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Geltore TE, Alemu G, Taye A, Sileshi E, Bekele M, Foto LL. Determinants and willingness to practice obstetric analgesia among women attending antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:470. [PMID: 38987713 PMCID: PMC11238436 DOI: 10.1186/s12884-024-06674-x] [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: 03/02/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Labor pain is uniquely experienced and described by the woman giving birth, and it is often considered one of the most excruciating experiences for many women. This study aimed to evaluate factors associated with the willingness to receive labor analgesia among women attending the antenatal clinic at Dr. Bogalech Gebre Memorial General Hospital Central Ethiopia in 2022. METHODS An institution-based, cross-sectional study was conducted from January to March 2022. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data was entered in EpiData 4.2 and exported to SPSS version 20 for analysis. Both Bivariable and multivariable logistic regressions were conducted to determine factors associated with pregnant women's willingness to choose labor analgesia. Crude odds ratio (COR) and adjusted odds ratio (AOR) were computed to assess the association between variables. RESULTS A total of 398 pregnant women have participated in the study with a response rate of 94%. Nearly 30%, (29.4%) of the pregnant women had a willingness to practice labor pain management. Being a housewife (AOR: 8.35, 95% CI: 2.07, 33.63). Women who live in urban (AOR: 2.60, 95% CI: 1.29, 5.29). Having had awareness about labor analgesia (AOR: 1.70, 95% CI: 1.00, 2.60) and the short duration of labor time (AOR: 1.84, 95% CI: 1.15, 2.96) were statistically significant with a willingness to practice labor analgesia. CONCLUSION We conclude that the willingness of pregnant mothers' toward obstetric analgesia practice was low in the study area. Being a housewife, urban residence, awareness about labor analgesia, and short duration of labor were statistically significant with the willingness of the mothers to practice labor analgesia. To increase willingness to use labor analgesia, authorities should prioritize delivering health education on pain management choices to address concerns and promote effective methods and practices.
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Affiliation(s)
- Teketel Ermias Geltore
- Department of Midwifery, College of Medicine and Health Science, Wachemo University, Durame Campus, Durame, Ethiopia.
- Teketel Ermias Geltore, PO Box 667, Wachemo, Ethiopia.
| | - Getachew Alemu
- Department of Medical Laboratory Science, College of Medicine and Health Science, Wachemo University, Durame Campus, Durame, Ethiopia
| | - Ayanos Taye
- Nursing Department, School of Nursing and Midwifery, College of Health Sciences and Medicine, Jimma University, Jimma, Ethiopia
| | - Eden Sileshi
- Department of Midwifery, College of Medicine and Health Science, Wachemo University, Durame Campus, Durame, Ethiopia
| | - Merkin Bekele
- Department of Midwifery, College of Medicine and Health Science, Wachemo University, Durame Campus, Durame, Ethiopia
| | - Lakew Lafebo Foto
- School of Public Health, Institute of Health Science, BuleHora University, BuleHora, Ethiopia
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Cheng J, Wan M, Yu X, Yan R, Lin Z, Liu H, Chen L. Pharmacologic Analgesia for Cesarean Section: An Update in 2024. Curr Pain Headache Rep 2024:10.1007/s11916-024-01278-8. [PMID: 38951467 DOI: 10.1007/s11916-024-01278-8] [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: 05/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE OF THE REVIEW With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens. RECENT FINDINGS Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.
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Affiliation(s)
- Jing Cheng
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Mengjiao Wan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Xiaoyan Yu
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Rongrong Yan
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Zirui Lin
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070
| | - Henry Liu
- Department of Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Lin Chen
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, NO.745 Wuluo Road, Hongshan District, Wuhan, Hubei, China, 430070.
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Parameshwar P, Guo N, Bentley J, Main E, Singer SJ, Peden CJ, Morris T, Ansari J, Butwick AJ. Variation in Hospital Neuraxial Labor Analgesia Rates in California. Anesthesiology 2024; 140:1098-1110. [PMID: 38412054 DOI: 10.1097/aln.0000000000004961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Neuraxial analgesia provides effective pain relief during labor. However, it is unclear whether neuraxial analgesia prevalence differs across U.S. hospitals. The aim of this study was to assess hospital variation in neuraxial analgesia prevalence in California. METHODS A retrospective cross-sectional study analyzed birthing patients who underwent labor in 200 California hospitals from 2016 to 2020. The primary exposure was the delivery hospital. The outcomes were hospital neuraxial analgesia prevalence and between-hospital variability, before and after adjustment for patient and hospital factors. Median odds ratio and intraclass correlation coefficients quantified between-hospital variability. The median odds ratio estimated the odds of a patient receiving neuraxial analgesia when moving between hospitals. The intraclass correlation coefficients quantified the proportion of the total variance in neuraxial analgesia use due to variation between hospitals. RESULTS Among 1,510,750 patients who underwent labor, 1,040,483 (68.9%) received neuraxial analgesia. Both unadjusted and adjusted hospital prevalence exhibited a skewed distribution characterized by a long left tail. The unadjusted and adjusted prevalences were 5.4% and 6.0% at the 1st percentile, 21.0% and 21.2% at the 5th percentile, 70.6% and 70.7% at the 50th percentile, 75.8% and 76.6% at the 95th percentile, and 75.9% and 78.6% at the 99th percentile, respectively. The adjusted median odds ratio (2.3; 95% CI, 2.1 to 2.5) indicated substantially increased odds of a patient receiving neuraxial analgesia if they moved from a hospital with a lower odds of neuraxial analgesia to one with higher odds. The hospital explained only a moderate portion of the overall variability in neuraxial analgesia (intraclass correlation coefficient, 19.1%; 95% CI, 18.8 to 20.5%). CONCLUSIONS A long left tail in the distribution and wide variation exist in the neuraxial analgesia prevalence across California hospitals that is not explained by patient and hospital factors. Addressing the low prevalence among hospitals in the left tail requires exploration of the interplay between patient preferences, staffing availability, and care providers' attitudes toward neuraxial analgesia. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Pooja Parameshwar
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Nan Guo
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Jason Bentley
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia
| | - Elliot Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; and California Maternal Quality Care Collaborative, Stanford, California
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carol J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theresa Morris
- Department of Sociology, Texas A&M University, College Station, Texas
| | - Jessica Ansari
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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McKenzie CP, Straube L, Webster C, Cobb B, Stuebe A. A Quality Improvement Effort to Reduce Inpatient Opioid Consumption following Cesarean Delivery. Am J Perinatol 2024; 41:e406-e411. [PMID: 35750319 DOI: 10.1055/a-1884-1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The amount of opioid prescribed following cesarean delivery (CD) is commonly in excess of patients' needs. An additional concern in a breastfeeding mother is neonatal opioid exposure. A maximum daily dose of 30 mg of oxycodone is recommended in breastfeeding women. Inadequate pain control can inhibit breastfeeding, as well as other negative consequences. We aimed to evaluate the effect of reducing the as-needed opioid ordered following CD on inpatient opioid consumption and analgesia. STUDY DESIGN At our tertiary-care institution, our standard as-needed opioid order was reduced from oxycodone 5 to 10 mg every 4 hours to oxycodone 5 mg every 6 hours, in May 2019. Orders for scheduled acetaminophen and nonsteroidal anti-inflammatory drugs were unchanged. We compared opioid use and pain scores before (February 2019-April 2019) and after (May 2019-July 2019) the order modification. Our primary outcome was the proportion of patients using >30 mg of oxycodone in the 24 hours prior to hospital discharge. We further assessed 48-hour opioid consumption and patient-reported verbal pain scores. RESULTS There were 559 patients who met inclusion criteria; 241 preintervention patients and 318 postintervention patients. In the preintervention group, 14.5% (35/241) used >30-mg oxycodone in the 24 hours before discharge, compared with 5.0% (16/318) after the order set change (relative risk [RR] = 0.34, 95% confidence interval [CI]: 0.19, 0.61; number needed to treat [NNT] = 10.5). There was no change in the proportion of women with one or more pain score >7 (preintervention: 44.4% [107/241], postintervention: 43.1% [137/318], p = 0.756) or >4 and ≤7 (preintervention: 36.9% [89/241], postintervention: 36.9% [125/318], p = 0.567), nor was there a change in mean pain score (mean ± standard deviation [SD]: preintervention = 2.8 ± 1.6 and postintervention = 2.7 ± 1.4, p = 0.464). CONCLUSION Reducing the amount of opioid ordered after CD reduced the proportion of post-CD patients exceeding the maximum recommended daily oxycodone dose for breastfeeding women. KEY POINTS · Inpatient opioid prescribing influences usage.. · Opioid orders influence consumption.. · Reducing opioids may not increase pain..
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Affiliation(s)
- Christine P McKenzie
- Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lacey Straube
- Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Carolyn Webster
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
| | - Benjamin Cobb
- Division of Obstetric Anesthesia, Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
| | - Alison Stuebe
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Tang GC, He M, Huang ZZ, Cheng Y. Safety and effectiveness of butorphanol in epidural labor analgesia: A protocol for a systematic review and meta-analysis. World J Clin Cases 2024; 12:1416-1421. [PMID: 38576817 PMCID: PMC10989441 DOI: 10.12998/wjcc.v12.i8.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/09/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Epidural analgesia is the most effective analgesic method during labor. Butorphanol administered epidurally has been shown to be a successful analgesic method during labor. However, no comprehensive study has examined the safety and efficacy of using butorphanol as an epidural analgesic during labor. AIM To assess butorphanol's safety and efficacy for epidural labor analgesia. METHODS The PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure, and Google Scholar databases will be searched from inception. Other types of literature, such as conference abstracts and references to pertinent reviews, will also be reviewed. We will include randomized controlled trials comparing butorphanol with other opioids combined with local anesthetics for epidural analgesia during labor. There will be no language restrictions. The primary outcomes will include the visual analog scale score for the first stage of labor, fetal effects, and Apgar score. Two independent reviewers will evaluate the full texts, extract data, and assess the risk of bias. Publication bias will be evaluated using Egger's or Begg's tests as well as visual analysis of a funnel plot, and heterogeneity will be evaluated using the Cochran Q test, P values, and I2 values. Meta-analysis, subgroup analysis, and sensitivity analysis will be performed using RevMan software version 5.4. This protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols statement, and the PRISMA statement will be used for the systematic review. RESULTS This study provides reliable information regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor. CONCLUSION To support clinical practice and development, this study provides evidence-based findings regarding the safety and efficacy of using butorphanol as an epidural analgesic during labor.
