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Ji C, Zhao J, Nie Q, Wang S. The role and outcomes of music therapy during pregnancy: a systematic review of randomized controlled trials. J Psychosom Obstet Gynaecol 2024; 45:2291635. [PMID: 38146963 DOI: 10.1080/0167482x.2023.2291635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION The abundant functions of music and its effects on human's mental and physical health have been verified since ancient times, but rarely received attention as an alternative obstetric intervention. OBJECTIVE This study aims to investigate the benefits of music therapy on prenatal and delivery experiences of pregnant women. METHOD A systematic search for articles was conducted in electronic databases including CINAHL, Web of Science, PubMed/Medline, and CNKI. A total of 240 articles were identified, and 17 studies were selected for this review. The extracted data included author, year, location, sample size, intervention phase, type of music, music therapy strategy, measuring instruments, and results. The data were organized chronologically based on the publication year of each study. RESULT The articles indicated that music therapy has advantages in reducing pain during childbirth, lowering anxiety and stress levels in mothers, improving sleep quality, and increasing fetal movements, basal fetal heart rate, and accelerations. CONCLUSION Based on the findings, it can be concluded that music therapy is an effective approach to enhance the experience of pregnant women during pregnancy and delivery. Therefore, its implementation in obstetrical clinical practice is highly recommended.
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Affiliation(s)
- Chao Ji
- Department of Obstetrics, Qingdao Municipal Hospital, Qingdao, China
| | - Jing Zhao
- Department of Obstetrics, Qingdao Municipal Hospital, Qingdao, China
| | - Qiaole Nie
- Musical anesthesia, Beijing Yuedi Music Analgesia Labor Institute, China
| | - Shuo Wang
- Labor Union, Qingdao Women and Children's Hospital, Qingdao, China
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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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Wu S, Lu Y, Zhang Z, Zhong L, Dai H, Fang C, Huang M, Liu Z, Wu L. Real-time analgesic efficacy and factors determining drug requirements of combined spinal-epidural analgesia for labor: a prospective cohort study. J Anesth 2024:10.1007/s00540-024-03368-8. [PMID: 38967786 DOI: 10.1007/s00540-024-03368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/20/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE Combined spinal-epidural analgesia (CSEA) is effective but not sufficient for labor pain. This study was conducted to assess the real-time analgesic efficacy, side effects of anesthetic drug dosage, and maternal satisfaction in labor to provide reference for the optimization of labor analgesia. METHODS This was a prospective, cohort, single-center study that included 3020 women who received CSEA for labor analgesia. The visual analogue scale (VAS) for labor pain, real-time anesthetic drug dosage, side effects, adverse labor outcomes, factors influencing average drug dosage, and maternal satisfaction with CSEA were assessed. RESULTS Overall, the VAS labor pain score was lowest at the first hour after the anesthesia was given. After 4 h for primiparas and 3 h for multiparas, the VAS score was greater than 3 but the anesthetic drug dosage did not reach the maximum allowed dosage at the same time. The average anesthetic drug dosage was positively correlated with fever, urinary retention, uterine atony, prolonged active phase, prolonged second stage, assisted vaginal delivery, and postpartum hemorrhage. The average anesthetic drug dosage was the highest in women ≤ 20 years old, those with a body mass index (BMI) ≥ 24.9 kg/m2, and those with a primary or secondary education level. CONCLUSION Appropriate age guidance and emphasis on education of labor analgesia, weight management during pregnancy, and real-time anesthetic dosage adjustment during labor based on VAS pain score may have positive effects on the satisfaction of labor analgesia. CLINICAL TRIAL NUMBER AND REGISTRY Clinicaltrials.gov (ChiCTR2100051809).
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Affiliation(s)
- Shuzhen Wu
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Yaxin Lu
- Big Data and Artificial Intelligence Center, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, Guangdong, 510630, China
| | - Zijing Zhang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Linjia Zhong
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Hongfei Dai
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Changping Fang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Minli Huang
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China
| | - Zifeng Liu
- Big Data and Artificial Intelligence Center, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, Guangdong, 510630, China
| | - Lingling Wu
- The Department of Obstetrics and Gynecology, The Third Affiliated Hospital Sun Yat-Sen University, No. 600 Tianhe Road, Tianhe District Guangzhou, Guangdong, China.
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Allert R, Brüggmann D, Raimann FJ, Zander N, Louwen F, Jennewein L. The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis. Arch Gynecol Obstet 2024; 310:261-268. [PMID: 37982831 PMCID: PMC11169086 DOI: 10.1007/s00404-023-07244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/20/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there's little evidence and recommends further evaluation. OBJECTIVE The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia. DESIGN This study was a retrospective cohort study. SAMPLE This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018. METHODS Neonatal and maternal outcome was analyzed and compared between women receiving "walking" epidural anesthesia and women without an epidural anesthesia. RESULTS Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)". CONCLUSION Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.
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Affiliation(s)
- Roman Allert
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany.
| | - Dörthe Brüggmann
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Florian J Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Nadja Zander
- Department of Midwifery Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Lukas Jennewein
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
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Chen Y, Chen H, Yuan C. Comparative efficacy of opioid and non-opioid analgesics in labor pain management: A network meta-analysis. PLoS One 2024; 19:e0303174. [PMID: 38889108 PMCID: PMC11185472 DOI: 10.1371/journal.pone.0303174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/20/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Effective labor pain management is crucial for parturient well-being, as it can improve the delivery experience of pregnant women and reduce anxiety and tension. This systematic review and network meta-analysis compared the efficacy and safety of various analgesics, classified by drug category and individual treatment methods, for labor pain control. METHODS A comprehensive literature search was conducted in Pubmed, EMBASE, Cochrane Library, and Web of Science databases. All searches commenced from the database's inception to the date of the literature search (May 31, 2023). The Cochrane Risk of Bias 2 tool assessed study bias risk. Network meta-analyses using a random-effects model and odds ratios (ORs) with 95% confidence intervals (CIs) were performed. RESULTS Fifteen randomized controlled trials evaluating analgesic interventions in ASA I or II parturients were included. Combination therapies (OR: 5.81; 95% CI, 3.76-7.84; probability: 60%) and non-opioid analgesics (OR: 5.61; 95% CI, 2.91-8.30; probability: 39.2%) were superior to placebo for labor pain relief. Specifically, dexmedetomidine/ropivacaine/sufentanil (OR: 7.32; 95% CI, 2.73-11.89; probability: 40.6%) and dexmedetomidine/ropivacaine (OR: 6.50; 95% CI, 2.51-10.33; probability: 11.9%) combinations, bupivacaine/fentanyl and ropivacaine/sufentanil combinations, and remifentanil monotherapy showed improved analgesic efficacy versus placebo. Dexmedetomidine/ropivacaine reduced parturient nausea and vomiting versus alternatives. CONCLUSION Non-opioids, opioids and combinations thereof effectively relieved labor pain. In addition, dexmedetomidine/ropivacaine combination demonstrated analgesic efficacy and lower nausea and vomiting incidence.
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Affiliation(s)
- Yiru Chen
- Department of Clinical Medicine, School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
| | - Hongchun Chen
- Department of Clinical Medicine, School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Chunhui Yuan
- Department of Clinical Medicine, School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
- Key Laboratory of Novel Targets and Drug Study for Neural Repair of Zhejiang Province, School of Medicine, Hangzhou City University, Hangzhou, Zhejiang, China
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Wiesmann C, Horky A, Hentrich A, Bahlmann F, Louwen F, Al Naimi A. The influence of epidural analgesic techniques on obstetrical outcomes. Arch Gynecol Obstet 2024:10.1007/s00404-024-07591-2. [PMID: 38880792 DOI: 10.1007/s00404-024-07591-2] [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: 04/02/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The aim of this study is to compare and evaluate the obstetrical differences between three techniques, including the programmed intermittent epidural bolus (PIEB), the patient-controlled epidural analgesia (PCEA), and the continuous epidural analgesia (CEA). METHODS This is a retrospective cohort study that investigates the obstetrical outcomes of 2240 patients who received EA during labor in a tertiary maternal unit over the course of 9 years (2011-2018). The only inclusion criterion was the use of epidural analgesia during childbirth and the only exclusion criteria were multiplets' gestation. Multivariate logistic regression, Kruskal-Wallis test, and the log-rank test were utilized to compare the differences between the three EA techniques in terms of cesarean section rate, the incidence of perineal tears, the use of Oxytocin, the duration of labor, and the incidence of paresthesia. RESULTS Out of the 2240 included deliveries; 1084 utilized PIEB, 1086 PCEA, and 70 CEA techniques. The incidence of Cesarean section was the highest in the CEA group (45.7%) compared to PIEB (24.8%) and PCEA (24.4%) P < 0.001. A significantly shorter duration of labor (vaginal delivery) was observed in the PCEA group (n: 821, 336.7 min) compared to the PIEB group (n: 814, 368.8 min) P < 0.001. There were no statistically significant differences in the incidence of perineal tears, the need of uterotonics, and the incidence of paresthesia. CONCLUSION The results of this study indicate that the PIEB and PCEA techniques are superior to the CEA technique when it comes to analgesia during childbirth. In this study, the PCEA technique seems to be the best-suited technique for childbirth, since it had a significantly shorter duration of labor than the PIEB technique.
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Affiliation(s)
- Christian Wiesmann
- Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Alex Horky
- Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany
| | - Anna Hentrich
- Department of Obstetrics, Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Franz Bahlmann
- Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany
| | - Frank Louwen
- Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Department of Obstetrics, Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ammar Al Naimi
- Department of Gynecology and Obstetrics, School of Medicine, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
- Department of Gynecology and Obstetrics, Buergerhospital, Nibelungenallee 37-41, 605318, Frankfurt, Germany.
