gestures from healthcare professionals and appropriate organisation of the PPH can make a difference to the woman and her partner's experience of major PPH. Particularly, efforts that support family bonding are greatly valued by women and their partners.
Collapse
Affiliation(s)
- L Rosvig
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - E Steffensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - L Brogaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - L Hvidman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - O Kierkegaard
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark
| | - A C Kjeldsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - K Taastrøm
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - N Uldbjerg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - S Lou
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,DEFACTUM - Public Health & Health Services Research, Aarhus, Denmark
| |
Collapse
|
20
|
Yang M, Yang N, Yan Z, Tong Y, Zhao X, Gu C, Gao C, Yang Q. Application value of analgesia throughout labor and analgesia during the first stage of labor in women with pregnancy-induced hypertension. Technol Health Care 2023:THC220680. [PMID: 36806526 DOI: 10.3233/thc-220680] [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: 02/16/2023]
Abstract
BACKGROUND Effective analgesia is required to ensure maternal and neonatal safety. OBJECTIVE To compare the therapeutic effects of analgesia applied throughout labor and analgesia applied during the first stage of labor in women with pregnancy-induced hypertension (PIH). METHODS In this study, 120 puerperae with PIH who gave birth in our hospital were enrolled as the study participants and were randomized into two groups (n= 60 in each group) using a coin flip. Those who received analgesia throughout labor were enrolled in the observation group, and those administered analgesia during the first stage of labor were enrolled in the control group. The analgesic effects, changes in blood pressure during labor, and neonatal health were compared between the two groups. RESULTS Differences in visual analog scale (VAS) scores before analgesia, 10 min after analgesia, and full cervical dilation between the two groups were not statistically significant (P> 0.05 in all). The VAS scores of the puerperae in the observation group during forced breathing in the second stage of labor and fetal head expulsion were lower than those in the control group (P< 0.05 for both). The incidence of postpartum hemorrhage, forceps delivery, and antihypertensive treatment in the observation group was slightly lower than in the control group, but the differences were not statistically significant (P> 0.05). The rate of oxytocin treatment in puerperae in the observation group was significantly lower than in the control group (P< 0.05). The differences in base excess, arterial partial pressure of oxygen, partial pressure of carbon dioxide, and pH between the two groups of newborns were not statistically significant (P> 0.05 for all). Differences in changes in systolic and diastolic blood pressure between the two groups of puerperae were not statistically significant (P> 0.05 for both). Eclampsia did not occur during labor in either group. CONCLUSION For patients with PIH, the application of analgesia throughout labor had a positive analgesic effect, effectively controlling the changes in blood pressure and ensuring the health of newborns. This is worthy of widespread clinical application.
Collapse
Affiliation(s)
- Mo Yang
- Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China.,Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Na Yang
- Medical Department, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China.,Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Zhanqiu Yan
- Department of Anesthesiology, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Yan Tong
- Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Xiumei Zhao
- Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Chengmin Gu
- Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Caiyun Gao
- Neonatal Department, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| | - Qing Yang
- Department of Gynecology and Obstetrics, Qinhuangdao Maternal and Child Health Hospital, Qinhuangdao, Hebei, China
| |
Collapse
|
21
|
Preparation for Childbirth: Coping with the Fear of Childbirth. Healthcare (Basel) 2023; 11:healthcare11040480. [PMID: 36833013 PMCID: PMC9957067 DOI: 10.3390/healthcare11040480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Pregnancy is a vital event in a woman's life that involves not only important physical changes, but also psychological changes [...].
Collapse
|
22
|
Midthun KM, Nelson BN, Strathmann FG, Browne T, Logan BK. Analysis of umbilical cord tissue as an indicator of in utero exposure to toxic adulterating substances. Front Pediatr 2023; 11:1127020. [PMID: 37025298 PMCID: PMC10070803 DOI: 10.3389/fped.2023.1127020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/27/2023] [Indexed: 04/08/2023] Open
Abstract
In utero drug exposure is a significant public health threat to the well-being and normal development of the neonate. Recently, testing of umbilical cord tissue (UCT) has been employed to measure illicit drug exposure, as drugs used by the mother during the third trimester may be retained in the UCT. Focus has also been given to potential adverse health effects among drug users, resulting from exposure to pharmacologically active adulterants and cutting agents in the street drug supply. The in utero effects of these substances have not been well studied in humans, nor has their presence been demonstrated as a means for assessing adverse health effects in the neonate. Here, we describe the application of a novel test method to analyze UCT for the presence of more than 20 common adulterating/cutting substances via LC/Q-TOF. In total, 300 de-identified UCT samples were analyzed-all had previously tested positive for cocaine or opiates. Generally, the positivity rates of individual compounds were similar between the Cocaine and Opiates Subgroups, apart from levamisole, xylazine, dipyrone (metabolites), and promethazine. Many of the adulterants used in the street drug supply do have legitimate medicinal/therapeutic uses, including several of the compounds most frequently detected in this study. Caffeine and lidocaine were the most frequently identified compounds both individually (>70% each) and in combination with each other. Alternatively, levamisole, an adulterant with no legitimate therapeutic use, was present in 12% of cases. Importantly, this data demonstrates that the detection of traditional drugs of abuse may serve as indicators of potential in utero exposure to toxic adulterating substances during gestation. While there is cause for concern with respect to any unintentional drug exposure, illicit drug use during pregnancy, including uncontrolled dosing, poly-adulterant consumption, and the interactions of these drug mixtures, produces a significant public health threat to the neonate which warrants further study.