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Affiliation(s)
- Guan-Cheng Tang
- Department of Anesthesiology, Yongkang Hospital of Traditional Chinese Medicine, Jinhua 321301, Zhejiang Province, China
| | - Man He
- Department of Gynecology and Obstetrics, Yongkang Hospital of Traditional Chinese Medicine, Jinhua 321301, Zhejiang Province, China
| | - Zhen-Zhao Huang
- Department of Anesthesiology, Hangzhou United Liger Sixth Medical Beauty Hospital, Hangzhou 311215, Zhejiang Province, China
| | - Yan Cheng
- Department of Ultrasound, Hangzhou Women’s Hospital, Hangzhou 310008, Zhejiang Province, China
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Meng X, Ye J, Qiao P, Ren T, Luo Q, Hu LQ, Zhang J. Labor Neuraxial Analgesia and Its Association With Perinatal Outcomes in China in 2015-2016: A Propensity Score-Matched Analysis. Anesth Analg 2023; 137:1047-1055. [PMID: 37862597 DOI: 10.1213/ane.0000000000006435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND The use of labor neuraxial analgesia (NA) in China has increased significantly in the past decade, and the current rate of use is unknown. This study aimed to describe the epidemiology of NA based on a large multicenter cross-sectional survey, the China Labor and Delivery Survey (CLDS) (2015-2016), and to evaluate the association between NA and intrapartum caesarean delivery (CD) and maternal and neonatal outcomes. METHODS The CLDS was a facility-based cross-sectional investigation with a cluster random sampling scheme conducted from 2015 to 2016. A specific weight was assigned to each individual based on the sampling frame. Logistic regression was adopted to analyze the factors associated with the use of NA. A propensity score matching scheme was used to analyze the associations between NA and intrapartum CD and perinatal outcomes. RESULTS A total of 51,488 vaginal deliveries or intrapartum CD were included in our study, excluding prelabor CDs. The weighted NA rate was 17.3% (95% confidence interval [CI], 16.6-18.0) in this survey population. Nulliparous, previous CD, hypertensive disorders, and labor augmentation were associated with higher use of NA. In the propensity score-matched analysis, NA was associated with reduced risks of intrapartum CD, especially intrapartum CD by maternal request (adjusted odds ratio [aOR], 0.68; 95% CI, 0.60-0.78 and aOR, 0.48; 95% CI, 0.30-0.76, respectively), 3rd or 4th degree perineal laceration (aOR, 0.36; 95% CI, 0.15-0.89), and 5-minute Apgar score ≤3 (aOR, 0.15; 95% CI, 0.03-0.66). CONCLUSIONS The use of NA may be associated with improved obstetric outcomes, including fewer intrapartum CD, less birth canal trauma, and better neonatal outcomes in China.
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Affiliation(s)
- Xi Meng
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiangfeng Ye
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Qiao
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tai Ren
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Luo
- Department of Research Service, Hainan Women and Children's Medical Center, Haikou, Hainan, China
| | - Ling-Qun Hu
- Department of Obstetric Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jun Zhang
- From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Research Service, Hainan Women and Children's Medical Center, Haikou, Hainan, China
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Samuelson Bannow B, Federspiel JJ, Abel DE, Mauney L, Rosovsky RP, Bates SM. Multidisciplinary care of the pregnant patient with or at risk for venous thromboembolism: a recommended toolkit from the Foundation for Women and Girls with Blood Disorders Thrombosis Subcommittee. J Thromb Haemost 2023; 21:1432-1440. [PMID: 36972785 PMCID: PMC10192106 DOI: 10.1016/j.jtha.2023.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
The care of pregnant persons with/at risk of venous thromboembolism is complex and often challenging. Although guidelines have been published regarding the use of specific therapies, such as anticoagulants; in this population, none have provided guidance on how to coordinate multidisciplinary care of these patients. Here we provide an expert consensus on the role of various providers in the care of this patient population, as well as necessary resources and suggestions for best practices.
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Affiliation(s)
| | - Jerome J Federspiel
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, USA
| | - David E Abel
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Logan Mauney
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel P Rosovsky
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shannon M Bates
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Lv FH, Wu Y, Xie HR, Sang L. Effects of different timing selections of labor analgesia for primiparae on parturition and neonates. Taiwan J Obstet Gynecol 2023; 62:402-405. [PMID: 37188443 DOI: 10.1016/j.tjog.2023.01.006] [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: 01/30/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To explore the effects of labor analgesia for primiparae with different stages of cervical dilation on parturition and neonates. MATERIALS AND METHODS In the past three years, 530 cases of primiparae who had delivered in the Second People's Hospital of Hefei and were eligible for a vaginal trial of parturition were enrolled as the research subjects. Of these, 360 puerperae had labor analgesia, and the remaining 170 were taken as the control group. Those given labor analgesia were divided into three groups based on the different stages of cervical dilation at that time. There were 160 cases in Group I (cervical dilation <3 cm), 100 cases in Group II (cervical dilation of 3-4 cm), and 100 cases in Group III (cervical dilation of 4-6 cm). The labor and neonatal outcomes were compared among the four groups. RESULTS The first, second, and total stages of labor in the three groups receiving labor analgesia were all longer than in the control group, and the differences were statistically significant (p < 0.05 in all). Group I had the longest duration of each stage and the total stage of labor. The differences in labor stages and the total stage of labor were not statistically significant between Group II and Group III (P > 0.05). In the three groups with labor analgesia, the usage rate of oxytocin was higher than in the control group, and the differences were statistically significant (P < 0.05). The differences in the incidence of postpartum hemorrhage, the incidence of postpartum urine retention, and the episiotomy rate were not statistically significant among the four groups (P > 0.05). The differences in the neonatal Apgar score were not statistically significant among the four groups (P > 0.05). CONCLUSION Labor analgesia might prolong the stages of labor but does not affect the neonatal outcomes. It would be optimal to conduct labor analgesia when cervical dilation reaches 3-4 cm.
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Affiliation(s)
- Fa-Hui Lv
- Department of Obstetrics and Gynaecology, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Yan Wu
- Department of Obstetrics and Gynaecology, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Hao-Ran Xie
- Department of Obstetrics and Gynaecology, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China
| | - Lin Sang
- Department of Obstetrics and Gynaecology, The Second People's Hospital of Hefei, Hefei, Anhui, 230011, China.
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Lu B, Hong L, Dai Q, Cai H, Lu Z, Chen A. Construction of a nomogram model for predicting infectious intrapartum fever. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:54-60. [PMID: 37283118 PMCID: PMC10407993 DOI: 10.3724/zdxbyxb-2022-0479] [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: 08/15/2022] [Accepted: 12/10/2022] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate influencing factors of intrapartum fever during vaginal delivery and to construct a prediction model for infectious intrapartum fever. METHODS A total of 444 patients with intrapartum fever admitted in Ningbo Women and Children's Hospital from January 2020 to December 2021 were enrolled. The clinical data and laboratory findings were compared between patients with infectious intrapartum fever and non-infectious intrapartum fever, and the factors associated with intrapartum fever were analyzed with a multivariate logistic regression model. A prediction nomogram model was constructed based on the factors of intrapartum fever and its predictive efficiency was evaluated by correction curve and receiver operator characteristic curve. RESULTS In the 444 cases, 182 (41.0%) had definite intrauterine infection and 262 (59.0%) had no infectious intrapartum fever. Univariate analysis showed that the length of hospital stay before induced labor, the time of induced abortion, misoprostol administration, autoimmune diseases, white blood cell count (WBC) and hypersensitive C-reactive protein (hs-CRP) levels were significantly different between the two groups (all P<0.05). Multivariate analysis showed that misoprostol administration and autoimmune diseases were protective factors (OR=0.31 and 0.36, both P<0.05) for infectious intrapartum fever, while high WBC and hs-CRP were risk factors (OR=1.20 and 1.09, both P<0.05). The area under the curve of nomogram model for predicting infectious intrapartum fever was 0.823, and the calibration curve validation showed that the predicted and measured values were in general agreement. CONCLUSIONS Multiple factors cause intrapartum fever. The nomogram model constructed in this study has good predictive accuracy for infectious intrapartum fever.
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Affiliation(s)
- Bilu Lu
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315000, Zhejiang Province, China.
| | - Ling Hong
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315000, Zhejiang Province, China
| | - Qiaohong Dai
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315000, Zhejiang Province, China
| | - Hairui Cai
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315000, Zhejiang Province, China
| | - Zhai'e Lu
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315000, Zhejiang Province, China
| | - An'er Chen
- Department of Obstetrics, Ningbo Women and Children's Hospital, Ningbo 315000, Zhejiang Province, China.