- Department of Obstetrics, Goethe-University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Qamar J, Mansoor M, Jabbar S, Khan MW. Analgesia in labour: a necessity or a privilege. Arch Gynecol Obstet 2024; 309:2943-2944. [PMID: 38528265 DOI: 10.1007/s00404-024-07485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Jaazba Qamar
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Mahnoor Mansoor
- Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan
| | - Shagufta Jabbar
- Gyneacology and Obstetrics Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Muhammad Waqas Khan
- Orthopedic Department, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, Pakistan.
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Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide, 7th Edition. Nurs Womens Health 2024; 28:e17-e44. [PMID: 38551535 DOI: 10.1016/j.nwh.2024.02.001] [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: 05/26/2024]
Abstract
This guide has been prepared by the AWHONN Task Force to revise the AWHONN Education Guide, Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide. Education guides are reviewed periodically. This guide is not intended to be exhaustive; other sources of information and guidance are available and should be consulted. This guide is intended to encourage systematic education and ongoing skill development in basic, high-risk, and critical care obstetrics during the intrapartum period, immediate postpartum period, and newborn transition. It is not designed to define standards of practice for employment, licensure, discipline, legal, or other purposes. Variations and innovations that demonstrably improve the quality of patient care are encouraged.
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Janipour M, Bastaninejad S, Mohebbi A, Amali A, Owji SH, Jazi K, Mirali RA, Moshfeghinia R. Dexmedetomidine versus remifentanil in nasal surgery: a systematic review and meta-analysis. BMC Anesthesiol 2024; 24:194. [PMID: 38816731 PMCID: PMC11138079 DOI: 10.1186/s12871-024-02563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Nasal surgeries, addressing anatomical variations for form and function, require careful anesthesia administration, including dexmedetomidine and remifentanil. This meta-analysis evaluates their safety and efficacy variations in nasal surgeries, emphasizing patient comfort and optimal outcomes. METHODS Four electronic databases (PubMed, Scopus, Web of Science, and CINAHL Complete) were searched for records in English. Studies that measure the effect of dexmedetomidine versus remifentanil on patients underwent nasal surgery were included. The Cochrane Collaboration's tool was used to assess the quality of the included studies. A random-effect model was preferred and statistical analysis was performed by Stata software version 17. RESULTS Out of an initial pool of 63 articles, five studies were selected for this analysis. All of these chosen studies were Randomized Controlled Trials (RCTs). The meta-analysis involved a total of 302 participants, with 152 in the remifentanil group and 150 in the dexmedetomidine group. The analysis aimed to compare the effects of Dexmedetomidine and Remifentanil on heart rate (HR) and mean arterial pressure (MAP) during surgery. Both groups exhibited similar MAP and HR, with the exception of a slightly lower HR in the remifentanil group at the 15th minute of surgery (Standardized Mean Difference: -0.24 [-0.83, 0.34]). Furthermore, when evaluating the impact of these medications on post-surgery outcomes, including pain levels, the use of pain relief medications, patient-surgeon satisfaction, agitation scores, and recovery time, no significant differences were observed between the two medications in any of these aspects. CONCLUSION In summary, the study compared Dexmedetomidine and Remifentanil in nasal surgeries anesthesia. No significant differences were found in heart rate, blood pressure, satisfaction, pain, agitation, or recovery time. The study had limitations, and future research should establish standardized protocols and consider various surgical factors.
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Affiliation(s)
- Masoud Janipour
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahin Bastaninejad
- Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mohebbi
- ENT and Head and Neck Research Center and Department, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Amali
- Otorhinolaryngology Research Center, Otorhinolaryngology Head and Neck Surgery Department, Imam Khomeni Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hossein Owji
- Otolaryngology Research Centre, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kimia Jazi
- Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
| | | | - Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
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Huang L, Hu N, Jiang L, Xiong X, Shi J, Chen D. Appraisal of clinical practice guidelines and consensus statements on obstetric anaesthesia: a systematic review using the AGREE II instrument. BMJ Open 2024; 14:e084759. [PMID: 38806417 PMCID: PMC11138284 DOI: 10.1136/bmjopen-2024-084759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVES Despite the publication of hundreds of trials on obstetric anaesthesia, the management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for obstetric anaesthesia. DESIGN This is a systematic review and quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) II methodology. DATA SOURCES Data sources include PubMed and Embase (8 June 2023), three Chinese academic databases, six guideline databases (7 June 2023) and Google and Google scholar (1 August 2023). ELIGIBILITY CRITERIA We included the latest version of international and national/regional clinical practice guidelines and consensus statements for the anaesthetic management of pregnant patients during labour, non-operative delivery, operative delivery and selected aspects of perioperative monitoring, postpartum care and analgesia, published in English or Chinese. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid. RESULTS Twenty-two guidance documents (14 clinical practice guidelines and 8 consensus statements) were included. Included documents performed well in the domains of scope and purpose (median 76.4%, IQR 69.4%-79.2%) and clarity of presentation (median 72.2%, IQR 61.1%-80.6%), but were unsatisfactory in applicability (median 21.9%, IQR 13.5%-27.1%) and editorial independence (median 47.9%, IQR 6.3%-73.2%). The majority of obstetric anaesthesia guidelines or consensus centred on different topics. Less than 30% of them specifically addressed the management of obstetric anaesthesia perioperatively. Recommendations were concordant on the perioperative preparation, and on some indications for the choice of anaesthesia method. Substantially different recommendations were provided for some items, especially for preoperative blood type and screen, and for the types and doses of neuraxial administration. CONCLUSIONS The methodological quality in guidance documents for obstetric anaesthesia necessitates enhancement. Despite numerous trials in this area, evidence gaps persist for specific clinical queries in this field. One potential approach to mitigate these challenges involves the endorsement of standardised guidance development methods and the synthesis of robust clinical evidence, aimed at diminishing difference in recommendations.
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Affiliation(s)
- Lu Huang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Na Hu
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ling Jiang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xinglong Xiong
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jing Shi
- Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Dongxu Chen
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Kearns RJ, Kyzayeva A, Halliday LOE, Lawlor DA, Shaw M, Nelson SM. Epidural analgesia during labour and severe maternal morbidity: population based study. BMJ 2024; 385:e077190. [PMID: 38777357 PMCID: PMC11109902 DOI: 10.1136/bmj-2023-077190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To determine the effect of labour epidural on severe maternal morbidity (SMM) and to explore whether this effect might be greater in women with a medical indication for epidural analgesia during labour, or with preterm labour. DESIGN Population based study. SETTING All NHS hospitals in Scotland. PARTICIPANTS 567 216 women in labour at 24+0 to 42+6 weeks' gestation between 1 January 2007 and 31 December 2019, delivering vaginally or through unplanned caesarean section. MAIN OUTCOME MEASURES The primary outcome was SMM, defined as the presence of ≥1 of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, with either occurring at any point from date of delivery to 42 days post partum (described as SMM). Secondary outcomes included a composite of ≥1 of the 21 CDC conditions and critical care admission (SMM plus critical care admission), and respiratory morbidity. RESULTS Of the 567 216 women, 125 024 (22.0%) had epidural analgesia during labour. SMM occurred in 2412 women (4.3 per 1000 births, 95% confidence interval (CI) 4.1 to 4.4). Epidural analgesia was associated with a reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), SMM plus critical care admission (0.46, 0.29 to 0.73), and respiratory morbidity (0.42, 0.16 to 1.15), although the last of these was underpowered and had wide confidence intervals. Greater risk reductions in SMM were detected among women with a medical indication for epidural analgesia (0.50, 0.34 to 0.72) compared with those with no such indication (0.67, 0.43 to 1.03; P<0.001 for difference). More marked reductions in SMM were seen in women delivering preterm (0.53, 0.37 to 0.76) compared with those delivering at term or post term (1.09, 0.98 to 1.21; P<0.001 for difference). The observed reduced risk of SMM with epidural analgesia was increasingly noticeable as gestational age at birth decreased in the whole cohort, and in women with a medical indication for epidural analgesia. CONCLUSION Epidural analgesia during labour was associated with a 35% reduction in SMM, and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health.
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Affiliation(s)
- Rachel J Kearns
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Aizhan Kyzayeva
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Lucy O E Halliday
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Science, University of Bristol, Bristol, UK
| | - Martin Shaw
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
- Department of Medical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
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Starosta A, Lundsberg L, Culhane J, Partridge C, Grechukhina O, Son M. Association Between Intrapartum Nitrous Oxide for Labor Analgesia and Short-Term Neonatal Outcomes. Obstet Gynecol 2024; 143:677-682. [PMID: 38484306 DOI: 10.1097/aog.0000000000005554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To evaluate the association between intrapartum nitrous oxide use and adverse short-term neonatal outcomes. METHODS This was a retrospective cohort study of individuals with singleton gestations at 35 or more weeks who attempted labor and delivered at an academic hospital between June 1, 2015, and February 28, 2020. Data were extracted from the electronic medical record using billing and diagnostic codes. Patients were classified based on whether they received no intrapartum analgesia or received nitrous oxide only. Those who received other analgesia types were excluded. The primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included Apgar score less than 7 at 1 minute and 5 minutes, respiratory composite outcome (including meconium aspiration syndrome, neonatal bronchopulmonary disorders, neonatal transient tachypnea, and other neonatal respiratory distress that required NICU admission), hypoglycemia, and hyperbilirubinemia. Univariable and multivariable analyses were used to estimate the association between nitrous oxide exposure intrapartum and the selected outcomes. RESULTS Of 6,047 included, 4,153 (68.7%) received no analgesia, and 1,894 (31.3%) received nitrous oxide only. In comparison with individuals who received no analgesia, those who received nitrous oxide were more likely to be nulliparous, be of Black racial identity, have noncommercial insurance, and be less likely to deliver by intrapartum cesarean. The reception of nitrous oxide, compared with the reception of no analgesia, was associated with a lower likelihood of NICU admission (6.4% vs 8.1%; adjusted odds ratio [aOR] 0.77, 95% CI, 0.62-0.96) and an increased likelihood of neonatal hyperbilirubinemia (aOR 1.23, 95% CI, 1.08-1.41). Inhaled nitrous oxide exposure, in comparison with the reception of no analgesia, was not associated with the other secondary outcomes, including Apgar score less than 7 at 1 minute (odds ratio [OR] 0.74, 95% CI, 0.50-1.10) or 5 minutes (OR 0.91, 95% CI, 0.32-2.60), respiratory composite outcome (OR 0.91, 95% CI, 0.70-1.17), and hypoglycemia (OR 0.82, 95% CI, 0.64-1.05). CONCLUSION In this single-center retrospective cohort of low-risk patients, intrapartum inhaled nitrous oxide, compared with the reception of no analgesia, was associated with a decreased risk for NICU admission but with an increased risk for hyperbilirubinemia; other outcomes did not differ. These findings may be used to counsel patients when considering nitrous oxide for labor analgesia.