Collapse
Affiliation(s)
- Kari M. Midthun
- NMS Labs, Horsham, PA, United States
- Correspondence: Kari M. Midthun
| | | | | | - Thom Browne
- Colombo Plan Secretariat, Colombo, Sri Lanka
| | - Barry K. Logan
- NMS Labs, Horsham, PA, United States
- Center for Forensic Science Research and Education (CFSRE) at the Fredric Rieders Family Foundation, Willow Grove, PA, United States
| |
Collapse
|
23
|
Ge L, Zhang P, Kong L, Wang W, Tong Q, Fan Q, Han X. Comparison of Efficacy and Safety of Different Doses of Dexmedetomidine for Epidural Labor Analgesia. Emerg Med Int 2023; 2023:2358888. [PMID: 37057296 PMCID: PMC10089781 DOI: 10.1155/2023/2358888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/30/2023] [Accepted: 03/03/2023] [Indexed: 04/15/2023] Open
Abstract
Objective To explore the efficacy and safety of different doses of dexmedetomidine (DEX) for epidural labor analgesia (ELA). Methods From June 2021 to June 2022, 147 parturients who underwent ELA in our hospital were selected and divided into low- (0.5 μg/kg DEX), medium- (0.75 μg/kg DEX), and high-dose (1.0 μg/kg DEX) groups (n = 49 for each) according to the random number table method. The analgesic effect was assessed using the Ramsay sedation score and Visual Analogue Scale (VAS), and the labor duration, mean arterial pressure (MAP), and heart rate (HR) before and after analgesia, vaginal bleeding within 2 h postpartum, and delivery outcomes (the cesarean section conversion rate and the neonatal Apgar score) were statistically analyzed. Furthermore, the incidence of adverse reactions was calculated, and maternal satisfaction with delivery was investigated. Results After analgesia, the the Ramsay and labor duration were higher in the high-dose group than those in the low- and medium-dose groups, and the VAS scores was lowerin the high-dose group than those in the low- and medium-dose groups(P < 0.05), while no difference was identified among the three groups in terms of the cesarean section conversion rate and the neonatal Apgar score (P > 0.05). The high-dose group had the greatest fluctuations in MAP and HR levels before and after analgesia than the other two groups, with a higher incidence of adverse reactions (P < 0.05). Finally, the survey of delivery satisfaction showed no significant difference in delivery satisfaction among the three groups (P > 0.05). Conclusion DEX has excellent performance in ELA, which can effectively relieve the pain of puerperae and shorten the labor process. Among them, low-dose DEX has higher safety and is recommended as the first choice. Trial Registrations. This trial is registered with ML2021073.