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Labor Analgesia: Can It Be Achieved Without an Epidural? Obstet Gynecol 2023; 141:1-3. [PMID: 36701603 DOI: 10.1097/aog.0000000000005038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Jian Z, Longqing R, Dayuan W, Fei J, Bo L, Gang Z, Siying Z, Yan G. Prolonged duration of epidural labour analgesia decreases the success rate of epidural anaesthesia for caesarean section. Ann Med 2022; 54:1112-1117. [PMID: 35443838 PMCID: PMC9891221 DOI: 10.1080/07853890.2022.2067353] [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] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To summarise the process of conversion of epidural labour analgesia to anaesthesia for caesarean delivery and explore the relationship between duration of labour analgesia and conversion. METHODS Parturients who underwent conversion from epidural labour analgesia to anaesthesia for caesarean delivery between May 2019 and April 2020 at the Chengdu Women's and Children's Central Hospital, Sichuan Maternal and Child Health Hospital, and Jinjiang District Maternal and Child Health Hospital were selected. If the position of the epidural catheter was correct and the effect was good, patients were converted to epidural surgical anaesthesia. If epidural labour analgesia was ineffective, spinal anaesthesia (SA) was administered immediately. For category-1 emergency caesarean sections, general anaesthesia (GA) was administered. RESULTS A total of 1084 parturients underwent conversion. Of these, 19 (1.9%) received GA due to the initiation of category-1 emergency caesarean section. 704 (64.9%) were converted to epidural surgical anaesthesia, 2 (0.2%) had failed conversions and were administered GA before delivery, and 357 (32.9%) were converted to SA. Logistic regression analysis showed that prolonged duration of epidural labour analgesia ([Crude odds ratio (OR)=1.065; 95% confidence interval (CI), 1.037-1.094; p < .01]; [Adjusted OR = 1.060; 95% CI, 1.031-1.091; p < .01]) was an independent risk factor for conversion failure. A receiver operating characteristic curve constructed using duration of epidural labour analgesia showed that parturients with a duration of epidural labour analgesia ≥8 h, more frequently required a change of anaesthesia technique during conversion, and the relative risk of conversion failure was 1.54 (95% CI, 1.23-1.93; p < .01). CONCLUSION Prolonged duration of epidural labour analgesia increases the possibility of having an invalid epidural catheter, resulting in an increased risk of conversion failure from epidural labour analgesia to epidural surgical anaesthesia. Further, this risk is higher when the time exceeds 8 h. KEY MESSAGESProlonged duration of epidural labour analgesia > 8 h is associated with conversion failure.If it is impossible to judge whether the conversion is successful immediately, spinal anaesthesia should be administered to minimise complications.
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Affiliation(s)
- Zhang Jian
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
| | - Ran Longqing
- Chengdu Women's and Children's Central Hospital (School of Medicine, University of Electronic Science and Technology of China), Chengdu
| | | | - Jia Fei
- Jinjiang Maternity and Child Health Hospital, Chengdu
| | - Liu Bo
- Jinjiang Maternity and Child Health Hospital, Chengdu
| | - Zhang Gang
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
| | - Zhu Siying
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
| | - Gao Yan
- Sichuan Provincial Maternity and Child Health Care Hospital (Women's and Children's Hospital Affiliated of Chengdu Medical College), Chengdu
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12
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Deepak D, Kumari A, Mohanty R, Prakash J, Kumar T, Priye S. Effects of Epidural Analgesia on Labor Pain and Course of Labor in Primigravid Parturients: A Prospective Non-randomized Comparative Study. Cureus 2022; 14:e26090. [PMID: 35875290 PMCID: PMC9295827 DOI: 10.7759/cureus.26090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/05/2022] Open
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13
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Xiao MZX, Whitney D, Guo N, Sun EC, Wong CA, Bentley J, Butwick AJ. Association of Medicaid Expansion With Neuraxial Labor Analgesia Use in the United States: A Retrospective Cross-Sectional Analysis. Anesth Analg 2022; 134:505-514. [PMID: 35180167 DOI: 10.1213/ane.0000000000005878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Affordable Care Act has been associated with increased Medicaid coverage for childbirth among low-income US women. We hypothesized that Medicaid expansion was associated with increased use of labor neuraxial analgesia. METHODS We performed a cross-sectional analysis of US women with singleton live births who underwent vaginal delivery or intrapartum cesarean delivery between 2009 and 2017. Data were sourced from births in 26 US states that used the 2003 Revised US Birth Certificate. Difference-in-difference linear probability models were used to compare changes in the prevalence of neuraxial labor analgesia in 15 expansion and 11 nonexpansion states before and after Medicaid expansion. Models were adjusted for potential maternal and obstetric confounders with standard errors clustered at the state level. RESULTS The study sample included 5,703,371 births from 15 expansion states and 5,582,689 births from 11 nonexpansion states. In the preexpansion period, the overall rate of neuraxial analgesia in expansion and nonexpansion states was 73.2% vs 76.3%. Compared with the preexpansion period, the rate of neuraxial analgesia increased in the postexpansion period by 1.7% in expansion states (95% CI, 1.6-1.8) and 0.9% (95% CI, 0.9-1.0) in nonexpansion states. The adjusted difference-in-difference estimate comparing expansion and nonexpansion states was 0.47% points (95% CI, -0.63 to 1.57; P = .39). CONCLUSIONS Medicaid expansion was not associated with an increase in the rate of neuraxial labor analgesia in expansion states compared to the change in nonexpansion states over the same time period. Increasing Medicaid eligibility alone may be insufficient to increase the rate of neuraxial labor analgesia.
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Affiliation(s)
- Maggie Z X Xiao
- From the Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dylan Whitney
- From the Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nan Guo
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eric C Sun
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Cynthia A Wong
- Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Jason Bentley
- Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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14
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Straub L, Huybrechts KF, Mogun H, Bateman BT. Association of Neuraxial Labor Analgesia for Vaginal Childbirth With Risk of Autism Spectrum Disorder. JAMA Netw Open 2021; 4:e2140458. [PMID: 34935925 PMCID: PMC8696569 DOI: 10.1001/jamanetworkopen.2021.40458] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Recent studies have reported conflicting findings regarding a potential association between analgesia used during labor and autism spectrum disorder in the offspring. OBJECTIVE To evaluate whether neuraxial labor analgesia increases the risk of autism spectrum disorder in the offspring. DESIGN, SETTING, AND PARTICIPANTS This cohort study included mother-child dyads who underwent vaginal delivery and were exposed to neuraxial labor analgesia. Delivery data were collected from the Medicaid Analytic eXtract (2005-2014) for mothers with public insurance and the IBM Health MarketScan Research Database (2005-2015) for mothers with private insurance. Data analysis was conducted from January to October 2021. EXPOSURES Presence of a procedure code indicating neuraxial labor analgesia. MAIN OUTCOMES AND MEASURES Children with autism spectrum disorder, identified using a validated algorithm (positive predictive value: 94% [95% CI, 83%-99%]). Cumulative incidence curves stratified by exposure were assessed using Kaplan-Meier analyses. Hazard ratios were estimated through Cox proportional hazards regression, using propensity-score fine stratification for confounding control. Estimates from both insurance cohorts were combined through fixed-effects meta-analysis. Subsequently, results from these analyses were combined with existing published studies. RESULTS The cohort of mother-child dyads with public insurance consisted of 910 696 deliveries (mean [SD] maternal age, 24.3 [5.7] years; 286 025 [31.4%] Black mothers; 374 282 [41.1%] White mothers), with 484 752 (53.2%) being exposed to neuraxial labor analgesia. The cohort of mother-child dyads with private insurance included 696 883 deliveries (mean [SD] maternal age, 31.0 [4.5] years; race and ethnicity data not available), with 513 347 (73.7%) being exposed. Cumulative incidence of autism spectrum disorder by 10 years of age was 1.93% (95% CI, 1.73%-2.13%) among children in the exposed group vs 1.64% (95% CI, 1.51%-1.76%) among children in the unexposed group in the publicly insured cohort. Respective numbers were 1.33% (95% CI, 1.19%-1.46%) and 1.19% (95% CI, 0.99%-1.38%) in the privately insured cohort. Adjusting for potential confounders and pooling across both cohorts resulted in a hazard ratio of 1.08 (95% CI, 1.02-1.15). Results were consistent when additionally adjusting for empirically identified variables through high-dimensional propensity score analyses (pooled hazard ratio, 1.07; 95% CI, 1.00-1.14) or expanding the cohorts to include cesarean deliveries and assisted vaginal deliveries (pooled hazard ratio, 1.07; 95% CI, 1.03-1.12). Meta-analysis of this study and recently published observational studies yielded similar findings with a pooled hazard ratio of 1.10 (95% CI, 1.06-1.13). CONCLUSIONS AND RELEVANCE Although a small increase in risk cannot be ruled out, the combined evidence from observational studies does not support the notion that neuraxial labor analgesia is associated with an increased risk of autism spectrum disorder.
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Affiliation(s)
- Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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15
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Expanded Perineal Coverage With Combined Pudendal and Inferior Cluneal Nerve Blocks: A Case Report. A A Pract 2021; 15:e01548. [PMID: 34807870 DOI: 10.1213/xaa.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pudendal nerve (PN) block is an effective regional technique for providing analgesia to the perineum. However, when the surgical site involves dermatomal areas lateral to the PN dermatome, additional blocks are necessitated. We present a case report of a 6-year-old female who presented for surgical resection of widespread condylomata accuminata involving the perineum and buttocks. Analgesia was achieved using a combined PN and inferior cluneal nerve block. To our knowledge, this is the first report of this combined technique used for perioperative analgesia.
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16
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Warner LL, Arendt KW, Theiler RN, Sharpe EE. Analgesic considerations for induction of labor. Best Pract Res Clin Obstet Gynaecol 2021; 77:76-89. [PMID: 34627722 DOI: 10.1016/j.bpobgyn.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 12/13/2022]
Abstract
Induction of labor may be indicated to minimize maternal and fetal risks. The rate of induction is likely to increase as recent evidence supports elective induction at 39 weeks gestation. We review methods of induction and then analgesic options as they relate to indications and methods to induce labor. We specifically focus on parturients at high risk for anesthetic complications including those requiring anticoagulation, and those with cardiac disease, obesity, chorioamnionitis, prior spinal instrumentation, elevated intracranial pressure, known or anticipated difficult airway, thrombocytopenia, and preeclampsia. Guidelines regarding timing of anticoagulation dosing with neuraxial anesthetic techniques have been defined through consensus statements. Early epidural placement may be beneficial in patients with cardiac disease, obesity, anticipated difficult airway, and HELLP syndrome. Questions remain regarding how early is too early for epidural placement, what options are safest for patients with bacteremia, and what pain relief should be offered to those unable to tolerate cervical exams in early labor.
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Affiliation(s)
- Lindsay L Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States.