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Affiliation(s)
- Anabel Starosta
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; and the Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, New York
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13
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Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide, 7th Edition. J Obstet Gynecol Neonatal Nurs 2024; 53:e49-e76. [PMID: 38551543 DOI: 10.1016/j.jogn.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
This guide has been prepared by the AWHONN Task Force to revise the AWHONN Education Guide, Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide. Education guides are reviewed periodically. This guide is not intended to be exhaustive; other sources of information and guidance are available and should be consulted. This guide is intended to encourage systematic education and ongoing skill development in basic, high-risk, and critical care obstetrics during the intrapartum period, immediate postpartum period, and newborn transition. It is not designed to define standards of practice for employment, licensure, discipline, legal, or other purposes. Variations and innovations that demonstrably improve the quality of patient care are encouraged.
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14
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Halliday L, Shaw M, Kyzayeva A, Lawlor DA, Nelson SM, Kearns RJ. Socio-economic disadvantage and utilisation of labour epidural analgesia in Scotland: a population-based study †. Anaesthesia 2024; 79:473-485. [PMID: 38359539 DOI: 10.1111/anae.16236] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 02/17/2024]
Abstract
Socio-economic deprivation is associated with adverse maternal and childhood outcomes. Epidural analgesia, the gold standard for labour analgesia, may improve maternal well-being. We assessed the association of socio-economic status with utilisation of epidural analgesia and whether this differed when epidural analgesia was advisable for maternal safety. This was a population-based study of NHS data for all women in labour in Scotland between 1 January 2007 and 23 October 2020, excluding elective caesarean sections. Socio-economic status deciles were defined using the Scottish Index of Multiple Deprivation. Medical conditions for which epidural analgesia is advisable for maternal safety (medical indications) and contraindications were defined according to national guidelines. Of 593,230 patients in labour, 131,521 (22.2%) received epidural analgesia. Those from the most deprived areas were 16% less likely to receive epidural analgesia than the most affluent (relative risk 0.84 [95%CI 0.82-0.85]), with the inter-decile mean change in receiving epidural analgesia estimated at -2% ([95%CI -2.2% to -1.7%]). Among the 21,219 deliveries with a documented medical indication for epidural analgesia, the socio-economic gradient persisted (relative risk 0.79 [95%CI 0.75-0.84], inter-decile mean change in receiving epidural analgesia -2.5% [95%CI -3.1% to -2.0%]). Women in the most deprived areas with a medical indication for epidural analgesia were still less likely (absolute risk 0.23 [95%CI 0.22-0.24]) to receive epidural analgesia than women from the most advantaged decile without a medical indication (absolute risk 0.25 [95%CI 0.24-0.25]). Socio-economic deprivation is associated with lower utilisation of epidural analgesia, even when epidural analgesia is advisable for maternal safety. Ensuring equitable access to an intervention that alleviates pain and potentially reduces adverse outcomes is crucial.
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Affiliation(s)
- L Halliday
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - M Shaw
- Department of Medical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Kyzayeva
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - D A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - S M Nelson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - R J Kearns
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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15
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DeJoy S, Killeen C, Jackson-Köhlin D, Psaltis A, Knee A. Nitrous Oxide Use for Pain in Labor, Conversion to Neuraxial Anesthesia and Birth Outcome. J Midwifery Womens Health 2024. [PMID: 38678432 DOI: 10.1111/jmwh.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/06/2024] [Indexed: 04/30/2024]
Abstract
INTRODUCTION A variety of labor pain management options is essential to patients and their care providers. Inhaled, patient controlled nitrous oxide (N2O) is a valuable addition to these options. The purpose of this study was to examine laboring patient, newborn, and provider characteristics associated with N2O use for pain relief in labor and to examine the association between N2O, conversion to neuraxial analgesia, and cesarean birth. METHODS This was a retrospective observational cohort study of the first year of N2O use in one large academic medical center. Patients at least 37 weeks' gestation who were admitted for labor with intended vaginal birth from August 1, 2018, to June 30, 2019, were included (N = 2605). Laboring patient and newborn factors and their relationship to N2O use were calculated as unadjusted and adjusted relative risks (RRs). Poisson regression was used to model the association between N2O use and subsequent use of neuraxial analgesia and type of birth for both nulliparous and multiparous patients. RESULTS Overall, 20.2% of patients used N2O during labor. Multiparous patients were 24% less likely to use N2O than nulliparous patients (RR, 0.76; 95% CI, 0.69-0.84). Use of N2O did not differ significantly between patients cared for by midwives compared with patients cared for by physicians (RR, 0.95; 95% CI, 0.90-1.00). In multivariable modeling, N2O use in multiparous patients was associated with a 17% decrease in use of neuraxial analgesia (RR, 0.83; 95% CI, 0.73-0.94). There was no association between N2O use and use of neuraxial analgesia in nulliparous patients (RR, 0.99; 95% CI, 0.93-1.06). N2O use was not associated with cesarean birth in either group. DISCUSSION N2O is an important pain management option for laboring patients and those who care for them. Study results may assist midwives, physicians, and nurses in counseling patients about analgesia options.
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Affiliation(s)
- Susan DeJoy
- Division of Midwifery, Baystate Medical Center, Springfield, Massachusetts
- Department of Obstetrics and Gynecology, UMass Chan Medical School - Baystate, Springfield, Massachusetts
| | - Candice Killeen
- Midwifery Education Program, Baystate Medical Center, Springfield, Massachusetts
- Eden Birth and Wellness, Rogers, Arkansas
| | - Donna Jackson-Köhlin
- Division of Midwifery, Baystate Medical Center, Springfield, Massachusetts
- Department of Obstetrics and Gynecology, UMass Chan Medical School - Baystate, Springfield, Massachusetts
| | - Audrey Psaltis
- Division of Midwifery, Baystate Medical Center, Springfield, Massachusetts
- Department of Obstetrics and Gynecology, UMass Chan Medical School - Baystate, Springfield, Massachusetts
| | - Alexander Knee
- Epidemiology/Biostatistics Research Core, Office of Research, Baystate Medical Center, Springfield, Massachusetts
- Department of Medicine, UMass Chan Medical School - Baystate, Springfield, Massachusetts
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16
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Zamstein O, Sheiner E, Binyamin Y, Pariente G, Wainstock T. Examining the relationship between autism spectrum disorder in children whose mother had labour epidural analgesia for their birth: A retrospective cohort study. Eur J Anaesthesiol 2024; 41:282-287. [PMID: 38084085 DOI: 10.1097/eja.0000000000001932] [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: 03/02/2024]
Abstract
BACKGROUND Controversy exists regarding the association between autism spectrum disorder (ASD) in children whose mother had labour epidural analgesia for their birth, as the few existing investigations have reported mixed findings. OBJECTIVE This study aims to evaluate the possibility of an association in our heterogeneous population. DESIGN A retrospective population-based cohort study. SETTING Vaginal deliveries that took place between the years 2005 and 2017 at Soroka University Medical Center, a tertiary referral hospital in Israel, and a follow-up on the incidence of ASD in the children. PATIENTS A hundred and thirty-nine thousand, nine hundred and eighty-one labouring patients and their offspring. MAIN OUTCOME MEASURES The incidence of children diagnosed with ASD (both hospital and community-based diagnoses) was compared based on whether their mothers had received labour epidural analgesia during their labour. A Kaplan-Meier survival curve compared cumulative incidence of ASD. A Cox proportional hazards model was used to control for relevant confounders. RESULTS Labour epidural analgesia was administered to 33 315 women. Epidural analgesia was more common among high-risk pregnancy groups (including pregnancies complicated with diabetes mellitus, hypertensive disorders, intrauterine growth restriction, and oligohydramnios; P < 0.001). In a Cox proportional hazards model, the association between epidural analgesia during labour and ASD in the children lost statistical significance following adjustment for confounders such as maternal age, gestational age, hypertensive disorders, diabetes mellitus, and ethnicity [adjusted hazard ratio = 1.13, 95% confidence interval (CI), 0.96 to 1.34, P = 0.152]. CONCLUSION In our population, after adjusting for confounders, epidural analgesia is not independently associated with autism spectrum disorder in the children. These findings enhance our knowledge regarding the safety of epidural analgesia and enable patients to make informed decisions about their pain relief techniques during labour.
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Affiliation(s)
- Omri Zamstein
- From the Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel (OZ, ES, GP), Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (YB) and Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel (TW)
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17
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Parkies LE, Murray D, Okafor UB. Pharmacological labour pain interventions: South African midwives' perspective. BMC Nurs 2024; 23:176. [PMID: 38486184 PMCID: PMC10938825 DOI: 10.1186/s12912-024-01844-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives' perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch's open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician's prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives' ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.
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Affiliation(s)
- L E Parkies
- Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa
| | - D Murray
- Department of Public Health, University of Fort Hare, 5 Oxford Street, 5201, East London, South Africa
| | - U B Okafor
- Faculty of Health Sciences, University of Fort Hare, 5 Oxford Street, 5201, East London, South Africa.