Collapse
Affiliation(s)
- Liang Ge
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Peng Zhang
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Lingguo Kong
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Wei Wang
- The Reproductive Medicine Special Hospital of the 1st Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu 730000, China
| | - Qian Tong
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Quanlong Fan
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| | - Xudong Han
- Department of Anesthesiology, Gansu Provincial Maternity and Child-Care Hospital (Gansu Provincial Central Hospital), Lanzhou, Gansu 730050, China
| |
Collapse
|
24
|
Jiang T, Jiang S, Cui Y, Yang JP, Du YH, Li J, Pang B, Li B. Assessment of reporting quality in randomized controlled trials of acupuncture for labor pain. FRONTIERS IN PAIN RESEARCH 2022; 3:999162. [DOI: 10.3389/fpain.2022.999162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
ObjectiveTo evaluate the reporting quality of randomized controlled trials (RCTs) of acupuncture for labor pain, and to explore relevant factors for facilitating reporting transparency and integrity for future RCTs.MethodEight Chinese and English databases were systematically searched from their inception until August 31, 2021. General characteristics and methodological quality of the included reports were evaluated based on the CONSORT statement and the STRICTA guidelines. Descriptive statistical analysis was performed. Cohen's κ-statistics were calculated to assess the agreement of all items between two reviewers.ResultsA total of 84 RCTs were included. Based on the CONSORT statement, a positive reporting rate (greater than 80%) was evident for the items “trial design” “participants” “intervention” “outcomes” “numbers analyzed” and “generalizability”. The quality of reporting for the items “randomized in the title or abstract” “sample size” “allocation concealment” “implementation” “blinding” “recruitment” “ancillary analyses” “harms” “interpretation” “registration” and “protocol” was poor with positive rates less than 10%. Based on the STRICTA guidelines, the items “extent to which treatment varied” “number of needle insertions per subject per session” and “control or comparator interventions” had poor reporting quality with positive rates of less than 10%. Substantial agreement was observed for most items and excellent agreement for some items.ConclusionThe reporting quality of RCTs of acupuncture for labor pain is suboptimal generally. Rigorous adherence to the CONSORT statement and the STRICTA guidelines should be emphasized in future studies to improve the quality of acupuncture RCT reports.
Collapse
|
25
|
Zeng Y, Jiang T, Zheng YH, He WR, Wang XW, Wei H, Wang L, Liu ZR, Zhang XF, Yi C, Chen KM. Evaluation efficacy and safety of epidural analgesia in second-trimester induced labor: A single-center, prospective, non-randomized, controlled study. Medicine (Baltimore) 2022; 101:e30767. [PMID: 36197253 PMCID: PMC9509083 DOI: 10.1097/md.0000000000030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Second-trimester induced labor in pregnant women was often more likely to suffer from psychological and physiological double pain. However, the analgesic management received less attention, and the optimal analgesic mode for second-trimester induced labor had not been determined. Our objective was to evaluate the feasible of epidural analgesia (EA) in second-trimester induced labor. METHODS From January 2020 to December 2021, Primipara who planned to undergo second-trimester induced labor in the First Affiliated Hospital of Yangtze University were collected. The method of labor induction was oral mifepristone + amniotic cavity injection of Ethacridine Lactate. Based on whether or not patients received epidural analgesia, which were divided into EA group (30 cases) and non-EA (NEA) group (30 cases). The primary outcome were visual analog scale (VAS) score of pain and result of follow-up, the secondary outcomes included relative clinical parameter and labor duration. RESULTS Vaginal induction of labor was successful in both groups. There was no statistically significant difference in VAS of pain between the two groups before analgesia (P > .05), but the VAS of pain in the EA group was significantly lower than the NEA group (P < .05) after analgesia or at delivery. The following outcomes showed no statistical difference between two groups: labor duration, postpartum hemorrhage, hemorrhage ≥ 500 mL, intrapartum injury, second days hemoglobin, C-reactive protein, antibiotic therapy days, hospitalizations days, and placenta residue (P > .05). The median hospitalization costs of EA group was 4697.5 yuan, and NEA group was 3673 yuan, the difference was statistically significant (P < .001). No adverse events related to EA occurred during hospitalization, only 3 patients showed mild lumbago and back pain after follow-up to three months postpartum, which was significantly relieved after proper rest. CONCLUSION EA can significantly reduce the pain of parturients, which may be effective and safe in the second-trimester induced labor.