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States
| | - Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st, St SW, Rochester, MN, United States
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17
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Yu PX, Bo LJ. Evaluation of efficacy and safety of propofol in the treatment of procedural sedation/anesthesia in neonates: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27147. [PMID: 34664839 PMCID: PMC8448078 DOI: 10.1097/md.0000000000027147] [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] [Received: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In newborns, propofol anesthesia is commonly utilized. Propofol is increasingly being shown to be effective and safe in treating procedural sedation and anesthesia in neonates. This research aims to evaluate the efficacy and safety of propofol in neonates using systematic review and meta-analysis methodologies. METHODS A thorough review and meta-analysis of studies on propofol anesthesia in neonates will be conducted. Conduct comprehensive searches in Web of Science, PubMed, Cochrane Library, EMBASE database, WanFang database, and Chinese biomedical literature database before May 25, 2021, to obtain published and qualified research. Two reviewers will assess the quality of the included papers and extract the data independently. Then, for meta-analysis, we will utilize RevMan 5.3 software. RESULTS This study will pool the data of separate trials to analyze the efficacy and safety of propofol in the treatment of procedural sedation/anesthesia in neonates. CONCLUSION Our findings will give strong data for determining whether propofol is an effective treatment for procedural anesthesia in neonates.
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Affiliation(s)
- Pei-Xia Yu
- Department of Anesthesiology, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li-Jun Bo
- The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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18
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The Effect of Epidural Nalbuphine Combined With Ropivacaine on Epidural Analgesia During Labor: A Multicenter, Randomized, Double-blind, Controlled Study. Clin J Pain 2021; 37:437-442. [PMID: 33758132 DOI: 10.1097/ajp.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The addition of a small dose of opioids during epidural labor analgesia can enhance the local analgesic effect, reduce the dose of local anaesthetic required, and minimize motor blockade. For the treatment of visceral pain, studies have shown that κ-opioid receptor agonist are more effective than μ-receptor agonists. This study compared the effectiveness of epidural nalbuphine and sufentanil in combination with ropivacaine for labor analgesia, respectively. MATERIALS AND METHODS We conducted a prospective, randomized, double-blind, multicentre clinical trial. Parturients who requested labor pain relief were randomly assigned to either the nalbuphine group or sufentanil group. After 5 minutes of initial dose, parturients in nalbuphine group received 10 mL 0.1% ropivacaine plus 0.3 mg/mL nalbuphine solution. The sufentanil group received the same ropivacaine dose plus 0.3 μg/mL sufentanil. The primary outcome was the duration of analgesia (the time to the first requirement for additional medication). Secondary outcomes included the ropivacaine dose per hour, and adverse reactions. RESULTS Between November 2018 and February 2019, 180 parturients were recruited for the study. The study showed that the duration of analgesia was shorter in the nalbuphine group as compared with the sufentanil group (P=0.040). The ropivacaine dose per hour in nalbuphine group 9.3 (2.4) mg was significantly greater versus sufentanil group 8.4 (2.5) mg (P=0.024). No serious adverse events directly associated with the analgesics were observed. DISCUSSION The analgesia effects of 0.3 mg/mL nalbuphine with ropivacaine are inferior to 0.3 μg/mL sufentanil with ropivacaine in labor analgesia. No serious side effects, either in the mother or in the fetus, were observed.
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19
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Rosseland LA, Reme SE, Simonsen TB, Thoresen M, Nielsen CS, Gran ME. Are labor pain and birth experience associated with persistent pain and postpartum depression? A prospective cohort study. Scand J Pain 2021; 20:591-602. [PMID: 32469334 DOI: 10.1515/sjpain-2020-0025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
Background and aims A considerable research-literature focuses on pain during labor and associations with postpartum persistent pain and depression, with findings pointing in various directions. The aim of this study was to examine the role of labor pain and overall birth experience in the development of pain and depression 8 weeks after delivery. Methods The study sample was drawn from the Akershus Birth Cohort. Data from multiple sources were used, including the hospital's birth record (n = 4,391), questionnaire data from gestational week 17 of pregnancy (n = 3,752), 8 weeks postpartum (n = 2,217), and two questions about pain and birth experience asked within 48 h after delivery (n = 1,221). The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain 8 weeks postpartum, while pain and birth experience were measured by numeric rating scales. A history of pre-pregnant depression and chronic pain were measured through self-report questions in gestational week 17. A total of 645 women had complete data from all sources. We applied multiple imputation techniques to handle missing responses on the two questions about pain and birth experience. Results The results showed that neither labor pain nor birth experience were associated with persistent pain 8 weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. A history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression 8 weeks after delivery. Conclusions and implications Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.
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Affiliation(s)
- Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Tone Breines Simonsen
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
| | - Magne Thoresen
- Oslo Centre of Biostatistics and Epidemiology, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Chronic Diseases and Ageing, National Institute of Public Health, Oslo, Norway
| | - Malin Eberhard Gran
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Department for Infant Mental Health, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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20
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Metzger L, Teitelbaum M, Weber G, Kumaraswami S. Complex Pathology and Management in the Obstetric Patient: A Narrative Review for the Anesthesiologist. Cureus 2021; 13:e17196. [PMID: 34540424 PMCID: PMC8439398 DOI: 10.7759/cureus.17196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 11/20/2022] Open
Abstract
Pregnant patients may present with multiple complex comorbidities that can affect peripartum management and anesthetic care. The preanesthesia clinic is the ideal setting for early evaluation of high-risk pregnant patients. Comorbidities may include cardiovascular pathology such as valvular abnormalities, septal defects, aortopathies, arrythmias and cardiomyopathies. Additional comorbidities include pulmonary conditions such as obstructive sleep apnea as well as preexisting neuromuscular and skeletal disorders that may impact anesthetic management. Hematologic conditions involving both bleeding diathesis and thrombophilias may present unique challenges for the anesthesiologist. Patients may also present with endocrinopathies including diabetes and obesity. While not as common, high-risk patients may also have preexisting gastrointestinal conditions such as liver dysfunction, renal failure, and even post-transplant status. Ongoing and prior substance abuse, obstetric conditions such as placenta accreta spectrum disorders, and fetal conditions needing ex utero Intrapartum treatment also require advanced planning. Preanesthesia evaluations also help address important ethical and cultural considerations. Counseling patients regarding anesthetic considerations as well as addressing concerns will play a role in reducing racial and ethnic disparities. Anticipatory guidance by means of pre-anesthetic planning can facilitate multidisciplinary communication and planning. This can allow for an impactful and meaningful role in the care provided, allowing for safe maternal care and optimal outcomes.
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Affiliation(s)
- Lia Metzger
- Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | - Garret Weber
- Anesthesiology, New York Medical College, Valhalla, USA
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21
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Whitburn LY, Jones LE. Looking for Meaning in Labour Pain: Are Current Pain Measurement Tools Adequate? PAIN MEDICINE 2021; 22:1023-1028. [PMID: 33200211 DOI: 10.1093/pm/pnaa380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura Yvette Whitburn
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Lester Edmund Jones
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia.,Singapore Institute of Technology, Singapore
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22
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Gitterman A, Klaus J, Williams K, Murphy J. Peripartum optimization and coordination of collaborative care practice: a critical role for the obstetric anesthesiologist in combating maternal morbidity and mortality. Curr Opin Anaesthesiol 2021; 34:205-211. [PMID: 33935167 DOI: 10.1097/aco.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Antenatal anesthesia clinics remain uncommon despite the rising incidence of maternal morbidity and mortality in the United States. The purpose of the present review is to outline the major considerations and challenges surrounding antenatal anesthetic evaluation. RECENT FINDINGS Data from the general surgical population would suggest a mortality benefit associated with preoperative anesthesia evaluation, although no such data exists in the obstetric population.Robust systems for case ascertainment and referral are needed. Recent publications on obstetric comorbidity indices may provide useful tools to ascertain high-risk parturients for a referral to antenatal obstetric anesthesiology clinics and higher levels of maternal care. Major obstetric organizations have identified and laid out criteria for maternal level of care. Anesthesiology resources also play a role in these designations and can help triage patients to facilities with appropriate resources. SUMMARY Obstetric anesthesiologists have a critical role not only in preoperative patient optimization but also in coordinating multidisciplinary care for optimal patient outcomes.
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Affiliation(s)
- Anna Gitterman
- Johns Hopkins Hospital, Department of Anesthesiology and Critical Care Medicine, Baltimore, Maryland, USA
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23
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Mu Y, Wang X, Wang Y, Liu Z, Li M, Li X, Li Q, Zhu J, Liang J, Wang H. The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence. BMC Med 2021; 19:74. [PMID: 33736635 PMCID: PMC7977606 DOI: 10.1186/s12916-021-01941-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 02/15/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China. METHODS We used the individual data from China's National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis. RESULTS Over the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04-2.26) and maternal near miss (aRR 1.35, 95% CI 1.08-1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel. CONCLUSIONS The national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.
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Affiliation(s)
- Yi Mu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Xiaodong Wang
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Zheng Liu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Mingrong Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Xiaohong Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Qi Li
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China
| | - Jun Zhu
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China.
| | - Juan Liang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Ren Min South Road Section 3 No.17, Chengdu, Sichuan, China.
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Ren J, Wang T, Yang B, Jiang L, Xu L, Geng X, Liu Q. Risk Factors and Safety Analyses for Intrapartum Fever in Pregnant Women Receiving Epidural Analgesia During Labor. Med Sci Monit 2021; 27:e929283. [PMID: 33720924 PMCID: PMC7976662 DOI: 10.12659/msm.929283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background We aimed to explore the factors leading to epidural-related maternal fever and the influence of intrapartum fever on neonates. Material/Methods A retrospective analysis was performed on data from pregnant women who received epidural analgesia during labor. The primary aim was to determine the influence of epidural labor analgesia on the incidence of intrapartum fever in pregnant women. The secondary aim was to determine the influence of intrapartum fever on neonates. Results Logistic regression analysis showed that premature rupture of membranes (OR=2.008, 95% CI: 1.551–2.600), vaginal examination performed more than 6 times (OR=1.681, 95% CI: 1.286–2.197), long duration of labor (OR=1.090, 95% CI: 1.063–1.118), and long time from rupture of membranes to delivery (OR=1.048, 95% CI: 1.010–1.087) were all risk factors for intrapartum fever in pregnant women with epidural labor analgesia. Regarding the secondary research outcome, the incidence of intrapartum fever was significantly associated with the number of neonates with Apgar score of 10 delivered from pregnant women with epidural labor analgesia (P<0.05). There was no statistically significant difference in the transfer rate of newborns to the Neonatal Intensive Care Unit (NICU) (P>0.05). Conclusions Premature rupture of membranes, vaginal examination performed more than 6 times, long duration of labor, and long time from rupture of membranes to delivery are all factors raising the risk of fever during epidural labor analgesia. Although intrapartum fever in the mothers had a significant influence on the number of neonates with Apgar score of 10, it did not affect the outcome of neonates in terms of NICU transfer rate.