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Cahill AG, Macones GA. Optimizing the length of the second stage and management of pushing. Am J Obstet Gynecol 2024; 230:S876-S878. [PMID: 38462261 DOI: 10.1016/j.ajog.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 03/12/2024]
Abstract
Although the optimal length of the second stage of labor to minimize maternal and neonatal morbidities and optimize spontaneous vaginal delivery is not known, available evidence suggests that increasing length of the second stage is associated with increasing maternal and neonatal morbidity. Thus, evidence-based strategies to safely shorten the second stage, such as initiating pushing when complete dilation is reached among those with neuraxial anesthesia, is prudent. Many aspects of optimal management of the second stage of labor require future study to continue to guide clinical second-stage management.
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Affiliation(s)
- Alison G Cahill
- Department of Women's Health, The University of Texas at Austin, Dell Medical School, Austin, TX.
| | - George A Macones
- Department of Women's Health, The University of Texas at Austin, Dell Medical School, Austin, TX
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Yuan J, Jin A, Shen J, Chen Y, Huang Q, Xiang H. Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors. Int J Nurs Pract 2024; 30:e13188. [PMID: 37667558 DOI: 10.1111/ijn.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/14/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND The management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour. METHODS This study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever. RESULTS A total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2 (OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2 h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044-3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05). CONCLUSIONS Maternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.
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Affiliation(s)
- Jinhua Yuan
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Aiying Jin
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jie Shen
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Youguo Chen
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qin Huang
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiyan Xiang
- Delivery room, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Yin Q, Yu B, Hao H, Li G, Sun J, Kong H, Deng L. A biased coin up-and-down sequential allocation trial to determine the ED90 of intrathecal sufentanil combined with ropivacaine 2.5 mg for labor analgesia. Front Med (Lausanne) 2024; 10:1275605. [PMID: 38259854 PMCID: PMC10800865 DOI: 10.3389/fmed.2023.1275605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose To determine the 90 percent effective dose (ED90) of intrathecal sufentanil combined with ropivacaine 2.5 mg for labor analgesia and observe its safety for parturients and neonates. Methods We conducted a prospective, double-blind, biased coin up-and-down study. We injected a fixed 2.5 mg ropivacaine combined with a designated dose of sufentanil intrathecally to observe the labor analgesic effect. The initial dose of sufentanil was assigned 1.0 μg, and the remaining doses were assigned as per the biased coin up-and-down method. The criterion of successful response was defined as VAS ≤ 30 mm after intrathecal injection at 10 min. Safety was evaluated in terms of maternal and neonatal outcomes. Results The ED90 dose of intrathecal sufentanil combined with ropivacaine 2.5 mg (0.1%, 2.5 mL) was 2.61 μg (95% CI, 2.44 to 2.70 μg) by isotonic regression. No respiratory depression, hypotension, or motor block was observed. Thirty-one (77.5%) parturients complained of pruritus, and 14 (35.0%) suffered nausea and vomiting. Three neonates reported a 1 min Apgar score of ≤7, and none reported a 5 min Apgar score of ≤7. Conclusion The ED90 of intrathecal sufentanil combined with ropivacaine 2.5 mg for labor analgesia was 2.61 μg. The dose is safe for parturients and neonates.
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Affiliation(s)
- Qiaoli Yin
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Bin Yu
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Hua Hao
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Gang Li
- Department of Anesthesiology, Peking University First Hospital, Ningxia Women’s and Children’s Hospital, Yinchuan, China
| | - Junyan Sun
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Anesthesiology, Guolong Hospital, Yinchuan, China
| | - Hao Kong
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Liqin Deng
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, China
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Ren HY, Zhang HF, Chen YY, Luo TZ. Factors associated with urinary retention after vaginal delivery under intraspinal anesthesia: a path analysis model. Int Urogynecol J 2024; 35:157-166. [PMID: 37999762 PMCID: PMC10810937 DOI: 10.1007/s00192-023-05684-1] [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: 05/09/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Women who have intraspinal anesthesia for delivery are more likely to experience postpartum urinary retention (PUR), which, if not recognized and treated promptly, can result in long-term urinary dysfunction. Many factors influencing PUR have been proposed, but no study has been conducted to investigate the relationship between them. This study is aimed at determining the influencing factors of PUR and to explore the relationship between them. METHODS A prospective, cross-sectional survey using self-made questionnaires was conducted among 372 puerperae in a Grade A hospital in Guangzhou, China, from April to September 2022. SPSS25.0 and AMOS24.0 were used for data analysis, and a path analysis model was established to determine the relationship between the influencing factors. RESULTS The incidence of PUR was 49.85%. Residence, the level of postpartum pain, and the change of postnatal urination position had a direct effect on PUR. Episiotomy and analgesic duration have both direct and indirect effects on PUR. Forceps delivery, perineal edema and oxytocin had an indirect effect on PUR. Variables could influence the occurrence of PUR by mediating the analgesic duration, episiotomy, postpartum pain level, and postnatal urination position changes. CONCLUSIONS This study provides an empirical model to illustrate the relationship between PUR and related factors in women who delivered under intraspinal anesthesia. In future management, more attention should be paid to women who live in cities, have higher levels of postpartum pain, longer analgesic duration, higher grade of perineal edema, and received episiotomy, forceps delivery, and oxytocin during labor.
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Affiliation(s)
- Hong-Yan Ren
- The Third Clinical College of Guangzhou Medical University, The Nursing College of Guangzhou Medical University, 195 West Dongfeng Road, Guangzhou, 510182, China
| | - Huan-Fang Zhang
- Department of Obstetrics and Gynecology, Obstetrics, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou, 510145, China
| | - Yu-Yi Chen
- Department of Obstetrics and Gynecology, Obstetrics, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital of Guangzhou Medical University, No. 63 Duobao Road, Guangzhou, 510145, China
| | - Tai-Zhen Luo
- Department of Nursing, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, No. 63, Duobao Road, 510145, Guangzhou, China.
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Bapodra A, Moy K, Nekola D, Schwartz GS. Neuraxial analgesia, nerve blocks, and special considerations for the parturient. Int Anesthesiol Clin 2024; 62:62-68. [PMID: 38063038 DOI: 10.1097/aia.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Anuj Bapodra
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York
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23
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Xu C, Fan C, Zhang J, Zeng X, Fan Y, Feng S. Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study. BMC Pregnancy Childbirth 2023; 23:766. [PMID: 37919654 PMCID: PMC10621168 DOI: 10.1186/s12884-023-06026-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND This study aimed to investigate the effect of the pathological staging of acute histological chorioamnionitis (HCA) on laboratory indicators and to conduct further studies to reassess the threshold values used by clinicians to identify acute HCA in febrile parturients undergoing epidural analgesia. METHODS A retrospective study of febrile mothers receiving epidural analgesia at Nanjing Maternal and Child Health Care Hospital from January 1, 2018 to December 31, 2018. The participants were grouped by the progression of acute HCA, and the laboratory parameters were compared between groups. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and monocyte-leukocyte ratio (M%), alone or in combination, to identify acute HCA in febrile parturients undergoing epidural analgesia was assessed using logistic regression and ROC curves. RESULTS The area under the curve (AUC) of the best logistic regression model predicting HCA climbed to 0.706 (CRP + MLR). Maternal CRP, NLR, and MLR significantly and progressively increased with the progression of acute HCA (p < 0.0001). Based on the ROC curves, the following thresholds were selected to define increased laboratory indicators for identifying acute HCA: CRP ≥ 6.90 mg/L, NLR ≥ 11.93, and MLR ≥ 0.57. In addition, the AUC of the best logistic regression model predicting HCA ≥ stage 2 was 0.710, so these inflammatory markers were more precise in predicting HCA ≥ stage 2. CONCLUSION Increased CRP (≥ 6.90 mg/L), NLR (≥ 11.93), and MLR (≥ 0.57) may help clinicians to identify early potential acute HCA in febrile parturients receiving epidural analgesia and to monitor progression to optimize clinical treatment options. TRIAL REGISTRATION The study was registered in the Chinese Clinical Trial Registry on November 24, 2021 ( http://www.chictr.org.cn , ChiCTR2100053554).
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Affiliation(s)
- Chenyang Xu
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China
| | - Chong Fan
- Department of Emergency, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China
| | - Jingjing Zhang
- Department of Delivery Room, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China
| | - Xin Zeng
- Department of Medical Research Center, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China.
| | - Yuru Fan
- Department of Delivery Room, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China.
| | - Shanwu Feng
- Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, 210001, Jiangsu, China.
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24
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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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Bakİ Erİn K, Erİn R, Sahal SO, Kartal S, Kulaksiz D. The evaluation of the efficacy of etofenamate spray in postoperative cesarean pain: Randomized, double-blind, placebo-controlled trial. Taiwan J Obstet Gynecol 2023; 62:697-701. [PMID: 37678997 DOI: 10.1016/j.tjog.2023.07.010] [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] [Accepted: 04/24/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE It was aimed to investigate the effect of etofenamate spray to be applied around the postoperative incision on pain control in cesarean section in this trial. MATERIAL AND METHODS This was a prospective, randomized, double-blind, and placebo-controlled trial. 187 patients (93 cases and 94 controls) were recruited for the study. In the trial group, we applied the etofenamate spray (Doline® 50 ml) after closing the cesarean skin incision and go on four times a day on the skin incision for 24 h. In the control group, we applied a placebo. All patients received paracetamol IV (Paracerol®) as standard analgesic doses. If analgesia was insufficient, tramadol (Contramal®) 50 mg IV doses were added and recorded. A visually analog pain scale (VAS) was performed on both groups at 6-12-18-24th hours. Independent t-tests were performed for data showing normal distributions. RESULTS There were no significant differences in the mean of differences VAS scores between the two groups at 6-12, and 6-18 h. However, a significant difference was obtained in the mean of differences VAS score at the 6-24th hour (p < 0.05). When the groups were compared in terms of additional paracetamol need, a significant difference was found again (p < 0.05). There was no significant difference between the groups in terms of tramadol need. CONCLUSION Postoperative administration of etofenamate spray provided an analgesic effect at 24 h and additional analgesic usage decreased. Postoperative analgesia can also be used by administering NSAIDs around the cesarean section incision. In this way, the side effects of other systemic analgesics are avoided. CLINICAL TRIAL ID PACTR201811864509898. CLINICAL TRIAL WEB LINK: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5745.
