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Duangkum C, Sirikarn P, Kongwattanakul K, Sothornwit J, Chaiyarah S, Saksiriwuttho P, Somjit M, Komwilaisak R, Hayagangchart S, Lumbiganon P. Subcutaneous vs intravenous fentanyl for labor pain management: a multicenter randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101310. [PMID: 38342306 DOI: 10.1016/j.ajogmf.2024.101310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Labor pain is the most intense pain a woman will experience during her lifetime. Epidural anesthesia is recommended as the most effective method for pain relief, but it has several limitations. Fentanyl has high analgesic potency with short-acting duration, but the large-scale trials that assessed the effectiveness and safety of it for labor pain management are still limited. OBJECTIVE This study aimed to compare the effectiveness and harm and maternal satisfaction of subcutaneous vs intravenous fentanyl for labor pain management. STUDY DESIGN We conducted a multicenter, open-label randomized controlled trial. A total of 226 women were randomized to receive intravenous or subcutaneous fentanyl for labor pain management. Pain scores were evaluated before and after fentanyl administration at 5, 30, and 60 minutes and then every 60 minutes until delivery. The data were analyzed based on the intention-to-treat principle. RESULTS Both intravenous and subcutaneous fentanyl significantly decreased labor pain from baseline to delivery (overall mean change, -1.39; 95% confidence interval, -1.62 to -1.17; and -0.89; 95% confidence interval, -1.24 to -0.05, respectively). The reduction in the pain score between the 2 groups was not different (overall mean difference, -0.35; 95% confidence interval, -0.76 to 0.05). Maternal satisfaction was high for both intravenous and subcutaneous fentanyl (89.4% and 93.8%, respectively). There was no difference in the maternal satisfaction rate between the 2 groups (relative risk, 0.95; 95% confidence interval, 0.88-1.03). No serious maternal and neonatal adverse effects were observed. CONCLUSION Both intravenously and subcutaneously administered fentanyl were safe and significantly reduced pain from baseline to delivery among low-risk pregnancies. Maternal satisfaction with the childbirth experience was high regardless of the route of administration of fentanyl. No serious adverse effects of fentanyl were observed in either the mothers or the neonates.
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Affiliation(s)
- Chatuporn Duangkum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon).
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand (Dr Sirikarn)
| | - Kiattisak Kongwattanakul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Jen Sothornwit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Dr Sothornwit)
| | - Sukanya Chaiyarah
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Piyamas Saksiriwuttho
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Monsicha Somjit
- Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Dr Somjit)
| | - Rattana Komwilaisak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
| | - Suppasiri Hayagangchart
- Department of Obstetrics and Gynecology, Khon Kaen Hospital, Khon Kaen, Thailand (Dr Hayagangchart)
| | - Pisake Lumbiganon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (Drs Duangkum, Kongwattanakul, Chaiyarah, Saksiriwuttho, Komwilaisak, and Lumbiganon)
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Ghidini A, Vanasche K, Cacace A, Cacace M, Fumagalli S, Locatelli A. Side effects from epidural analgesia in laboring women and risk of cesarean delivery. AJOG GLOBAL REPORTS 2024; 4:100297. [PMID: 38283322 PMCID: PMC10820310 DOI: 10.1016/j.xagr.2023.100297] [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] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Epidural analgesia may cause maternal hypotension and changes in the fetal heart rate. The implications of such side effects on the course of labor and delivery are incompletely understood. OBJECTIVE This study aimed to assess whether the occurrence of maternal or fetal side effects associated with labor epidural analgesia increased the risk for cesarean delivery. STUDY DESIGN This was a cohort study of all women who underwent epidural analgesia during labor for the period October 1, 2020 to December 31, 2020. Excluded were cases of multiples, fetal death, noncephalic presentation, and gestational age at birth <37.0 weeks. Maternal vital signs and fetal heart rate tracings for the 1 hour before and 1 hour after epidural analgesia was administered were reviewed. The occurrence of maternal hypotension, defined as a continuous variable and dichotomized into a decrease in maternal systolic blood pressure to <90 mm Hg or a drop in systolic blood pressure by >20% below the last value before epidural analgesia was administered, was related to changes in the fetal heart rate category. The principal outcome was cesarean delivery rate; binary logistic regression analysis was used to control for confounders, and mediation model analysis was used to quantify the extent to which significant variables participated in the causation pathway to cesarean delivery (SPSS version 28 was used for the analyses). RESULTS A total of 439 women met the study criteria. Significant adverse reactions owing to epidural occurred in 184 of 439 women (41.9%) and included severe maternal hypotension in 159 of 439 participants (36.2%) and worsening fetal heart rate category in 50 of 439 participants (11.4%). The logistic regression analysis revealed that cervical dilation at epidural (P=.03), the duration of labor after epidural (P<.001), and worsening fetal heart rate category within 60 minutes of epidural administration (P=.01) were independently associated with recourse to cesarean delivery. The mediation analysis showed that both cervical dilatation at epidural administration and worsening fetal heart rate category had significant direct and indirect effects in the pathway to cesarean delivery. CONCLUSION Worsening fetal heart rate category related to labor epidural independently increased the risk for cesarean delivery.