Collapse
Affiliation(s)
- Yong Zeng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Tao Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Ya-Hong Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Wen-Rong He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Xiao-Wen Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Hua Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Li Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Zu-Rong Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Xu-Feng Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Cunjian Yi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Ke-Ming Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
- *Correspondence: Ke-Ming Chen, 8 Hangkong Road, Shashi District, Jingzhou City, Hubei Province 434000, China (e-mail:)
| |
Collapse
|
26
|
Zuo R, Dang J, Zhuang J, Chen Q, Zhang J, Zheng H, Wang Z. The incidence of breakthrough pain of different programmed intermittent bolus volumes for labor epidural analgesia: a randomized controlled trial. Int J Obstet Anesth 2022; 51:103571. [DOI: 10.1016/j.ijoa.2022.103571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/27/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
|
27
|
Application Analysis of Multiacupoint Stimulation in Multimodal Labor Analgesia during the Whole Stage of Labor in Primipara. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5161562. [PMID: 35711500 PMCID: PMC9197660 DOI: 10.1155/2022/5161562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
Purpose To analyze the application value of multimodal analgesia (MMA) regimen of patient-controlled epidural analgesia (PCEA) combined with multiacupoint stimulation analgesia during the whole stage of labor analgesia in primipara. Methods 300 primiparas with natural delivery were selected. According to the different ways of labor analgesia, they were divided into the first stage of labor active period PCEA group (group A), the whole stage of labor PCEA group (group W), and the whole stage of labor PCEA combined with multiacupoint stimulation analgesia group (group WM). The effect of MMA during the whole-labor process on maternal and infant safety was evaluated. The specific observation indicators were as follows: visual analogue scale (VAS) scores before analgesia (T 0), at full opening of the uterus (T 1), at the end of the second stage of labor (T 2), and at the end of the third stage of labor (T 3); stress response indicators at T 0 and T 1: epinephrine (E), norepinephrine (NE), glucose (Glu), and β-endorphin (β-EP) levels; delivery time of each stage of labor; the Apgar score of newborns at 1 and 5 min after birth; indicators of umbilical artery blood gas analysis immediately after delivery: PH value, base excess (BE), partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2); incidence of postpartum depression (PPD) at 6 weeks after delivery. Results At T 1, T 2, and T 3, the VAS scores were lower in groups W and WM than in group A, and the VAS scores were lower in group WM than in group W (P < 0.05). At T 0, there was no significant difference in the comparison of E, NE, Glu, and β-EP levels among the three groups (P > 0.05). At T 1, the levels of E, NE, Glu, and β-EP were higher in the three groups than in the same group at T 0, the levels of E, NE, and Glu were lower, the levels of β-EP were higher in groups W and WM than in group A, and the levels of β-EP were higher in group WM than in group W (P < 0.05). Comparing the delivery time of the first stage of labor in the three groups, groups A and WM were shorter than group W (P < 0.05). Comparing the delivery time of the second and third stages of labor in the three groups, there was no significant difference (P > 0.05). Comparing the Apgar scores of the three groups of newborns at 1 and 5 min after birth, there was no significant difference (P > 0.05). Comparing the incidence of newborn asphyxia in the three groups, there was also no significant difference (P > 0.05). Comparing the PH, BE, PaO2, and PaCO2 of three groups of newborns after delivery, there were no significant differences (P > 0.05). At 6 weeks after delivery, the incidence of PPD was lower in groups W (10.00%) and WM (8.00%) than in group A (20.00%) (P < 0.05). Conclusion The application of the MMA regimen of PCEA combined with multiacupoint stimulation for labor analgesia during the whole stage of labor in primipara can effectively reduce labor pain and stress response during the whole stage of labor and shorten the delivery time of the first stage of labor, the indicators of newborn Apgar score and umbilical artery blood gas analysis are not affected, and the incidence of PPD in patients is reduced, which can play a protective role for the safety of mother and infant.
Collapse
|
28
|
Akbaş P, Özkan Şat S, Yaman Sözbir Ş. The Effect of Holistic Birth Support Strategies on Coping With Labor Pain, Birth Satisfaction, and Fear of Childbirth: A Randomized, Triple-Blind, Controlled Trial. Clin Nurs Res 2022; 31:1352-1361. [PMID: 35698748 DOI: 10.1177/10547738221103329] [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: 11/15/2022]
Abstract
The current study was aimed to evaluate the effects of interventions conducted in line with the coping with labor pain algorithm (holistic birth support strategies) on women's coping with labor pain, birth satisfaction, and fear of childbirth. The study is a single-center, parallel-group randomized, three-blind, controlled trial. The study was completed with 33 women in the experimental group and 31 in the control group. The mean score of the women in the experimental group from the Birth Satisfaction Scale (128.57 ± 5.83) was statistically significantly higher than that of the women in the control group (81.80 ± 7.73). The mean score of the women in the experimental group (61.96 ± 9.78) from the Wijma Birth Expectation/Experience Scale, Version B scale was statistically significantly lower than that of the women in the control group (148.64 ± 14.62). It was found that the women in the experimental group were able to better cope with labor pain, had higher birth satisfaction, and had less fear of childbirth.