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Affiliation(s)
- Jie Ren
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Tao Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Bo Yang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Lihua Jiang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Linglan Xu
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Xiaoyuan Geng
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Qian Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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Miao F, Feng K, Feng X, Fan L, Lang Y, Duan Q, Hou R, Jin D, Wang T. The Analgesic Effect of Different Concentrations of Epidural Ropivacaine Alone or Combined With Sufentanil in Patients After Cesarean Section. Front Pharmacol 2021; 12:631897. [PMID: 33692693 PMCID: PMC7937801 DOI: 10.3389/fphar.2021.631897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 01/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Patients experience moderate-high intensity postoperative pain after cesarean section (CS). The aim of this study was to investigate the optimal concentrations of ropivacaine and sufentanil for use in controlling pain after CS. Methods: One hundred and seventy-four women undergoing elective CS were randomly allocated to four groups. Epidural analgesia was administered with 0.1% ropivacaine in the R1 group, 0.15% ropivacaine in the R2 group, a combination of 0.1% ropivacaine and 0.5 μg/ml of sufentanil in the R1S group, and a combination of 0.15% ropivacaine and 0.5 μg/ml of sufentanil in the R2S group (at a basal rate of 4 ml/h, bolus dose of 4 ml/20 min as needed). Pain scores (numerical rating scale [NRS]: 0-10 cm) at rest (NRS-R), during movement (NRS-M), and when massaging the uterus (NRS-U) were documented at 6 and 24 h. We also recorded patient satisfaction scores, time to first flatus, motor deficits, and adverse drug reactions. Results: NRS (NRS-R, NRS-M, NRS-U) scores in the R2S group (2 [1-3], 4 [3-5], 6 [5-6], respectively) were lower than in the R1 group (3 [3-4], 5 [4-6], 7 [6-8], respectively) (p < 0.001, p < 0.05, p < 0.01, respectively) at 6 h; and patient satisfaction (9 [8-10]) was improved compared to the R1 group (8 [6-8]) (p < 0.01). The time to first flatus (18.7 ± 11.8 h) was reduced relative to the R1 group (25.9 ± 12.0 h) (p < 0.05). The time to first ambulation was not delayed (p > 0.05). However, the incidence of pruritus (4 [9.3%]) was increased compared to the R2 group (0 [0]) (p < 0.05) at 6 h, and the incidence of numbness (23 [53.5%], 23 [53.5%]) was increased compared to the R1 group (10 [23.3%], 10 [23.3%]) (all p < 0.01) at both 6 and 24 h. Conclusions: Although we observed a higher incidence of pruritus and numbness, co-administration of 0.15% ropivacaine and 0.5 μg/ml of sufentanil administered epidurally optimized pain relief after CS, with treated subjects exhibiting lower NRS scores, shorter time to first flatus, and higher patient-satisfaction scores.
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Affiliation(s)
- Fangfang Miao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuexin Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Long Fan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Lang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfang Duan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ruixue Hou
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Jin
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Hoffman S, Sidebottom A, Wrede J, Kreiger R, Watkins A, Taghon J. Association of Self-Administered Nitrous Oxide for Labor Analgesia With Maternal and Neonatal Process and Outcome Measures. J Obstet Gynecol Neonatal Nurs 2021; 50:154-166. [PMID: 33493464 DOI: 10.1016/j.jogn.2020.11.002] [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: 11/01/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To describe patterns of use of self-administered nitrous oxide (N2O) during labor and to determine if maternal and neonatal process and outcome measures differ for women who use N2O compared to women who do not use N2O. DESIGN Retrospective, full-census, observational cohort. SETTING An upper midwestern U.S., urban, 75-bed quaternary perinatal center with more than 5,000 annual births. PARTICIPANTS The participants included two groups of women: 400 who used N2O during labor and a comparison group of 6,733 who met N2O eligibility but did not use N2O. METHODS We used descriptive statistics to examine patterns of use of N2O during labor between January 2015 and March 2017. We examined associations of N2O with process (length of first and second stages of labor, time from hospital admission to birth, time from birth to hospital discharge, and total length of stay) and outcome measures (shoulder dystocia, instrumentation, vaginal lacerations, Apgar scores at 5 minutes, nursery disposition) using multivariate linear, logistic, and ordinal regression models. RESULTS Three percent (12/400) of women who used N2O discontinued because of side effects. Among participants with vaginal births who used N2O, 17.6% (62/352) used N2O as the only form of pain medication during labor. We found no significant differences in maternal and neonatal outcome measures between the two groups. Among the process measures examined, we found a mean 2-hour-longer time from admission to birth and total length of stay in the N2O group (p < .05) compared to the non-N2O group. CONCLUSION Most participants who used N2O (290/352, 82.3%) transitioned to other pain modalities during labor. Maternal and neonatal process and outcome measures were comparable relative to other pain management modalities, with the exception of longer time durations for two measures.
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Gupta R, Kaur G, Kaur J, Chawla S, Kaur S, Kullar KK, Aujla S. Evaluating the effectiveness of TENS for maternal satisfaction in laboring parturients - Comparison with epidural analgesia. J Anaesthesiol Clin Pharmacol 2021; 36:500-505. [PMID: 33840931 PMCID: PMC8022049 DOI: 10.4103/joacp.joacp_286_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/03/2019] [Accepted: 03/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Aims: Labor pain is one of the most severe pain that a woman experiences in her lifetime. Various methods are being used to relieve this pain and to achieve higher maternal satisfaction. One such technique is transcutaneous electrical nerve stimulation (TENS) that uses low-frequency electrotherapy. The aim of our study was to evaluate TENS by comparing it to an established labor analgesia technique, i.e., epidural analgesia in terms of maternal satisfaction. Material and Methods: This prospective study was conducted on 60 parturients in active stage of labor. The choice of analgesia was made by the parturient after informed consent. In group A (n = 30) TENS was used, while in group B (n = 30) epidural ropivacaine 0.125% + 2 μg/ml fentanyl was given. Continuous monitoring of maternal vitals, visual analogue score, and fetal heart rate (FHR) was done. Maternal satisfaction was scored considering pain relief, ability to move and experience of labor at the end of delivery and outcome was labeled as favorable and unfavorable. Results: TENS was found to be favorable in 90% of parturients as compared to 96.6% in epidural (P 0.301). The number of highly satisfied parturients was 4 (13.3%) in TENS group and 17 (56.6%) in the epidural group (P= 0.000). Three patients in the epidural group had assisted delivery and two had cesarean section whereas all patients in TENS group delivered normally (P= 0.065). No significant difference was found in the fetal outcome. Conclusions: TENS is a good alternate choice for providing labor analgesia and may have a major role in future.
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Affiliation(s)
- Ruchi Gupta
- Department of Anaesthesia, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Gaganjot Kaur
- Department of Anaesthesia, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Jasleen Kaur
- Department of Anaesthesia, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Sunil Chawla
- Department of Anaesthesia, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Shubhdeep Kaur
- Department of Anaesthesia, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Keerat K Kullar
- Department of Anaesthesia, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - S Aujla
- Department of Anaesthesia, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
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Souza MA, Cecatti JG, Guida JP, Souza JP, Gulmezoglu AM, Betran AP, R Torloni M, Vogel JP, Costa ML. Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health. Int J Gynaecol Obstet 2020; 152:401-408. [PMID: 33064850 DOI: 10.1002/ijgo.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/10/2020] [Accepted: 10/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the use of analgesia during labor in women who had a vaginal birth and to determine the factors associated with its use. METHODS A secondary analysis was performed of the WHO Multicountry Survey on Maternal and Newborn Health, a cross-sectional, facility-based survey including 359 healthcare facilities in 29 countries. The prevalence of analgesia use for vaginal birth in different countries was reported according to the Human Development Index (HDI). Sociodemographic and obstetric characteristics of the participants with and without analgesia were compared. The prevalence ratios were compared across countries, HDI groups, and regions using a design-based χ2 test. RESULTS Among the 221 345 women who had a vaginal birth, only 4% received labor analgesia, mainly epidural. The prevalence of women receiving analgesia was significantly higher in countries with a higher HDI than in countries with a lower HDI. Education was significantly associated with increased use of analgesia; nulliparous women and women undergoing previous cesarean delivery had a significantly increased likelihood of receiving analgesia. CONCLUSION Use of analgesia for women undergoing labor and vaginal delivery was low, specifically in low-HDI countries. Whether low use of analgesia reflects women's desire or an unmet need for pain relief requires further studies.
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Affiliation(s)
- Marcio A Souza
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose P Guida
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Joao P Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ahmet M Gulmezoglu
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana P Betran
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Joshua P Vogel
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Maternal and Child Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - Maria L Costa
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Zhao Y, Gao Y, Sun G, Yu L, Lin Y. The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study. BMC Pregnancy Childbirth 2020; 20:613. [PMID: 33045998 PMCID: PMC7552515 DOI: 10.1186/s12884-020-03294-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). METHODS NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. RESULTS The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p < 0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p>0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 (p < 0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p>0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p < 0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p>0.05). There was a negative correlation between the rate of NA and rate of overall CD, r = - 0.782 (95%CI [- 0.948, - 0.534], p<0.001), and between the utilization rate of NA and rate of MRCD, r = - 0.914 (95%CI [- 0.989, - 0.766], p<0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p>0.05). CONCLUSIONS Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.