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Affiliation(s)
- Kübra Bakİ Erİn
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Department of Obstetrics and Gynecology, Trabzon, Turkey.
| | - Recep Erİn
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Department of Obstetrics and Gynecology, Trabzon, Turkey; University of Health Sciences, Somalia Mogadishu Recep Tayyip Erdogan Health Practice and Research Center, Department of Obstetrics and Gynecology, Mogadishu, Somalia
| | - Safia Omar Sahal
- University of Health Sciences, Somalia Mogadishu Recep Tayyip Erdogan Health Practice and Research Center, Department of Obstetrics and Gynecology, Mogadishu, Somalia
| | - Seyfi Kartal
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Department of Anesthesiology and Reanimation, Trabzon, Turkey
| | - Deniz Kulaksiz
- University of Health Sciences, Trabzon Kanuni Health Practice and Research Center, Department of Obstetrics and Gynecology, Trabzon, Turkey; University of Health Sciences, Somalia Mogadishu Recep Tayyip Erdogan Health Practice and Research Center, Department of Obstetrics and Gynecology, Mogadishu, Somalia
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Su YH, Su HW, Chang SL, Tsai YL, Juan PK, Tsai JF, Lai HC. Involving a Dedicated Epidural-Caring Nurse in Labor Ward Practice Improves Maternal Satisfaction towards Childbirth: A Retrospective Study. Healthcare (Basel) 2023; 11:2181. [PMID: 37570420 PMCID: PMC10419099 DOI: 10.3390/healthcare11152181] [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: 06/30/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
The quality of healthcare is crucially linked to patient satisfaction, particularly in the provision of neuraxial analgesia for labor pain. Neuraxial analgesia for labor pain control should ideally be readily available when requested. However, in real-world practice, anesthesiologists may not always respond immediately to maternal demands, which can compromise the quality of care. To address this issue, this study aimed to evaluate the effectiveness of involving a dedicated nurse in epidural care to improve maternal satisfaction. This study was conducted in a single tertiary center. Medical records of women with singleton pregnancies above 36 gestational weeks who received neuraxial analgesia for labor pain control were reviewed (N = 354). Among them, 104 women (29%) received care from a dedicated nurse. The results showed that involving a dedicated nurse led to higher maternal satisfaction scores before (4.7 ± 0.5 versus 4.5 ± 0.6, p = 0.001), during (4.7 ± 0.6 versus 4.5 ± 0.6, p = 0.002), and at 24 h postpartum (4.7 ± 0.5 versus 4.5 ± 0.5, p = 0.001), without any adverse impact on maternal, neonatal, or epidural-related complications. These findings suggest that allocating a dedicated nurse to epidural care can effectively enhance maternal satisfaction and potentially improve overall care quality.
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Affiliation(s)
- Yun-Han Su
- Department of Obstetrics, Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-H.S.); (H.-W.S.)
| | - Hsiu-Wei Su
- Department of Obstetrics, Gynecology & Women’s Health, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-H.S.); (H.-W.S.)
| | - Szu-Ling Chang
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-L.C.)
- Department of Medicine, National Yang-Ming-Chiao-Tung University School of Medicine, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung-Hsin University, Taichung 402227, Taiwan
| | - Yu-Lian Tsai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-L.C.)
| | - Po-Kai Juan
- Wuri Lin Shin Hospital, Taichung 414013, Taiwan
| | - Jen-Fu Tsai
- Show Chwan Memorial Hospital, Changhua 505029, Taiwan
| | - Hui-Chin Lai
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (S.-L.C.)
- Department of Medicine, National Yang-Ming-Chiao-Tung University School of Medicine, Taipei 112304, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung-Hsin University, Taichung 402227, Taiwan
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Moirano J, Khoury J, Yeisley C, Noor A, Voutsinas N. Interventional Radiology and Pregnancy: From Conception through Delivery and Beyond. Radiographics 2023; 43:e230029. [PMID: 37440450 DOI: 10.1148/rg.230029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Interventional radiology (IR) plays a unique and often invaluable role in the care of pregnant patients. Special considerations regarding radiation exposure and medication choice must be taken into account when evaluating a pregnant patient for an interventional procedure. In addition, the physiologic changes that occur during pregnancy can pose special challenges for an interventionalist when treating this patient population and should be appropriately recognized. Still, the majority of standard IR procedures can be safely performed in the pregnant population, often with additional precautions and proper patient education about the risks, benefits, and alternatives. In many cases, interventional radiologists can provide lifesaving and fertility-preserving alternatives to more invasive surgical intervention. The authors summarize radiation exposure effects and guidelines and medication choice during pregnancy. The physiologic changes that occur during pregnancy are discussed, with specific interest in the pathologic consequences that can be treated with IR. The authors also describe a wide variety of minimally invasive image-guided procedures offered by IR in pregnant, peripartum, or postpartum patients. The areas where IR can help in the treatment of pregnant patients include venous access, biopsies, genitourinary and biliary interventions, venous thromboembolism treatments, ectopic pregnancy management, aneurysm intervention, and management of trauma patients. IR is also involved in management during the peripartum or postpartum periods, with roles in treatment of invasive placenta spectrum, postpartum hemorrhage after vaginal delivery, and postcesarean delivery complications. ©RSNA, 2023 Supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Joseph Moirano
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Joe Khoury
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Christopher Yeisley
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Amir Noor
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
| | - Nicholas Voutsinas
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Dr, Manhasset, NY 11030 (J.M.); Department of Radiology, Division of Vascular and Interventional Radiology, Northwell Health, Manhasset, NY (J.K., C.Y.); Department of Radiology, Division of Vascular and Interventional Radiology, NYU Grossman School of Medicine, New York, NY (A.N.); and Department of Radiology and Radiologic Sciences, Division of Vascular and Interventional Radiology, Vanderbilt University School of Medicine, Nashville, Tenn (N.V.)
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28
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Guesine GD, Paschoini MC, Melo GA, Araujo Júnior E, Peixoto AB. Labor analgesia and its impact on the maternal and perinatal outcomes. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230500. [PMID: 37466614 DOI: 10.1590/1806-9282.20230500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)-analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)-analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)-analgesia performed with cervical dilatation ≥9.0 cm. RESULTS Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.
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Affiliation(s)
- Georgeana Debs Guesine
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Marina Carvalho Paschoini
- Universidade Federal do Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
| | - Giselle Agreli Melo
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
| | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Obstetrics - São Paulo (SP), Brazil
- Universidade Municipal de São Caetano do Sul, Medical Course - São Paulo (SP), Brazil
| | - Alberto Borges Peixoto
- Universidade de Uberaba, Mário Palmério University Hospital, Gynecology and Obstetrics Service - Uberaba (MG), Brazil
- Universidade Federal do Triângulo Mineiro, Department of Obstetrics and Gynecology - Uberaba (MG), Brazil
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Callahan EC, Lee W, Aleshi P, George RB. Modern labor epidural analgesia: implications for labor outcomes and maternal-fetal health. Am J Obstet Gynecol 2023; 228:S1260-S1269. [PMID: 37164496 DOI: 10.1016/j.ajog.2022.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 05/12/2023]
Abstract
Epidural analgesia is an important means of pain control during labor throughout the world. Over its historic development, it has been implicated in several undesirable outcomes, including prolongation of labor and increased need for operative delivery. These effects have emerged in some retrospective and observational studies, but such methods of investigation are highly prone to bias and are particularly ill-suited for the study of labor analgesia. In high-quality studies, including Cochrane reviews and meta-analyses, epidural analgesia has been suggested to extend the first stage of labor by 30 minutes and the second stage by 15 minutes, when compared with alternative forms of analgesia. Although this may be a reproducible effect, it may be argued that it is clinically negligible. With respect to mode of delivery, similar high-quality studies have consistently shown no increased risk of cesarean delivery associated with epidural analgesia. Some forms of epidural analgesia were associated with higher risk of assisted vaginal delivery, but the use of newer modalities has been shown to abolish this effect. Specific advancements have centered on reducing total anesthetic consumption, given that local anesthetic-induced motor block is theorized to interfere with maternal expulsive efforts in the second stage of labor. These measures include the use of low-concentration local anesthetic solutions equivalent to ≤0.1% bupivacaine, shown in meta-analyses to lead to no higher risk of assisted vaginal delivery relative to nonepidural analgesia. Additional advancements in the maintenance of analgesia include programmed intermittent epidural bolus and patient-controlled epidural analgesia, the combination of which has been shown to reduce the risk of assisted vaginal delivery, also likely mediated by reduction in local anesthetic dose. These techniques have gained popularity in the past two decades, such that studies published since 2005 show no higher risk of assisted vaginal delivery with epidural than with opioid analgesia (as reported in a Cochrane review). Labor epidural analgesia has implications for maternal and fetal health perinatally. It is known to result in transient maternal hypotension (particularly with initiation), which may progress to the level of necessitating fluid or vasopressor therapy. This is not clearly associated with any adverse outcomes. There is also a consistently higher incidence of fever in parturients receiving neuraxial anesthesia, likely of noninfectious origin, which has similarly not been associated with adverse neonatal outcomes. Finally, neonates of parturients who receive epidural analgesia have been shown to have no worse Apgar scores and more favorable acid-base status than their counterparts. These observations should serve to reassure providers that modern labor analgesia, as currently understood, is not consistently associated with any significant adverse outcomes for the parturient or fetus. In this review, we describe variations of modern labor epidural analgesia, conduct an in-depth review of current literature on its use, and explore the most up-to-date evidence on its implications for the progression and outcomes of labor, including the pertinent maternal and fetal side effects.