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Affiliation(s)
- Alessandro Ghidini
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Kelly Vanasche
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Alyssa Cacace
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA, USA (Alyssa Cacace)
| | - Marietta Cacace
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli)
- Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli)
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli)
- Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli)
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Hung KC, Chen JY, Hsing CH, Hsu CW, Liu PH, Chang YJ, Chen JY, Chiu SF, Sun CK. Association of labor epidural analgesia exposure with long-term risk of autism spectrum disorder in offspring: A meta-analysis of observational studies. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1177-1189. [PMID: 36448720 DOI: 10.1177/13623613221138690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
LAY ABSTRACT A previous meta-analysis has demonstrated a superior analgesic efficacy of epidural analgesia (e.g. labor epidural analgesia) in comparison with non-epidural approaches. The widely accepted safety of labor epidural analgesia also endorses its current popularity in obstetric practice. However, the results of a recent large-scale longitudinal study that demonstrated a significant increase in risk of autism spectrum disorder in offspring from mothers with labor epidural analgesia exposure have raised some concerns over the safety of its use. The current meta-analysis aimed at examining the strength of evidence regarding this issue based on updated clinical data. Through systematically reviewing seven eligible observational studies involving 4,021,406 children from electronic databases, our results showed a slight but statistically significant increase in risk of autism spectrum disorder in children with exposure to labor epidural analgesia compared with those without. The finding was consistent in subgroup analysis focusing on siblings and children delivered vaginally. Nevertheless, despite the tendency of an increased risk of autism spectrum disorder in children exposed to labor epidural analgesia <4 h, this effect was not observed in those exposed to labor epidural analgesia >8 h (data from two studies). In conclusion, the level of evidence linking labor epidural analgesia to autism spectrum disorder development in offspring was very low based on the latest data because of the small effect size and the finding of a lack of cumulative dose-response effect in the current analysis. Further studies are warranted to provide an insight into this issue.
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Affiliation(s)
- Kuo-Chuan Hung
- Chi Mei Medical Center, Taiwan
- Chia Nan University of Pharmacy and Science, Taiwan
| | | | | | - Chih-Wei Hsu
- Kaohsiung Chang Gung Memorial Hospital, Taiwan
- Chang Gung University, Taiwan
| | | | - Ying-Jen Chang
- Chi Mei Medical Center, Taiwan
- Chia Nan University of Pharmacy and Science, Taiwan
| | - Jui-Yi Chen
- Chi Mei Medical Center, Taiwan
- Chia Nan University of Pharmacy and Science, Taiwan
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Nenko I, Kopeć-Godlewska K, Towner MC, Klein LD, Micek A. Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland. Evol Med Public Health 2023; 11:139-148. [PMID: 37252430 PMCID: PMC10224696 DOI: 10.1093/emph/eoad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/31/2023] [Indexed: 05/31/2023] Open
Abstract
Background and objectives Birth is a critical event in women's lives. Since humans have evolved to give birth in the context of social support, not having it in modern settings might lead to more complications during birth. Our aim was to model how emotional factors and medical interventions related to birth outcomes in hospital settings in Poland, where c-section rates have doubled in the last decade. Methodology We analysed data from 2363 low-risk primiparous women who went into labor with the intention of giving birth vaginally. We used a model comparison approach to examine the relationship between emotional and medical variables and birth outcome (vaginal or c-section), including sociodemographic control variables in all models. Results A model with emotional factors better explained the data than a control model (ΔAIC = 470.8); women with continuous personal support during labor had lower odds of a c-section compared to those attended by hospital staff only (OR = 0.12, 95% CI = 0.09 - 0.16). A model that included medical interventions also better explained the data than a control model (ΔAIC = 133.6); women given epidurals, in particular, had increased odds of a c-section over those who were not (OR = 3.55, 95% CI = 2.95 - 4.27). The best model included variables for both the level of personal support and the use of epidural (ΔAIC = 598.0). Conclusions and implications Continuous personal support during childbirth may be an evolutionarily informed strategy for reducing complications, including one of the most common obstetrical complications in modern hospital settings, the c-section.