Collapse
Affiliation(s)
- Pınar Akbaş
- Karabük Yenice State Hospital, Karabük, Turkey
| | - Sultan Özkan Şat
- Bitlis Eren University, Faculty of Health Sciences, Nursing Department, Bitlis, Turkey
| | - Şengül Yaman Sözbir
- Gazi University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
| |
Collapse
|
29
|
Sharpe EE, Rollins MD. Beyond the epidural: Alternatives to neuraxial labor analgesia. Best Pract Res Clin Anaesthesiol 2022; 36:37-51. [PMID: 35659959 DOI: 10.1016/j.bpa.2022.04.005] [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: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Labor creates an intense pain experienced by women across the world. Although neuraxial analgesia is the most effective treatment of labor pain, in many cases, it may not be undesired, not available, or have contraindications. In addition, satisfaction with labor analgesia is not only determined by the efficacy of analgesia but a woman's sense of agency and involvement in the childbirth experience are also key contributors. Providing safe choices for labor analgesia and support is central to creating a tailored, safe, and effective analgesic treatment plan with high maternal satisfaction. Healthcare provider knowledge of various nonneuraxial analgesic options, including efficacy, contraindications, safe clinical implementation, and side effects of various techniques is needed for optimal patient care and satisfaction. Future rigorous scientific studies addressing all of these labor analgesia options are needed to improve our understanding. This review summarizes the current published literature for commonly available non-neuraxial labor analgesic options.
Collapse
Affiliation(s)
- Emily E Sharpe
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Mark D Rollins
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
30
|
Farrer J, Peralta F. Anaesthesia for the parturient with multiple gestations. BJA Educ 2022; 22:306-311. [PMID: 36097576 PMCID: PMC9463626 DOI: 10.1016/j.bjae.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
|
31
|
Carus EG, Albayrak N, Bildirici HM, Ozmen SG. Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:354. [PMID: 35461248 PMCID: PMC9034564 DOI: 10.1186/s12884-022-04598-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of immersive virtual reality (VR) on patient satisfaction as a distractive tool and pain relief among laboring women. METHODS This was a randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among women in the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey, measured by a Visual Analog Scale (VAS) score and evaluated by questioning them about whether they would choose VR in future labor. As a primary outcome, patient satisfaction scores regarding the overall childbirth experience were compared between women in the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in women in both groups. Psychometric information was also collected from participants in each group using the Beck Anxiety Inventory and Beck Depression Inventory. RESULTS We observed a high level of patient satisfaction with the use of immersive VR during labor. The VAS revealed a mean satisfaction score of 87.7 ± 12.9 out of a maximum of 100. Twenty out of 21 (95%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to the overall childbirth experience. The mean pain score pre-VR was 2.6 ± 1.2 compared to 2.0 ± 1.3 post-VR (p < 0.01). Anxiety and depression scores were similar in participants in the intervention and control groups (p = 0.103 and p = 0.13, respectively). CONCLUSION Immersive VR application during labor was associated with higher patient satisfaction based on our study findings. VR also improved participants' pain scores in early labor before epidural administration. Immersive VR may find a place as an adjunct in labor and delivery units to improve lengthy labor experiences for women. Studies with larger groups of participants are needed to confirm these observations. TRIAL REGISTRATION ClinicalTrials.gov: NCT05032456.
Collapse
Affiliation(s)
- Elif Gizem Carus
- Graduate School of Health Sciences, Neuroscience Master's Program, Bahcesehir University, Istanbul, Turkey.
| | - Nazli Albayrak
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Selen Gur Ozmen
- Department of Physiotherapy and Rehabilitation, Faculty Of Health Sciences, Bahcesehir University, Istanbul, Turkey
| |
Collapse
|
32
|
Sulu R, Akbas M, Cetiner S. Effects of transcutaneous electrical nerve stimulation applied at different frequencies during labor on hormone levels, labor pain perception, and anxiety: a randomized placebo-controlled single-blind clinical trial. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
33
|
Firth PG, Rollins MD. Nitrous Oxide for Labor Analgesia at Altitude. Anesth Analg 2022; 134:291-293. [PMID: 35030124 DOI: 10.1213/ane.0000000000005751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paul G Firth
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark D Rollins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
34
|