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Affiliation(s)
- Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Ying Gao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Guoqiang Sun
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Ling Yu
- Department of Anesthesiology Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
| | - Ying Lin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070 China
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Morgan JA, Hankins ME, Wang Y, Hutchinson D, Sams HL, Voltz JH, McCathran CE, Kaye AD, Lewis DF. Prolonged Fetal Heart Rate Decelerations in Labor: Can We Reduce Unplanned Primary Cesarean Sections in This Group? Adv Ther 2020; 37:4325-4335. [PMID: 32839938 DOI: 10.1007/s12325-020-01468-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Non-reassuring fetal tracing is the second leading cause of primary cesarean delivery in the United States. Prolonged fetal heart rate decelerations are non-reassuring fetal heart rate characteristics, which do not uniformly predict poor fetal outcome but can prompt obstetricians to proceed with cesarean delivery. The objective of this manuscript is to identify a strategy to reduce the primary cesarean section rate in patients with prolonged fetal heart rate decelerations in labor. METHODS This is a retrospective cohort study over a 5-year period at an academic medical center, including patients undergoing primary cesarean section following labor induction, augmentation, or spontaneous labor who were noted to have prolonged fetal heart rate deceleration(s) in the 1 h prior to the time of delivery. Two groups were compared: "crash" cesarean sections versus "emergent" cesarean sections. The primary outcome was if fetal heart tones were rechecked in the operating room prior to cesarean section incision. Secondary outcomes included maternal-fetal monitoring versus Doppler fetal heart tones in the operating room, return to baseline noted in the operating room, fetal outcomes, fetal monitoring characteristics, and anesthesia type between crash versus emergent groups. RESULTS Of 1969 term singleton cesarean sections, 119 patients met our inclusion criteria (emergent group n = 80) (crash group n = 39), which accounted for 13.9% of all primary cesarean sections during the study period. The emergent group had a significantly higher rate of reassessment of fetal heart tones in the operating room n = 61 (76.2%) versus the crash group n = 15 (38.4%) (p ≤ 0.0001). There were no statistically significant differences regarding fetal outcomes between the two groups. The crash group had a higher rate of category 1 fetal heart rate tracing prior to the prolonged deceleration, a longer median prolonged deceleration, and a deeper median nadir of the prolonged deceleration; these differences were statistically significant. The prolonged-to-delivery interval was significantly shorter in the crash group (median = 15 min) than tin he emergent group (median = 33 min) (p ≤ 0.0001). The crash group also had a higher rate of general anesthesia (n = 11, 28.2%) than the emergent group (n = 6, 7.5%) (p = 0.002). The crash group was specifically investigated. Of the 15 patients with fetal heart tones rechecked in the crash group, 7 had returned to baseline in the operating room, but underwent cesarean section without fetal monitoring. CONCLUSION Our results indicate that the practice of placing patients on fetal monitor upon arrival to the operating room prior to performing crash cesarean delivery could reduce the rate of primary cesarean deliveries performed for prolonged decelerations in labor. When fetal heart tones have returned to baseline upon arrival in the operating room, the decision to proceed with cesarean delivery can be reconsidered. However, many clinical factors must be taken into consideration, and the decision to proceed is ultimately at the discretion of the obstetrics provider.
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Affiliation(s)
- John A Morgan
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - Miriam E Hankins
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - Yuping Wang
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - Donna Hutchinson
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - Hannah L Sams
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - John H Voltz
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - Charles E McCathran
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA.
| | - David F Lewis
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Shreveport, LA, USA
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Hill KL, Gross ME, Sutton KM, Mulcahey MK. Evaluation and Resuscitation of the Pregnant Orthopaedic Trauma Patient: Considerations for Maternal and Fetal Outcomes. JBJS Rev 2020; 7:e3. [PMID: 31841448 DOI: 10.2106/jbjs.rvw.19.00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kelly L Hill
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
| | - Maya E Gross
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
| | | | - Mary K Mulcahey
- Department of Orthopaedic Surgery (K.L.H. and M.K.M.), Tulane University School of Medicine (M.E.G.), New Orleans, Louisiana
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Meram MK, Pederson TS, Ouyang DW. Strip of the Month: Recurrent Late Decelerations in a Patient with HELLP Syndrome. Neoreviews 2020; 20:e48-e55. [PMID: 31261075 DOI: 10.1542/neo.20-1-e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mary K Meram
- Department of Obstetrics and Gynecology, Presence Resurrection Medical Center, Chicago, IL
| | | | - David W Ouyang
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL
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Wilson EH, Burkle CM. The Meaning of Consent and Its Implications for Anesthesiologists. Adv Anesth 2020; 38:1-22. [PMID: 34106829 DOI: 10.1016/j.aan.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Elizabeth H Wilson
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, B6/319 CSC, 600 Highland Avenue, Madison, WI 53792-3272, USA
| | - Christopher M Burkle
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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The analgesic effect of tramadol combined with butorphanol on uterine cramping pain after repeat caesarean section: a randomized, controlled, double-blind study. J Anesth 2020; 34:825-833. [PMID: 32627064 DOI: 10.1007/s00540-020-02820-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to explore the effect of patient-controlled intravenous analgesia (PCIA) using tramadol combined with butorphanol on uterine cramping pain in women undergoing repeat caesarean section. METHODS A total of 126 patients, who were scheduled to undergo repeat caesarean section under spinal anesthesia, were included. PCIA using tramadol combined with butorphanol or sufentanil was randomly performed for postoperative pain control. Postoperative uterine cramping pain and wound pain within 48 h after surgery were evaluated. Postoperative analgesic consumption, early activity time, and length of hospital stay were also recorded and analyzed. RESULTS Uterine cramping pain intensity in women undergoing repeat caesarean section was significantly higher compared with their wound pain (P < 0.05). The mean visual analog scale (VAS) score for uterine cramping pain in the tramadol-butorphanol group was significantly lower than that in the sufentanil group at rest, and at 6 h and 12 h after surgery. VAS scores for uterine cramping pain during movement at 6 h, 12 h, and 24 h after surgery in the tramadol-butorphanol group were also significantly lower than that in sufentanil group (P < 0.05). There was no significant difference in VAS score for wound pain at the different time points between the tramadol-butorphanol and sufentanil groups (P > 0.05). Patient-controlled intravenous analgesia with tramadol accelerated early rehabilitation and decreased the length of hospital stay (P < 0.05). CONCLUSION PCIA using tramadol combined with butorphanol provided a better analgesic effect and accelerated postoperative rehabilitation compared with sufentanil, and may be an optimal analgesic strategy for women undergoing repeat caesarean section. CLINICAL TRIAL REGISTRATION The trial was registered at Chinese Clinical Trial Registry ( www.chictr.org.cn ) with ID: ChiCTR-1800014986.
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Zhu HM, Li BY, Tang Z, She J, Liang XY, Dong LK, Zhang M. Epidemiological investigation of Helicobacter pylori infection in elderly people in Beijing. World J Clin Cases 2020; 8:2173-2180. [PMID: 32548147 PMCID: PMC7281052 DOI: 10.12998/wjcc.v8.i11.2173] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Helicobacter pylori (H. pylori) infection rate in China is approximately 50%. H. pylori is a pathogenic factor of peptic ulcer and chronic gastritis. In addition, H. pylori infection may also be associated with a variety of cardiovascular diseases in elderly people, such as arteriosclerosis, coronary heart disease, and cerebral infarction, having deleterious effect on their health. With the aging of the population, the disease characteristics of the elderly population have been increasingly valued by the whole society. We conducted an epidemiological survey of H. pylori infection among elderly people in Beijing to provide a basis for health management of H. pylori infection.
AIM To understand the epidemiological characteristics of H. pylori infection in elderly people in Beijing.
METHODS A total of 1090 elderly people aged more than 60 years from different parts of Beijing (urban and rural areas) were selected using the random cluster sampling method. Structured questionnaires were completed during home visits and the 13C-urea breath test was conducted for H. pylori detection.
RESULTS The prevalence of H. pylori infection was 46.5% (507/1090). The infection rate in men was 51.8%, which was significantly higher than that in women (42.5%; P < 0.05). The H. pylori infection rate in illiterate people was significantly higher than that in literate persons (53.5% vs 44.8%, P < 0.05). The total infection rate of H. pylori gradually increased with age and the difference was statistically significant (P < 0.01). The H. pylori infection rate in smokers was significantly higher than that in non-smokers and those who had quit smoking (P < 0.05).
CONCLUSION The prevalence of H. pylori infection among elderly people is 46.5% and the infection rate gradually increases with age. Sex, education level, age, and smoking were determined to be H. pylori infection risk factors. The relationship of H. pylori infection with region, occupation, drinking, and diet structure needs to be further studied.
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Affiliation(s)
- Hong-Ming Zhu
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Bang-Yi Li
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhe Tang
- National Geriatric Disease Clinical Medical Research Center, Xuanwu Hospital, Beijing 100053, China
| | - Jing She
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xue-Ying Liang
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Li-Kou Dong
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Mei Zhang
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Fiedler A, Brun R, Randegger D, Balsyte D, Zimmermann R, Haslinger C. Adverse effect of delayed pushing on postpartum blood loss in nulliparous women with epidural analgesia. Int J Gynaecol Obstet 2020; 150:92-97. [PMID: 32364638 DOI: 10.1002/ijgo.13175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/27/2018] [Accepted: 04/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test for an association between blood loss and time until pushing (TUP) after full cervical dilation in nulliparous women with epidural analgesia. METHODS A prospective cohort study was performed at the University Hospital of Zurich between October 2015 and November 2016. Included were 228 nulliparous women with singleton pregnancy, planned vaginal delivery after 36 completed weeks of gestation, epidural analgesia, and guided active pushing. TUP was defined as the interval between full cervical dilation and initiation of active pushing. The primary outcome measure was blood loss, assessed by the postpartum decrease in hemoglobin (ΔHb), estimated blood loss, and rate of ΔHb ≥30 g/L. Associations between TUP and primary and secondary maternal and neonatal delivery outcomes were assessed using Spearman correlation, Mann-Whitney U test, Kruskal-Wallis test, or Fisher exact test, as appropriate. RESULTS Longer TUP correlated significantly with increased ΔHb (ρ=0.142, P=0.033) and higher rates of ΔHb ≥30 g/l (P=0.002). Composite adverse maternal and neonatal outcomes were unaffected. CONCLUSION On the grounds of increased maternal blood loss, and in contrast to the current International Federation of Gynecology and Obstetrics (FIGO) guideline, delayed active pushing is not recommended in nulliparous women with epidural analgesia.