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Affiliation(s)
- Elliott C Callahan
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.
| | - Won Lee
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
| | - Pedram Aleshi
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
| | - Ronald B George
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA
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Vaajala M, Kekki M, Mattila VM, Kuitunen I. Use of labor analgesia in trials of labor after previous cesarean section: A nationwide register-based analysis in Finland. Eur J Obstet Gynecol Reprod Biol 2023; 286:1-4. [PMID: 37156132 DOI: 10.1016/j.ejogrb.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The literature concerning the overall use of labor analgesia among women with trials of labor after cesarean section (TOLAC) is lacking. The primary aim of this study is to report the rate of different labor analgesia methods among women with TOLAC. The secondary aim was to compare the use of labor analgesia between women with the first TOLAC and control group consisting of nulliparous women. STUDY DESIGN Data from the National Medical Birth Register was used to evaluate the usage of labor analgesia in TOLACs. The use of labor analgesia in the first TOLAC is compared to the pregnancies of nulliparous women. The analgesia methods were stratified into neuraxial analgesia, pudendal, paracervical, nitrous oxide, other medical, other non-medical, and no analgesia. These are analyzed as categorized dichotomy (yes or no) variables. RESULTS A total of 38 596 TOLACs as second pregnancy of the mother was found during our study period. The control group consisted of a total of 327 464 pregnancies of nulliparous women. Epidural analgesia (61.6% vs 67.1%), nitrous oxide (56.1% vs 62.0%), and non-medical analgesia (30.1% vs 35.0%) were less consumed among women with TOLAC. The rate of spinal analgesia was higher among women with TOLAC (10.1% vs 7.6%) when compared to the control group. However, when only vaginal deliveries were included, the rate of labor analgesia increased especially in the TOLAC group. CONCLUSIONS The main finding of this study is that women with TOLAC had a generally lower rate of labor analgesia. However, the rate of spinal analgesia was higher among women with TOLAC when compared to the control group, however. The results of this study inform midwives, obstetricians, and anesthesiologists on current practices and how to improve the analgetic treatment in TOLAC.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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31
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Dimic N, Djuric M, Nenadic I, Bojic S, Bobos M, Janicijevic A, Bojanic M, Mijovic M, Stevanovic P. Nitrous Oxide — Application in Modern Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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Lazzari C, Raffaelli R, D'Alessandro R, Simonetto C, Bosco M, Zorzato PC, Uccella S, Taddei F, Franchi M, Garzon S. Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study. Arch Gynecol Obstet 2023; 307:1233-1241. [PMID: 35599249 PMCID: PMC10023596 DOI: 10.1007/s00404-022-06600-6] [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: 03/23/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the effects of epidural analgesia (EA) and combined spinal epidural analgesia (SEA) on labor and maternal-fetal outcomes. METHODS We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal-fetal outcomes were retrieved from the prospectively collected delivery room database and medical records. RESULTS SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 min. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06-1.64, p = 0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34-0.9, p = 0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes. CONCLUSIONS SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal-fetal outcomes will allow concluding about the superiority of one technique upon the other.
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Affiliation(s)
- Cecilia Lazzari
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Ricciarda Raffaelli
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Roberto D'Alessandro
- Department of Anesthesia and Intensive Care, AOUI Verona, University of Verona, Verona, Italy
| | - Chiara Simonetto
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Fabrizio Taddei
- Department of Obstetrics and Gynecology, Santa Chiara Hospital, APSS Trento, Trento, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
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Watanabe K, Sakamaki D, Shiko Y, Kawasaki Y, Noguchi S, Mazda Y. Comparison between neonatal outcomes of labor and delivery with labor neuraxial analgesia and without analgesia: A propensity score-matched study. J Obstet Gynaecol Res 2023; 49:1144-1153. [PMID: 36734027 DOI: 10.1111/jog.15571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
AIM This single-center observational study aimed to investigate the association between labor neuraxial analgesia (LNA) and neonatal outcomes. METHODS We conducted a retrospective cohort study at a tertiary perinatal center and included all vaginal deliveries performed between November 2015 and December 2021. Obstetric and neonatal outcomes were compared between deliveries with LNA (LNA group) and without analgesia (control group). Propensity score (PS) matching was used for statistical analysis. RESULTS We included 2343 singleton deliveries performed in 1367 nulliparous and 976 multiparous women, in whom LNA was induced in 352 and 178 deliveries, respectively. After PS matching, the nulliparous LNA group had a significantly higher incidence of Apgar scores <7 at 1 (7.1% vs. 3.6%, p = 0.0139) and 5 min (2.3% vs. 0.7%, p = 0.0397) and meconium staining (29.8% vs. 23.2%, p = 0.0272) than the nulliparous control group. Other neonatal outcomes, including umbilical artery pH and neonatal intensive care unit admission rate, were comparable between the nulliparous LNA and control groups. No significant differences in neonatal outcomes were seen in multiparous women. Regarding fetal heart rate abnormalities, severe late deceleration (4.8% vs. 1.7%, p = 0.0036) and severe prolonged deceleration (17.0% vs. 11.9%, p = 0.0224) were more common in the nulliparous LNA group than in the nulliparous control group, and the multiparous LNA group exhibited more severe variable deceleration (21.3% vs. 14.3%, p = 0.0485) than the multiparous control group. CONCLUSION Our findings suggest that LNA is associated with short-term adverse neonatal and obstetric outcomes in vaginal deliveries. LNA should be performed with precautionary measures and adequate medical resources.
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Affiliation(s)
- Kaede Watanabe
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Daisuke Sakamaki
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yuki Shiko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.,Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Shohei Noguchi
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yusuke Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Hegvik TA, Klungsøyr K, Kuja-Halkola R, Remes H, Haavik J, D'Onofrio BM, Metsä-Simola N, Engeland A, Fazel S, Lichtenstein P, Martikainen P, Larsson H, Sariaslan A. Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings. Am J Obstet Gynecol 2023; 228:233.e1-233.e12. [PMID: 35973476 DOI: 10.1016/j.ajog.2022.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder. Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect, and the causal nature of this association remains unknown. OBJECTIVE This study aimed to investigate the extent to which exposure to labor epidural analgesia is associated with offspring autism spectrum disorder and attention-deficit/hyperactivity disorder following adjustments for unmeasured familial confounding. STUDY DESIGN We identified 4,498,462 singletons and their parents using the Medical Birth Registers in Finland (cohorts born from 1987-2005), Norway (1999-2015), and Sweden (1987-2011) linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6-16.8 years), whichever occurred first. Cox regression models were used to estimate country-specific associations between labor epidural analgesia recorded at birth and outcomes (eg, at least 1 secondary care diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder or at least 1 dispensed prescription of medication used for the treatment of attention-deficit/hyperactivity disorder). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling comparisons. Pooled estimates across all the 3 countries were estimated using inverse variance weighted fixed-effects meta-analysis models. RESULTS A total of 4,498,462 individuals (48.7% female) were included, 1,091,846 (24.3%) of which were exposed to labor epidural analgesia. Of these, 1.2% were diagnosed with autism spectrum disorder and 4.0% with attention-deficit/hyperactivity disorder. On the population level, pooled estimates showed that labor epidural analgesia was associated with increased risk of offspring autism spectrum disorder (adjusted hazard ratio, 1.12; 95% confidence interval, 1.10-1.14, absolute risks, 1.20% vs 1.07%) and attention-deficit/hyperactivity disorder (adjusted hazard ratio, 1.20; 95% confidence interval, 1.19-1.21; absolute risks, 3.95% vs 3.32%). However, when comparing full siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions with narrow confidence intervals (adjusted hazard ratio [autism spectrum disorder], 0.98; 95% confidence interval, 0.93-1.03; adjusted hazard ratio attention-deficit/hyperactivity disorder, 0.99; 95% confidence interval, 0.96-1.02). CONCLUSION In this large cross-national study, we found no support for the hypothesis that exposure to labor epidural analgesia causes either offspring autism spectrum disorder or attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Tor-Arne Hegvik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Remes
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jan Haavik
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IA
| | - Niina Metsä-Simola
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Stockholm, Sweden; Max Planck Institute for Demographic Research, Rostock, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Amir Sariaslan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
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Cai M, Liu H, Peng Y, Miao JK, Lei XF, Yu J. Prolonged Anesthesia Induction to Delivery Time Did Not Influence Plasma Remifentanil Concentration in Neonates. Drug Des Devel Ther 2023; 17:1395-1403. [PMID: 37188282 PMCID: PMC10179318 DOI: 10.2147/dddt.s407602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
Objective Remifentanil, in combination with etomidate and sevoflurane, is commonly used in clinics for general anesthesia induction in cesarean section (CS). This study aimed to evaluate the correlation between the induction to delivery (I-D) time and neonatal plasma drug concentration and anesthesia, as well as its effects on neonates. Methods Fifty-two parturients in whom general anesthesia was induced for CS were divided into group A (I-D<8 min) and group B (I-D≥8 min). Maternal arterial (MA), umbilical venous (UV), and umbilical arterial (UA) blood samples were collected at delivery to analyze the remifentanil and etomidate concentrations using liquid chromatography-tandem mass spectrometry. Results There were no statistically significant differences between the two groups in terms of plasma concentrations of remifentanil in the MA, UA, and UV blood (P > 0.05). The plasma concentration of etomidate in MA and UV was higher in group A than that in group B (P<0.05), whereas the UA/UV ratio of etomidate was higher in group B than that in group A (P<0.05). The Spearman rank correlation test showed no correlation between the I-D time and plasma remifentanil concentration in the MA, UA, and UV plasma (P>0.05). The concentrations of etomidate in the MA and UV were negatively correlated with the I-D time (P < 0.05). Conclusion Prolonged I-D time did not significantly influence the maternal or neonatal plasma concentration of remifentanil. It is safe to administer remifentanil target-controlled infusion in combination with etomidate and sevoflurane for general anesthesia induction during CS.