Sulimenko YM, Loskutov OA, Zhezher AO. SAFETY OF USING DURAL PUNCTURE EPIDURAL ANALGESIA AS A METHOD OF LABOR ANALGESIA. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2416-2418. [PMID: 36472271 DOI: 10.36740/wlek202210118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To evaluate the clinical characteristics of complications and side effects of CSE and DPE as a method of analgesia. PATIENTS AND METHODS Materials and methods: The study included 137 patients who had a vaginal birth using one of two, CSE or DPE methods of analgesia. All of them were divided into two groups: Group I - 54 women (DPE group) and Group II - 83 women (CSE group). In group I, an epidural kit with a Tuohy G18 needle, G20 catheter, and a Whitacre G25 x 120 mm spinal needle was passed through the epidural needle for puncture of dura mater and removed after cerebrospinal fluid receiving, the epidural catheter was conducted on 3-4 cm. The initial dose of anesthetic was: 3 ml of Naropin 0.12% - test dose and 17 ml of working solution (Naropin 0.12% + Fentanyl 2 μg / ml) - main dose. In group II, a spinal-epidural kit with Tuohy G18 needle, catheter G20, spinal needle "Whitacre" G27 x 132 mm for dura mater puncture was used. Bupivacaine 1.5 mg + Fentanyl 15 mcg, 1 ml solution was administered spinally. To maintain analgesia in both groups - the patient-controlled analgesia with a working solution (Naropin 0.12% + Fentanyl 2 μg / ml) with a bolus of 8 - 10 ml, lockout 15 minutes. RESULTS Results: The higher frequency of hypotension in childbirth when using CSE - 4 women (4.8%) vs 1 woman (1.9%) in the DPE group. Inadequate or insufficient analgesia in group I was found in 2 women (3.7%), and in group II in 4 women (4.8%). The severity of monolateral block in group I was not high and did not cause significant discomfort in women. The higher incidence of monolateral blockade was in group II, in three cases there was a need for additional anesthesiologist interventions and catheter manipulations. In the CSE group there were two cases (2.4%) of severe itching in women, in group I such an adverse reaction was absent. No complication such as PDPH was documented in either group. CONCLUSION Conclusions: 1. The use of the DPE technique showed a lower frequency of complications compared to CSE. 2. The use of a G 25 spinal needle for puncture of the dura mater does not lead to an increase in the frequency of PDPH. 3. DPE technique using G25 spinal needles reduces the need for additional manipulations with the epidural catheter to overcome unilateral blockades.
Collapse
Affiliation(s)
- Yevhen M Sulimenko
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; MATERNITY HOSPITAL "LELEKA", KYIV, UKRAINE
| | - Oleg A Loskutov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | | |
Collapse
|
35
|
Tan A, Wilson AN, Eghrari D, Clark H, Tse WC, Bohren MA, Homer C, Vogel JP. Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials. BJOG 2021; 129:845-854. [PMID: 34839565 DOI: 10.1111/1471-0528.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential. OBJECTIVE To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth. DESIGN A review of systematic reviews and their included randomised controlled trials was undertaken. SEARCH STRATEGY Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language. SELECTION CRITERIA Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment. DATA COLLECTION AND ANALYSIS All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported. MAIN RESULTS Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains. CONCLUSIONS Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice. TWEETABLE ABSTRACT Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.
Collapse
Affiliation(s)
- A Tan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - A N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - D Eghrari
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - H Clark
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - W C Tse
- School of Medicine, Faculty of Medicine, Nursing, and Health Science, Monash University, Clayton, Vic., Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Vic., Australia
| | - Cse Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - J P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| |
Collapse
|
36
|
Martínez-Burnes J, Muns R, Barrios-García H, Villanueva-García D, Domínguez-Oliva A, Mota-Rojas D. Parturition in Mammals: Animal Models, Pain and Distress. Animals (Basel) 2021; 11:2960. [PMID: 34679979 PMCID: PMC8532935 DOI: 10.3390/ani11102960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Parturition is a complex physiological process and involves many hormonal, morphological, physiological, and behavioural changes. Labour is a crucial moment for numerous species and is usually the most painful experience in females. Contrary to the extensive research in humans, there are limited pain studies associated with the birth process in domestic animals. Nonetheless, awareness of parturition has increased among the public, owners, and the scientific community during recent years. Dystocia is a significant factor that increases the level of parturition pain. It is considered less common in polytocous species because newborns' number and small size might lead to the belief that the parturition process is less painful than in monotocous animal species and humans. This review aims to provide elements of the current knowledge about human labour pain (monotocous species), the relevant contribution of the rat model to human labour pain, and the current clinical and experimental knowledge of parturition pain mechanisms in domestic animals that support the fact that domestic polytocous species also experience pain. Moreover, both for women and domestic animal species, parturition's pain represents a potential welfare concern, and information on pain indicators and the appropriate analgesic therapy are discussed.