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Affiliation(s)
- Anton Fiedler
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Romana Brun
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | | | - Dalia Balsyte
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
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Meyers RS, Thackray J, Matson KL, McPherson C, Lubsch L, Hellinga RC, Hoff DS. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr Pharmacol Ther 2020; 25:175-191. [PMID: 32265601 DOI: 10.5863/1551-6776-25.3.175] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The safe use of medications in pediatric patients requires practitioners to consider the unique pharmacokinetics and pharmacodynamics of drugs prescribed in this age group. In an effort to create a standard of care for the safe use of medications in this population, a list of drugs that are potentially inappropriate for use in pediatric patients has been developed and titled the "KIDs List." METHODS A panel of 7 pediatric pharmacists from the Pediatric Pharmacy Association were recruited to evaluate primary, secondary, and tertiary literature; FDA Pediatric Safety Communications; the Lexicomp electronic database; and product information for drugs that should be considered potentially inappropriate for use in pediatric patients. Information was rated using predefined criteria. A PubMed search was conducted using the following terms: adverse drug events OR adverse drug reactions. The search was limited to humans; age <18 years; case reports, observational studies, or clinical trials; and English language. No date range was used. Results were used to create an evidence-based list of candidate drugs that was then peer-reviewed and subjected to a 30-day public comment period prior to being finalized. RESULTS A PubMed search yielded 4049 unique titles, of which 210 were deemed relevant for full review. Practitioner recommendations highlighted an additional 77 drugs. FDA Pediatric Safety Communications and the Lexicomp database yielded 22 and 619 drugs, respectively. After critical analysis, peer review, and public review the final KIDs List contains 67 drugs and/or drug classes and 10 excipients. CONCLUSIONS This extensive effort led to compilation of the first list of drugs that are potentially inappropriate for prescribing in all or in a select subgroup of pediatric patients. If avoidance is not clinically possible, the drug should be used with caution and accompanied by appropriate monitoring.
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Yang G, Bao X, Peng J, Li J, Yan G, Jing S, Li H, Duan G. Repeated Cesarean Delivery Predicted a Higher Risk of Inadequate Analgesia Than Primary Cesarean Delivery: A Retrospective Study with Propensity Score Match Analysis. J Pain Res 2020; 13:555-563. [PMID: 32256103 PMCID: PMC7090207 DOI: 10.2147/jpr.s229566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/07/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose This study aimed to compare the analgesic outcomes between primary and repeated cesarean delivery. Patients and Methods We performed a retrospective analysis based on the medical records of a teaching hospital in China from January 2018 to March 2019. We collected data on demographic characteristics, perioperative complications, anesthesia, and surgical factors for cesarean delivery patients. We also recorded the postoperative analgesic strategy, pain intensity (assessed by the number rating scale) during the first 48 hrs after surgery, hospital cost, and hospital stay. Postoperative inadequate analgesia was defined by a score of ≥ 4 in the number rating scale. Analgesic outcomes after cesarean delivery between primiparas and multiparas were compared using propensity score matching analysis. Moreover, subgroup logistic analysis for different age groups (≥ 35 and < 35 years) was performed to investigate the effect of the maternal category on postoperative inadequate analgesia. Results A total of 1543 patients were included in the analysis and 571 pairs (1142 patients) were matched in the primiparas and multiparaparas group according to their propensity score. In both the non-matched and matched cohort, the incidence of inadequate analgesia in the primiparas group was lower than that in the multiparas group (16.7% vs. 24.0%, P < 0.001 and 16.1% vs. 23.5%, P = 0.002; respectively). The multiparas group was identified as being at risk of inadequate analgesia after cesarean delivery in both age groups (age ≥ 35 years, odds ratio: 2.18, 95% confidence interval: 1.20–3.95; age < 35 years, odds ratio: 1.43, 95% confidence interval 1.08–1.89). Conclusion Multiparas that undergo a repeat cesarean delivery had a significantly higher risk of inadequate postoperative pain treatment than primiparas. The maternal category should be considered when formulating the postoperative analgesia strategy after cesarean delivery.
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Affiliation(s)
- Guiying Yang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Xiaohang Bao
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Jing Peng
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Jie Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Guangming Yan
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Sheng Jing
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Hong Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
| | - Guangyou Duan
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing 400037, People's Republic of China
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Park HY, Park YW, Hwang JW, Do SH, Na HS. The influence of preoperative epidural labor analgesia on postoperative pain in parturients undergoing emergency cesarean section : A retrospective analysis. Anaesthesist 2020; 69:352-358. [PMID: 32152737 DOI: 10.1007/s00101-020-00753-2] [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: 07/03/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intense noxious input from the periphery may result in central sensitization and hyperexcitability, thus accentuating subsequent postoperative pain. Parturients who undergo emergency cesarean section (C-sec) after experiencing labor pain often develop labor pain-induced sensitization. OBJECTIVE This retrospective study evaluated whether parturients without epidural labor analgesia (ELA) who underwent emergency C‑sec, experienced more severe postoperative pain and required more rescue analgesics during the postoperative period. METHODS The institution's medical database was searched for parturients who underwent emergency C‑sec under spinal anesthesia for any reason between January 2013 and December 2016. Those who underwent elective C‑sec under spinal anesthesia were included as the reference arm. Parturients were divided into three groups: ELA, no-ELA and elective. Characteristics of patients and perioperative outcomes were evaluated. As primary outcomes, numerical rating scale (NRS) for postoperative pain (0-10) was recorded up to 96 h postoperatively, and use of rescue analgesics was evaluated at 6, 24, and 48 h postoperatively. RESULTS In the ELA, no-ELA, and elective groups, 61, 73, and 88 parturients, respectively, were ultimately enrolled. The NRS for pain were similar among the three groups, except at 6 h postoperatively. Parturients in the no-ELA group demonstrated significantly higher NRS at 6 h postoperatively than those in the ELA group (P = 0.01).More patients in the no-ELA group required rescue analgesics than in the ELA (P = 0.001) and elective groups (P < 0.001) at 6-24 h postoperatively. Moreover, the proportion of patients requiring rescue analgesics ≥2 times was also significantly higher in the no-ELA group (vs. the ELA group, P = 0.004; vs. the elective group, P < 0.001). CONCLUSION Parturients undergoing emergency C‑sec without ELA management during labor experienced greater postoperative pain and a greater use of rescue analgesics during the postoperative period. The findings suggest that administration of ELA before emergency C‑sec may act as pre-emptive analgesia against postoperative pain.
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Affiliation(s)
- H-Y Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of).,Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Gachon, Korea (Republic of)
| | - Y-W Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)
| | - J-W Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)
| | - S-H Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of)
| | - H-S Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea (Republic of).
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Lipschuetz M, Nir EA, Cohen SM, Guedalia J, Hochler H, Amsalem H, Karavani G, Hochner-Celnikier D, Unger R, Yagel S. Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery. Acta Obstet Gynecol Scand 2020; 99:1039-1049. [PMID: 32031682 DOI: 10.1111/aogs.13822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. MATERIAL AND METHODS A retrospective electronic medical records-based study of 18 870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. RESULTS In primiparas, receiving EA correlated with longer medians of active first stage (+51 minutes; P < .001) and second stage (+55 minutes; P < .001). In multiparas, median increases in active first stage (+43 minutes; P < .001) and second stage (+8 minutes; P < .001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10 cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. CONCLUSIONS Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.
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Affiliation(s)
- Michal Lipschuetz
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Eshel A Nir
- Division of Anesthesiology & Critical Care, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Anesthesiology, Perioperative Medicine, and Pain Treatment, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sarah M Cohen
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Joshua Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Hila Hochler
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Amsalem
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gilad Karavani
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Simcha Yagel
- Division of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Zhi M, Diao Y, Liu S, Huang Z, Su X, Geng S, Shen L, Sun J, Liu Y. Sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2020; 76:501-506. [PMID: 31912188 DOI: 10.1007/s00228-019-02806-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/22/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE To systematically compare the efficacy and safety of sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia (CSEA), a systematic review and meta-analysis of randomized controlled trials targeting parturients requesting labor analgesia was conducted. METHODS The primary outcome measure was visual analog scale scores assessed at 10, 15, 30, and 60 min after intrathecal injection. Secondary outcomes included duration of spinal analgesia, incidence of side effects in parturients, and neonatal Apgar scores. RESULTS Twelve randomized controlled trials, including data from 881 patients fulfilled the inclusion criteria. No clinically meaningful differences in pain reduction after intrathecal injection were found between the two analgesics. Sufentanil extended the duration of spinal analgesia by 25.40 min (95% CI 21.82 to 28.98 min; p < 0.00001) compared with fentanyl. The risk for pruritus, nausea, and vomiting among parturients was 82% for those using sufentanil (relative risk 0.82 [95% CI 0.67-0.99]; p = 0.04) and 48% for those using fentanyl (relative risk 0.48 [95% CI 0.29-0.80]; p = 0.005). Both the synthesis results and sensitivity analysis demonstrated no differences in the risk for respiratory depression between parturients using sufentanil versus fentanyl. The neonates in sufentanil group exhibited higher Apgar scores than the fentanyl group 5 min after delivery (weighted mean difference 0.10 [95% CI 0.05-0.16]; p = 0.0002). CONCLUSION Existing evidence suggests that compared with fentanyl, sufentanil used for analgesia in combined spinal-epidural during labor is more effective in extending the duration of spinal analgesia, and may be safer for the infant. There was overall low clinical and statistical heterogeneity among the included studies. For all outcomes, variations caused by heterogeneity across trials were acceptable. Thus the findings of this meta-analysis may provide additional evidence for future clinical practices of pain relief in labor involving CSEA. Stronger evidence supporting this conclusion will require data from more high-quality and multicenter randomized controlled trials.