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Affiliation(s)
- Meng Cai
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Hao Liu
- Department of Pediatrics, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yong Peng
- Department of Pediatrics, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jing-Kun Miao
- Department of Pediatrics, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiao-Feng Lei
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Jin Yu, Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, No. 120, Longshan Road, Yubei District, Chongqing, 401147, People’s Republic of China, Tel +86-18623117820, Email
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Analgesic outcomes of tramadol alone and in combination with Butorphanol or Flurbiprofen Axetil after cesarean section: a retrospective study with propensity score matching analysis. BMC Anesthesiol 2022; 22:391. [PMID: 36526971 PMCID: PMC9756475 DOI: 10.1186/s12871-022-01939-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Society for Obstetric Anesthesia and Perinatology recommends a multimodal analgesia regimen for cesarean delivery analgesia. This study aimed to compare the analgesic effects of tramadol alone and combined with butorphanol or flurbiprofen axetil after a cesarean section. METHODS We performed a retrospective analysis based on the electronic medical records of a teaching hospital in China from January 2018 to January 2020. We collected data on demographic characteristics, anesthesia, analgesia strategy, and pain intensity postoperatively during the first 48 hours. Inadequate postoperative analgesia during this period was defined as an NRS score ≥ 4. We also collected data regarding off-bed activity and intestinal function recovery. Participants were classified into three groups according to analgesia regimens. Groups T, TF, and TB received tramadol, a mixture of tramadol and flurbiprofen axetil, and a combination of tramadol and butorphanol, respectively. Analgesic outcomes were compared using propensity score matching analysis. RESULTS Data from 2323 cases of caesarean section were included in the analysis, and 521 pairs were matched in each group according to their propensity score. Compared with group T, The inadequate analgesia on pain at rest and pain at movement was lower in group TF (RR: 0.42, 95% CI: 0.36-0.49, P = 0.001 and RR: 0.58, 95% CI: 0.48-0.69, P < 0.001, respectively),and the incidence of inadequate control of pain at movement was higher in group TB (RR: 1.38, 95% CI: 1.22-1.55, P < 0.001). Additionally, the percentage of off-bed activity at 2 days postoperatively was higher in group TB than in groups TF and T (78.7% vs. 68.5 and 78.7% vs. 64.9%, respectively, P < 0.001). The incidence of intestinal function recovery 2 days after cesarean delivery in group TB was higher than that in group TF (73.3% vs. 66.2%, P = 0.013). CONCLUSIONS Combining tramadol and flurbiprofen axetil could enhance the analgesic effect and be safely used for analgesia after a cesarean section. However, combining tramadol and butorphanol may produce an antagonistic effect.
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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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Changes in sensory block level during a programmed intermittent epidural bolus regimen for labour analgesia: a prospective observational cohort study. Can J Anaesth 2022; 69:1471-1476. [PMID: 36076123 DOI: 10.1007/s12630-022-02318-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE In the context of a programmed intermittent epidural bolus (PIEB) regimen for labour analgesia, one can identify an upper sensory block level (USBL), defined as the highest dermatome with any altered sensation to cold, and a lower sensory block level (LSBL), defined as the highest dermatome with complete sensory block to cold. This study investigated whether and how these sensory block levels vary within PIEB cycles. METHODS We enrolled patients requesting epidural analgesia. An epidural catheter was placed at L2/L3 or L3/L4. A test dose of 3 mL of bupivacaine 0.125% with fentanyl 3.3 µg·mL-1 was administered, followed by 12 mL of the same solution as the loading dose. A PIEB plus patient-controlled epidural analgesia (PCEA) regimen was initiated 40 min after the loading dose, with bupivacaine 0.0625% with fentanyl 2 µg·mL-1: PIEB 10 mL, PIEB interval 40 min, PCEA 5 mL, lockout interval 10 min, maximum hourly 30 mL. As per institutional protocol, sensory block levels to ice were assessed 20 min after the loading dose and then hourly. Patients included in the study underwent eight extra assessments: immediately before the second and fourth PIEB and 10, 20, and 30 min after the second and third PIEB. RESULTS We studied 30 patients. The USBL and LSBL achieved their peak value 100 min after the loading dose. The median [interquartile range] USBL was T8 [T9-T7] and T6 [T7-T4] 20 and 100 min after the loading dose, respectively; LSBL was T10 [T11-T6] and T8 [T9-T6], respectively. There was no significant variation in USBL or LSBL within the PIEB cycle between the second and the third or the third and the fourth PIEB. CONCLUSION Once peak sensory block levels are established, there is no significant variation in the USBL and LSBL within the PIEB cycles. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT04716660); registered 21 January 2021.
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Goswami S, Jelly P, Sharma S, Negi R, Sharma R. The effect of heat therapy on pain intensity, duration of labor during first stage among primiparous women and Apgar scores: A systematic review and meta-analysis. Eur J Midwifery 2022; 6:66. [DOI: 10.18332/ejm/156487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
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Pronounced Declines in Meperidine in the US: Is the End Imminent? PHARMACY 2022; 10:pharmacy10060154. [PMID: 36412830 PMCID: PMC9680368 DOI: 10.3390/pharmacy10060154] [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: 09/13/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Once a widely used analgesic in the United States (US), meperidine offered an alternative opioid to other opioids as a pain reliever and was widely assumed to be safer with acute pancreatitis. However, within the last two decades meperidine, has gone from a frequently used drug to being used only when patients exhibit atypical reactions to opioids (e.g., morphine and hydromorphone), to being taken off the World Health Organization List of Essential Medications and receiving strong recommendations for overall avoidance. The aim of this study was to identify changes in meperidine distribution in the US, and regional disparities as reported to the Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (DEA ARCOS) and Medicaid. Methods: Data related to meperidine distribution was obtained through ARCOS (2001−2021) and Medicaid public use files (2016−2021). Heat maps were used to visualize regional disparities in distribution by state. States outside a 95% confidence interval were statistically significant. Results: Meperidine distribution between 2001 and 2021 decreased by 97.4% (R = −0.97, p < 0.0001). There was a 34-fold state-level difference in meperidine distribution between Arkansas (16.8 mg/10 persons) and Connecticut (0.5 mg/10 persons) in 2020. Meperidine distribution in 2020 was elevated in Arkansas, Mississippi, and Alabama. In 2021, meperidine distribution was highest in Arkansas (16.7 mg/10 persons) and lowest in Connecticut (0.8 mg/10 persons). Total prescriptions of meperidine as reported by Medicaid decreased by 73.8% (R = −0.67, p = 0.045) between 2016 and 2021. Conclusion: We observed a decrease in the overall distribution of meperidine in the past two decades, with a similar recent decline in prescribing it to Medicaid enrollees. The shortage of some parenteral formulations is an important contributor to these declines, however, the most likely explanation for this global decline in use is related to an increased recognition of safety concerns related to important drug interactions and a neurotoxic metabolite. This data may reflect plans to phase out the use of this opioid, especially in the many situations where safer and more preferred opioids are available.
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Zeng Y, Jiang T, Zheng YH, He WR, Wang XW, Wei H, Wang L, Liu ZR, Zhang XF, Yi C, Chen KM. Evaluation efficacy and safety of epidural analgesia in second-trimester induced labor: A single-center, prospective, non-randomized, controlled study. Medicine (Baltimore) 2022; 101:e30767. [PMID: 36197253 PMCID: PMC9509083 DOI: 10.1097/md.0000000000030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Second-trimester induced labor in pregnant women was often more likely to suffer from psychological and physiological double pain. However, the analgesic management received less attention, and the optimal analgesic mode for second-trimester induced labor had not been determined. Our objective was to evaluate the feasible of epidural analgesia (EA) in second-trimester induced labor. METHODS From January 2020 to December 2021, Primipara who planned to undergo second-trimester induced labor in the First Affiliated Hospital of Yangtze University were collected. The method of labor induction was oral mifepristone + amniotic cavity injection of Ethacridine Lactate. Based on whether or not patients received epidural analgesia, which were divided into EA group (30 cases) and non-EA (NEA) group (30 cases). The primary outcome were visual analog scale (VAS) score of pain and result of follow-up, the secondary outcomes included relative clinical parameter and labor duration. RESULTS Vaginal induction of labor was successful in both groups. There was no statistically significant difference in VAS of pain between the two groups before analgesia (P > .05), but the VAS of pain in the EA group was significantly lower than the NEA group (P < .05) after analgesia or at delivery. The following outcomes showed no statistical difference between two groups: labor duration, postpartum hemorrhage, hemorrhage ≥ 500 mL, intrapartum injury, second days hemoglobin, C-reactive protein, antibiotic therapy days, hospitalizations days, and placenta residue (P > .05). The median hospitalization costs of EA group was 4697.5 yuan, and NEA group was 3673 yuan, the difference was statistically significant (P < .001). No adverse events related to EA occurred during hospitalization, only 3 patients showed mild lumbago and back pain after follow-up to three months postpartum, which was significantly relieved after proper rest. CONCLUSION EA can significantly reduce the pain of parturients, which may be effective and safe in the second-trimester induced labor.
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Affiliation(s)
- Yong Zeng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Tao Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Ya-Hong Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Wen-Rong He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Xiao-Wen Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Hua Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Li Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Zu-Rong Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Xu-Feng Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Cunjian Yi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Ke-Ming Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
- *Correspondence: Ke-Ming Chen, 8 Hangkong Road, Shashi District, Jingzhou City, Hubei Province 434000, China (e-mail:)
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Fieni S, di Pasquo E, Formisano D, Basevi V, Perrone E, Ghi T. Epidural analgesia and the risk of operative delivery among women at term: A propensity score matched study. Eur J Obstet Gynecol Reprod Biol 2022; 276:174-178. [DOI: 10.1016/j.ejogrb.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Toledo P, Wong CA. A Century of Progress and Collaboration Between Obstetric Anesthesiologists, Anesthesia & Analgesia, and the International Anesthesia Research Society. Anesth Analg 2022; 135:S26-S30. [PMID: 35839830 DOI: 10.1213/ane.0000000000005989] [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 past century has seen significant advances in the practice of obstetric anesthesiology. This article will review the role of Anesthesia & Analgesia and the International Anesthesia Research Society in contributing to fundamental paradigm shifts in our understanding of obstetric anesthesiology.