Collapse
Affiliation(s)
- Julio Martínez-Burnes
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Tamaulipas, Mexico;
| | - Ramon Muns
- Agri-Food and Biosciences Institute, Hillsborough, Co Down BT26 6DR, Northern Ireland, UK;
| | - Hugo Barrios-García
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Tamaulipas, Mexico;
| | - Dina Villanueva-García
- Division of Neonatology, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Adriana Domínguez-Oliva
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico;
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico;
| |
Collapse
|
37
|
Linzbach A, Nitschke D, Rothaug J, Komann M, Weinmann C, Schleußner E, Meißner W, Jimenez Cruz J, Schneider U. Peripartal pain perception and pain therapy: introduction and validation of a questionnaire as a quality instrument. Arch Gynecol Obstet 2021; 305:1409-1419. [PMID: 34542680 PMCID: PMC9166832 DOI: 10.1007/s00404-021-06246-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Labor pain is difficult to measure. The aim of this proof-of-concept study is to implement and test a questionnaire assessing pain sensation during and after vaginal deliveries. Its key aspect is a highly standardized survey of patient-reported outcome (PRO) by staff not involved in routine care. METHODS Between January and November 2015 339 women were assessed 24-48 h after spontaneous or operative-vaginal delivery of a singleton. German language skills were a prerequisite to participate. The test-retest reliability was calculated in 38 women 24-36 and 48-72 h postpartum between July and October 2017. Primiparae after spontaneous delivery and multiparae with no history of operative deliveries were compared in a subgroup analysis. RESULTS Maximum labor pain and post-partum pain were reported a median of 9 [8-10] and 4 [3-6]. Higher ratings were associated with younger age, higher gestational ages, infant's biometrics, and the duration of laboring. Only regional analgesia tended to reduce pain perception (NRS 8 vs. 9). Higher-degree injuries were associated with less pain postpartum. The questionnaire proved to be reliable in most aspects (Cronbach's α > 0.6 for 19/21 questions) and showed an acceptable content and criterion validity (Cohen correlation > ± 0.3, interrelation between items). CONCLUSION Labor is a very painful experience, irrespective of previous obstetric history. Ratings indicate inadequateness of treatment except for patients receiving preventive postoperative pain management. Systematic postpartum pain assessment, hence, is still a pending issue. Adjustments will be made concerning language skills and specific questions on effectiveness of analgesia otherwise good reliability and validity of the questionnaire were proven.
Collapse
Affiliation(s)
- A Linzbach
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - D Nitschke
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - J Rothaug
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - M Komann
- Department of Anesthesiology and Intensive Care Medicine, Section Pain Therapy, University Hospital Jena, Jena, Germany
| | - C Weinmann
- Department of Anesthesiology and Intensive Care Medicine, Section Pain Therapy, University Hospital Jena, Jena, Germany
| | - E Schleußner
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - W Meißner
- Department of Anesthesiology and Intensive Care Medicine, Section Pain Therapy, University Hospital Jena, Jena, Germany
| | - J Jimenez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - U Schneider
- Department of Obstetrics, Division of Prenatal Diagnostics and Fetal Physiology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| |
Collapse
|
38
|
de Souza KCR, da Silva TPR, Damasceno AKDC, Manzo BF, Souza KVD, Filipe MML, Matozinhos FP. Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership. BMC Pregnancy Childbirth 2021; 21:618. [PMID: 34503471 PMCID: PMC8431849 DOI: 10.1186/s12884-021-04092-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/29/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it. METHODS Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile. RESULTS Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2. CONCLUSION(S) Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.
Collapse
Affiliation(s)
- Karina Cristina Rouwe de Souza
- Graduate Nursing Program, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil
- Health Sciences, Child and Adolescent Health, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil
| | - Thales Philipe Rodrigues da Silva
- Health Sciences, Child and Adolescent Health, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil
| | | | - Bruna Figueiredo Manzo
- Maternal and Child Nursing and Public Health Department, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil
| | - Kleyde Ventura de Souza
- Maternal and Child Nursing and Public Health Department, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil
| | | | - Fernanda Penido Matozinhos
- Maternal and Child Nursing and Public Health Department, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil.