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Affiliation(s)
- Mengjia Zhi
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Yifan Diao
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Shiyang Liu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Zhiran Huang
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Xiawen Su
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Shuai Geng
- Beijing 306 Hospital, Beijing, 100101, People's Republic of China
| | - Le Shen
- Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Jing Sun
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China.
| | - Yuanli Liu
- School of Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People's Republic of China
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Duan G, Yang G, Peng J, Duan Z, Li J, Tang X, Li H. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol 2019; 19:189. [PMID: 31640565 PMCID: PMC6806491 DOI: 10.1186/s12871-019-0865-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 09/30/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The differences in post-operative pain are unclear between the primiparas who underwent a primary cesarean section and multiparas who underwent their first repeat cesarean section. The study aimed to explore the possible differences in postoperative pain between primiparas and multiparas. METHODS A prospective cohort study was performed only including women who underwent cesarean deliveries under spinal anesthesia. Postoperative patient-controlled intravenous analgesia (PCIA) was administered to all subjects with 0.2 mg/kg hydromorphone and 4 mg/kg flurbiprofen; the pump was programmed as 2.0 mL/h background infusion with a loading dose of 1 mL and a lockout period of 15 min. Postoperative incision and visceral pain intensity were evaluated using the visual analogue scale, and inadequate analgesia was defined as a visual analogue scale score ≥ 40 during 48 h post-operation. Additionally, the patients' pain statuses in postoperative week 1 and week 4 were also assessed during follow-up via telephone. RESULTS From January to May 2017, a total of 168 patients (67 primiparas and 101 multiparas) were included. The relative risk for multiparas to experience inadequate analgesia on incision pain was 0.42 (95% CI: 0.25 to 0.74) compared to primiparas. In patients aged < 30 years, inadequate analgesia on visceral pain was higher in multiparas than in primiparas (RR, 3.56 [1.05 to 12.04], P = 0.025). There was no significant difference in the combined incidence of inadequate analgesia in both types of pain between the multiparas and primiparas (33.7% vs. 40.2%, P = 0.381). No difference was found in PCIA use between the two groups (111.1 ± 36.0 mL vs. 110.9 ± 37.3 mL, P = 0.979). In addition, a significantly higher incidence of pain was noted 4 weeks post-surgery in primiparas than that in multiparas (62.2% vs. 37.7%, P = 0.011). CONCLUSION Multiparas who underwent their first repeat cesarean section have a lower for inadequate analgesia on incision pain during the first 48 h after surgery than primiparas. Multiparas aged under 30 years may be more prone to experiencing postoperative inadequate analgesia on visceral pain. TRAIL REGISTRATION ClinicalTrial.gov: NCT03009955 , Date registered: December 30, 2016.
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Affiliation(s)
| | | | - Jing Peng
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Zhenxin Duan
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Jie Li
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Xianglong Tang
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Hong Li
- Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
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Effect of delivery mode and anaesthesia methods on cardiac troponin T. J Gynecol Obstet Hum Reprod 2019; 49:101630. [PMID: 31499278 DOI: 10.1016/j.jogoh.2019.101630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 07/11/2019] [Accepted: 09/05/2019] [Indexed: 11/20/2022]
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Logtenberg S, Vink M, Godfried M, Beenakkers I, Schellevis F, Mol B, Verhoeven C. Serious adverse events attributed to remifentanil patient-controlled analgesia during labour in The Netherlands. Int J Obstet Anesth 2019; 39:22-28. [DOI: 10.1016/j.ijoa.2018.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 01/03/2023]
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Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide, 6th edition. Nurs Womens Health 2019; 23:e1-e22. [PMID: 30975290 DOI: 10.1016/j.nwh.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This education guide provides a framework for educational content and skills verification for nurses who care for women and their newborns in basic, high-risk, and critical care obstetric settings.
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Peretz H, Tal A, Garmi G, Zafran N, Romano S, Salim R. Impact of epidural on labor duration and vacuum deliveries in twin gestations. Midwifery 2019; 74:134-139. [PMID: 30953969 DOI: 10.1016/j.midw.2019.03.025] [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: 08/13/2018] [Revised: 02/08/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Epidural analgesia may lead to a prolonged second stage, and increased instrumental vaginal deliveries rate in singleton gestations. We aimed to examine the association between epidural and vacuum deliveries rate and second stage duration among twin deliveries. METHODS Retrospective study conducted at a single teaching hospital on data between January 1995 and December 2015. All twin pregnancies, >24 weeks that had a trial of labor were included. Twins with major malformations, intrauterine death, or had a caesarean delivery without a trial of labor, were excluded. Women were divided to those who had an epidural analgesia (group 1) and those who did not (group 2). Primary outcome was vacuum delivery rate. RESULTS Of all 1955 twin pregnancies delivered during the study period, 827 (42.3%) were eligible and included; 332 (40.1%) in group 1 and 495 (59.9%) in group 2. Vacuum delivery rate of any twin was 7.5% and 6.3% in groups 1 and 2, respectively (p = 0.48; Relative Risk 1.20; 95% Confidence Interval: 0.72-2.0). Vacuum delivery rate of first twin only or second twin only did not differ significantly as well. After adjusting for variables that differed significantly between the groups in univariate analysis, second stage duration of first and second twins in group 1 was significantly longer than in group 2 (p = 0.001; ratio=1.66; 95% Confidence Interval: 1.42-1.94 and p = 0.001; ratio=1.40; 95% Confidence Interval: 1.24-1.58, respectively). CONCLUSIONS Epidural use in twin deliveries did not affect vacuum deliveries rate. Epidural was associated with a prolonged second stage of both twins.
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Affiliation(s)
- Hadar Peretz
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gali Garmi
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Noah Zafran
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shabtai Romano
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Sananpanichkul P, Sawadhichai C, Leaungsomnapa Y, Yapanya P. Possible Role of Court-Type Thai Traditional Massage During Parturition: a Randomized Controlled Trial. Int J Ther Massage Bodywork 2019; 12:23-28. [PMID: 30854152 PMCID: PMC6398988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Court-type Thai traditional Massage (c-TTM) applied during intrapartum may have some benefit other than pain relief. This study aimed to evaluate the effect of c-TTM during the first and second stage of labor, as well as pain alleviation in the first stage. METHODS This was a randomized controlled trial study. Eligible participants were singleton pregnant mothers with cervical dilation between 3-5 cm and no medical complications. Both trial groups received the same routine antepartum care except for 1 hour additional c-TTM given to the experimental group when they were in the active phase of labor. The pain score was taken from the participants at the time before labor pains started, at the time of active labor, 1, 2, 3, and 4 hours after the intervention. Pain was recorded by the researcher using a visual analog scale. The primary outcome during the first and second stages of labor was compared between groups. Pain relief during the first stage of labor and analgesic drugs used were compared as a secondary outcome. This trial is registered under the identification number TCTR20171115003. RESULTS Fifty-nine participants were enrolled and randomly assigned with 1:1 allocation to groups. The duration of first and second stage labor was significantly shorter in the experimental c-TTM than in the conventional control group (mean ± SD: 198.37 ± 62.80 minutes: 268.52 ± 137.81 minutes, p value =.02 and 17.54 ± 9.49 minutes: 23.35 ± 15.01 minutes, p value =.03, respectively). There was no difference of pain score between the groups. CONCLUSION One hour of c-TTM can significantly decrease the duration of the first and second stages of labor. The pain score recorded is not statistically different between the groups.
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Affiliation(s)
- Panya Sananpanichkul
- Department of Obstetrics and Gynecology, Prapokklao Hospital, Chanthaburi, Thailand,Corresponding author: Panya Sananpanichkul, MD, Department of Obstetrics and Gynecology, Prapokklao Hospital, Chanthaburi 22000, Thailand,
| | | | - Yosapon Leaungsomnapa
- Department of Adult and Elderly Nursing, Prapokklao Nursing College, Chanthaburi, Thailand
| | - Paweena Yapanya
- Department of Thai Traditional Medicine and Alternative Medicine, Prapokklao Hospital, Chanthaburi, Thailand
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Analgesia during Labor and Vaginal Birth among Women with Severe Maternal Morbidity: Secondary Analysis from the WHO Multicountry Survey on Maternal and Newborn Health. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7596165. [PMID: 30895195 PMCID: PMC6393865 DOI: 10.1155/2019/7596165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/12/2019] [Accepted: 01/29/2019] [Indexed: 01/05/2023]
Abstract
Aim To evaluate the use of analgesia for vaginal birth, in women with and without severe maternal morbidity (SMM) and to describe sociodemographic, clinical, and obstetric characteristics and maternal and perinatal outcomes associated with labor analgesia. Methods Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHO-MCS), a global cross-sectional study performed between May 2010 and December 2011 in 29 countries. Women who delivered vaginally and had an SMM were included in this analysis and were then divided into two groups: those who received and those who did not receive analgesia for labor/delivery. We further compared maternal characteristics and maternal and perinatal outcomes between these two groups. Results From 314,623 women originally included in WHO-MCS, 9,788 developed SMM and delivered vaginally, 601 (6.1%) with analgesia and 9,187 (93.9%) without analgesia. Women with SMM were more likely to receive analgesia than those who did not experience SMM. Global distribution of SMM was similar; however, the use of analgesia was less prevalent in Africa. Higher maternal education, previous cesarean section, and nulliparity were factors associated with analgesia use. Analgesia was not an independent factor associated with an increase of severe maternal outcome (Maternal Near Miss + Maternal Death). Conclusions The overall use of analgesia for vaginal delivery is low but women with SMM are more likely to receive analgesia during labor. Social conditions are closely linked with the likelihood of having analgesia during delivery and such a procedure is not associated with increased adverse maternal outcomes. Expanding the availability of analgesia in different levels of care should be a concern worldwide.
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Abstract
The use of intermittent auscultation (IA) for fetal surveillance during labor decreased with the introduction of electronic fetal monitoring (EFM). The increased use of EFM is associated with an increase in cesarean births. IA is an evidence-based method of fetal surveillance during labor for women with low risk pregnancies and considered one component of comprehensive efforts to reduce the primary cesarean rate and promote vaginal birth. Many clinicians are not familiar with IA practice. This practice monograph includes information on IA techniques; interpretation and documentation; clinical decision-making and interventions; communication; education, staffing, legal issues, and strategies to promote implementation of IA into practice.
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Postoperative Opioid Consumption After Scheduled Compared With Unscheduled Cesarean Delivery. Obstet Gynecol 2019; 133:354-363. [DOI: 10.1097/aog.0000000000003087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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