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Affiliation(s)
- Paloma Toledo
- From the Department of Anesthesiology.,Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia A Wong
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Lang D, Long C, Lin S, Xie Y, Chen F, Zhao R, Liu C, Tang S. Satisfaction as a Mediator and Its Interaction With Adherence to Labor Analgesia Protocols: A Cross-Sectional Survey of Chinese Medical Personnel. Front Public Health 2022; 10:899515. [PMID: 35836986 PMCID: PMC9275786 DOI: 10.3389/fpubh.2022.899515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although the Chinese promotion of labor analgesia began in 2018 to improve maternal health, high-quality medical care is difficult to provide to pregnant women when medical staff cannot implement standard labor analgesia procedures. This study aims to examine medical personnel's adherence to labor analgesia protocols and to explore the relationships among adherence, satisfaction, and other factors. Methods The data were from a national cross-sectional dataset (N = 13,944) of the 2020 Chinese Labor Analgesia Pilot Evaluation Project. Mediating and moderating effects analyses were used to examine the role of satisfaction as a mediator between support measures and adherence. Results There were differences in adherence between different types of medical personnel. Support measures and satisfaction had a positive association with adherence to labor analgesia protocols. Satisfaction had a significant mediating and moderating effect on the relationship between support measures and adherence to labor analgesia standards. Moderating effects of professional titles and attitudes were also observed. Conclusion Primary health care policies worth considering include comprehensive incentives for medical institutions to improve the use of labor analgesia by medical personnel. It is also worth considering providing more training opportunities for the staff in anesthesiology departments.
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Affiliation(s)
- Dong Lang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Chengxu Long
- Department of Global Health & Social Medicine, King's College London, London, United Kingdom
| | - Shuna Lin
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Yinghua Xie
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Fangfei Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Rui Zhao
- China National Health Development Research Center, Beijing, China
| | - Chunping Liu
- China National Health Development Research Center, Beijing, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China
- *Correspondence: Shangfeng Tang
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Spiral Computed Tomography Imaging Analysis of Positioning of Lumbar Spinal Nerve Anesthesia under the Concept of Enhanced Recovery after Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1703250. [PMID: 35711532 PMCID: PMC9187486 DOI: 10.1155/2022/1703250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022]
Abstract
The objective of this research was to explore the effect of perioperative anesthesia management for patients based on the concept of enhanced recovery after surgery (ERAS) and the application value of the computed tomography (CT) localization method in lumbar spinal nerve anesthesia, reducing the damage caused by anesthesia. One hundred and twenty patients who underwent the lumbar spinal anesthesia in lower limb surgery were selected as the research subjects. According to puncture positioning and nursing intention, the patients were classified into the control group with 30 patients (method of anatomical landmarks), CT group with 50 patients (the CT localization), and ERAS group with 40 patients (the CT localization and the ERAS management). The effects of the anesthesia positioning method and the ERAS management were compared and analyzed. The results showed that d (0.32) and r (0.27) of exponential filtering function were notably smaller than those of R-L filtering function (d = 0.40, r = 0.39) and of S-R filtering function (d = 0.37, r = 0.36) (P < 0.05). Puncture time ((9.23 ± 0.32) min vs. (13.11 ± 0.45) min), puncture direction change (20% vs. 33.33%), abnormal puncture sensation (22% vs. 40%), and nerve root touch (4% vs. 23.33%) in the CT group were all lower than those in the control group. The proportion of Degree I anesthesia effect (94%) of the CT group was greatly higher than that of the control group (76.67%) (P < 0.05). The VAS score, time of activity and gastrointestinal function recovery, and the incidence of adverse reactions (2.5% vs. 28%) in the ERAS group were lower than those in the CT group (P < 0.05). All in all, the CT localization method can improve the difficulty of anesthesia puncture and improve the anesthetic effect; the ERAS nursing concept can improve the postoperative pain of patients and contribute to the prognosis of patients and have a good clinical value.
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2600755. [PMID: 35677370 PMCID: PMC9168087 DOI: 10.1155/2022/2600755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the impact of intraspinal nerve block anesthesia on intrapartum fever and the neonate. Methods In this prospective study, between October 2019 and December 2020, 90 eligible primiparous women enrolled in the obstetrics and gynecology department of our hospital for delivery were recruited and assigned via the random number table method at a ratio of 1 : 1 to either an analgesic group given intraspinal nerve block anesthesia for labor or a nonanalgesic group without anesthesia for labor. Outcome measures included intrapartum body temperature, cases of intrapartum fever, Apgar scores of neonates, visual analogue scale (VAS) scores, delivery mode, and indomethacin use. Results Intraspinal nerve block anesthesia was associated with a higher body temperature at 4 h and 5 h after analgesia and more cases of intrapartum fever versus no anesthesia (P < 0.05). There were no significant differences in the Apgar scores between the two groups (P > 0.05). Participants given intraspinal nerve block anesthesia had lower VAS scores during labor versus those without anesthesia (P < 0.05). The differences in the delivery mode between the two groups were not significant (P > 0.05). Intraspinal nerve block anesthesia resulted in a significantly higher demand for indomethacin versus no anesthesia (P < 0.05). Conclusion Intraspinal nerve block anesthesia is clinically effective in labor analgesia but may cause increased body temperature or even overt clinical fever, so close clinical observation of maternal temperature changes is required to mitigate the effects of anesthesia on the mothers. No adverse consequences of intraspinal nerve block anesthesia on the newborns were reported in this study.
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Chorioamnionitis and its association with neonatal and maternal adverse outcomes in women with and without epidural analgesia administration. Eur J Obstet Gynecol Reprod Biol 2022; 273:33-37. [PMID: 35453070 DOI: 10.1016/j.ejogrb.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/05/2022] [Accepted: 04/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate neonatal fever and adverse maternal and neonatal outcomes in febrile laboring women and assess whether the time interval between epidural analgesia (EA) administration and chorioamnionitis is associated with these complications. METHODS A retrospective cohort study at a university affiliated medical center between 2003 and 2015. Included were women who underwent term vaginal delivery attempt and diagnosed with chorioamnionitis. The primary outcomes compared between febrile women with and without EA were neonatal fever and adverse neonatal and maternal outcomes. The association between time from EA to fever (<6, 6-12, >12 h) and maternal and neonatal complications was also assessed. RESULTS During the study period, 1,933 women with chorioamnionitis were assessed. Of them, 1,810 (93.6%) received EA prior to fever and 123 (6.4%) febrile parturients did not receive EA. Neonatal fever and other neonatal adverse outcomes were similar in the EA vs. non-EA group (2.2% vs. 0.8% and 2.7% vs. 4.9% (NS)), except for transient tachypnea of the newborn rates which were lower in the EA group (1.4% vs. 4.1%, p = 0.043). Maternal complications were similar, besides for higher rates of instrumental deliveries found in the EA group (24.0% vs. 5.7%, p < 0.001). Time between EA and fever onset was not associated with neonatal complications in logistic regression analysis. CONCLUSION Neonatal and maternal outcomes are similar in febrile laboring women with and without EA. The time interval between EA and onset of fever is not associated with increased rates of neonatal fever or adverse outcomes and should not affect the management of labor.
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Chen Y, Wan J, Zhu Z, Su C, Mei Z. Embedding evidence of early postoperative off-bed activities and rehabilitation in a real clinical setting in China: an interrupted time-series study. BMC Nurs 2022; 21:98. [PMID: 35473628 PMCID: PMC9044807 DOI: 10.1186/s12912-022-00883-5] [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: 11/05/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Patients should be encouraged to mobilize with 24 h of caesarean section. However, the time of the first off-bed activity after surgery is usually 24 ~ 48 h in China. Due to the lack of knowledge of early off-bed activities, lack of attention to medical pain, and the absence of systematic evidence for the clinical transformation process. the aim of this study was showed that the application of evidence needs to be embedding in the real setting to construct the localization plan and achieve the effective result. Methods To establish evidence of the benefits of early postoperative off-bed activities on patients’ well-being based on a literature review. An interrupted time series analysis was used to evaluate the effectiveness of the intervention. The first and third periods were both five months (from February 1st, 2019 to January 31st, 2020), with a two-month interrupted time (from July 1st, 2019 to August 31st, 2019). Results Eight clinical practices were retrieved from the literature and incorporated into the intervention. A total of 465 patients were included: 226 patients before and 239 patients after implementing the intervention. The average onset time of postoperative off-bed activities was significantly earlier after the intervention than before the intervention (20.01 vs. 31.89 h after the operation, P < 0.001). The 24-h off-bed rate increased from 30.94% before to 91.21% after the intervention (P < 0.001). The average pain score of patients decreased from 5.23 points before to 3.82 points after the intervention (P = 0.032). The average postoperative hospital stay was shortened from 5.06 days before to 3.51 days after the intervention (P < 0.001). In addition, the incidence rates of postoperative ileus (POI) and infection decreased from 5.38% and 2.65% before to 1.67% and 0.84% after the intervention, respectively (P < 0.001). Conclusions We established an evidence-based nursing intervention. Evaluation of the effect of evidence-based practices should be considered in the clinical setting and include preoperative health education, effective analgesia management, and safety management. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00883-5.
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Affiliation(s)
- Yun Chen
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Wan
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China.
| | - Chunhong Su
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhengrong Mei
- Department of Obstetrics and Gynecology,Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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