| |
Collapse
|
39
|
Hu Y, Lu H, Huang J, Zang Y. Efficacy and safety of non-pharmacological interventions for labour pain management: A systematic review and Bayesian network meta-analysis. J Clin Nurs 2021; 30:3398-3414. [PMID: 34075656 DOI: 10.1111/jocn.15865] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/19/2021] [Accepted: 05/01/2021] [Indexed: 12/17/2022]
Abstract
AIMS AND OBJECTIVES To compare and rank the efficacy and safety of non-pharmacological interventions in the management of labour pain. BACKGROUND Recently, various non-pharmacological interventions have been applied to manage labour pain and have shown positive effects. However, evidence identifying which type of non-pharmacological intervention is more efficient and safer is limited. DESIGN Systematic review and Bayesian network meta-analysis based on PRISMA-NMA. METHODS Seven databases were searched from database inception-March 2020. Two reviewers independently performed study selection, quality appraisal and data extraction. Conventional meta-analysis was conducted using either fixed-effects model or random-effects model according to statistical heterogeneity. The Bayesian network meta-analysis was conducted using the consistency model. RESULTS 43 studies involving nine non-pharmacological interventions were included. The Bayesian network meta-analysis showed that acupressure (SMD = -2.00, 95% CrI -3.09 to -0.94), aromatherapy (SMD = -2.01, 95% CrI -3.70 to -0.35) and massage therapy (SMD = -1.26, 95% CrI -2.26 to -0.30) had significant positive effects on alleviating labour pain, with aromatherapy being the most effective. The results also revealed that yoga (SMD = -130.85, 95% CrI -212.01 to -59.32) and acupressure (SMD = -10.14, 95% CrI -20.24 to -0.41) were the most effective interventions for shortening the first stage and the second stage of labour, respectively. There were no significant differences between non-pharmacological interventions and usual care or placebo control on the use of pharmacological methods and neonatal 5-min Apgar score. CONCLUSIONS The evidence in this network meta-analysis illustrates that non-pharmacological interventions are effective and safe for labour pain management in low-risk pregnant women. In the future, well-designed studies are needed to validate the conclusion of this network meta-analysis. RELEVANCE TO CLINICAL PRACTICE The results support the use of non-pharmacological interventions, especially aromatherapy and acupressure, to relieve labour pain in low-risk pregnant women. Non-pharmacological interventions for labour pain management are recommended to apply according to maternal women's preference and values.
Collapse
Affiliation(s)
- Yinchu Hu
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yu Zang
- School of Nursing, Peking University, Beijing, China.,School of Nursing, Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
40
|
Bui E, Merchant K, Seligman KM. Alternatives to neuraxial analgesia for labor and delivery. Int Anesthesiol Clin 2021; 59:22-27. [PMID: 34029246 DOI: 10.1097/aia.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Emily Bui
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Kanwal Merchant
- Department of Anesthesiology & Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Katherine M Seligman
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
41
|
Töpel L, Wenk M. [Spinal Analgesia - Cleverly Used for Vaginal Delivery]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:210-218. [PMID: 33725741 DOI: 10.1055/a-1101-8522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuroaxial procedures are among the most effective ways of relieving pain during childbirth. Especially in the late phase of vaginal delivery, surprising moments, instrumental methods or special maneuvers require quick and sufficient analgesia. This refers to situations with a sudden, often unexpected and particularly pronounced intensity of pain. Here the advantages of spinal analgesia over the gold standard of obstetric analgesia, catheter epidural analgesia, can be used. Spinal analgesia is characterized by a fast onset of pain relief, a profound blockage and simple technical feasibility and, like other neuroaxial procedures, is comparatively uncomplicated in pregnant women. However, it is only effective if the delivery situation is well assessed. There is no possibility of repetition without re-puncture, so that limited duration of action is a significant disadvantage. Applied drugs correspond to those described for combined spinal and epidural analgesia, such as a mixture of low-dose bupivacaine and sufentanil, and can be adapted to local conditions. In the future, longer acting substances could overcome the main limitation (temporary effect) of spinal analgesia and suitable adjuvants could further increase the attractiveness of the procedure.
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers. RECENT FINDINGS COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean section. Epidural failure is a concern: it may lead to a general anesthesia in case of emergency cesarean section. Local protocols and well-trained anesthesiologists will be helpful. COVID-19 patients require special circuits and every step (transfer to and from theatre, recovery, analgesia, and so on) should be planned in advance. For cesarean section under general anesthesia, personal protection equipment must be enhanced. Postoperative analgesia with neuraxial opioids, NSAIDs, or regional blocks are recommended. COVID-19 and pregnancy increase the risk of thrombosis, so thromboprophylaxis has to be considered and protocolized. SUMMARY Anesthetic care for delivery in COVID-19 parturients should include neuraxial blocks. Special attention should be paid on the risk of thrombosis.
Collapse
Affiliation(s)
- Emilia Guasch
- Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz
| | - Nicolas Brogly
- Department of Anaesthesia and Reanimation, Maternal Hospital, Hospital Universitario La Paz
| | - Fernando Gilsanz
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
43
|
Optimal intrapartum care in the twenty-first century. Best Pract Res Clin Obstet Gynaecol 2020; 67:1-3. [PMID: 32698995 DOI: 10.1016/j.bpobgyn.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022]
|