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Affiliation(s)
- Ilona Nenko
- Corresponding author. Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Skawinska 8, Krakow 31-066, Poland. E-mail:
| | - Katarzyna Kopeć-Godlewska
- Laboratory of Fundamental Obstetric Care, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Mary C Towner
- Department of Integrative Biology, Oklahoma State University, Stillwater, OK, USA
| | - Laura D Klein
- Business Growth and Innovation, Australian Red Cross Lifeblood, Alexandria, Australia
| | - Agnieszka Micek
- Department of Nursing Management and Epidemiological Nursing, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
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Zanfini BA, Catarci S, Vassalli F, Laurita Longo V, Biancone M, Carducci B, Frassanito L, Lanzone A, Draisci G. The Effect of Epidural Analgesia on Labour and Neonatal and Maternal Outcomes in 1, 2a, 3, and 4a Robson's Classes: A Propensity Score-Matched Analysis. J Clin Med 2022; 11:jcm11206124. [PMID: 36294447 PMCID: PMC9604843 DOI: 10.3390/jcm11206124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Lumbar epidural analgesia (EA) is the most commonly used method for reducing labour pain, but its impact on the duration of the second stage of labour and on neonatal and maternal outcomes remains a matter of debate. Our aim was to examine whether EA affected the course and the outcomes of labour among patients divided according to the Robson-10 group classification system. Methods: Patients of Robson’s classes 1, 2a, 3, and 4a were divided into either the EA group or the non-epidural analgesia (NEA) group. A propensity score-matching analysis was performed to balance the intergroup differences. The primary goal was to analyse the duration of the second stage of labour. The secondary goals were to evaluate neonatal and maternal outcomes. Results: In total, 21,808 cases were analysed. The second stage of labour for all groups was prolonged using EA (p < 0.05) without statistically significant differences in neonatal outcomes. EA resulted in a lower rate of episiotomies in nulliparous patients, with a higher rate of operative vaginal deliveries (OVD) (p < 0.05) and Caesarean sections (CS) (p < 0.05) in some classes. Conclusions: EA prolonged the duration of labour without affecting neonatal outcomes and reduced the rate of episiotomies, but also increased the rate of OVDs.
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Affiliation(s)
- Bruno Antonio Zanfini
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Correspondence:
| | - Stefano Catarci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Francesco Vassalli
- Obstetric Anesthesia, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Valentina Laurita Longo
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Largo F. Vito 1, 00168 Roma, Italy
| | - Matteo Biancone
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Brigida Carducci
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Luciano Frassanito
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Antonio Lanzone
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Largo F. Vito 1, 00168 Roma, Italy
| | - Gaetano Draisci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Obstetric Anesthesia, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, 16147 Genova, Italy
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Largo F. Vito 1, 00168 Roma, Italy
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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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Carrascosa MDC, Navas A, Artigues C, Ortas S, Portells E, Soler A, Bennasar-Veny M, Leiva A. Effect of aerobic water exercise during pregnancy on epidural use and pain: A multi-centre, randomised, controlled trial. Midwifery 2021; 103:103105. [PMID: 34352600 DOI: 10.1016/j.midw.2021.103105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 05/28/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The physical and psychological benefits of exercise during pregnancy are well established. However, the impact of exercise on pain during labour and the use of epidural analgesia has been less explored. The main aim of this study was to analyse the effectiveness and safety of moderate aerobic water exercise by pregnant women on the subsequent use of epidural analgesia during labour, induction of labour, mode of delivery, and pain perception. DESIGN A multi-centre, parallel, randomised, evaluator blinded, controlled trial in a primary care setting. SETTING Primary care centres in a health district of a tertiary obstetric metropolitan hospital in Mallorca, Spain. PARTICIPANTS Pregnant women (14 to 20 weeks' gestation) who had low risk of complications. METHODS Three hundred and twenty pregnant women were randomly assigned to two groups: women who practiced moderate aquatic aerobic exercise with usual antenatal care, and those who received usual prenatal care alone. The gynaecologist, anaesthesiologist and midwife who assisted the women during labour were blinded to group allocations. Principal outcome: use of epidural analgesia during labour. Other outcomes: use of epidural analgesia before 6 cm cervical dilation, labour pain, type of delivery, time of active labour, episiotomy or perineal tear, and induction of labour. RESULTS The exercise program did not affect the use of epidural analgesia (OR = 0.79, 95% CI = 0.44 to 1.40), vaginal delivery (OR = 1.35, 95% CI = 0.73 to 2.41), or caesarean section (OR = 0.94, 95% CI = 0.47 to 1.89). However, women in the exercise group reported less pain during labour (mean difference: -0.6, 95% CI = -1.11 to -0.09). The two groups (moderate aquatic aerobic exercise versus usual antenatal care) showed no significant differences in maternal or newborn adverse events. CONCLUSION Aquatic aerobic exercise during pregnancy had no effect on the use of epidural analgesia during labour, whereas pain perception was lower after aquatic exercise compared to usual care in pregnancy. The intervention was safe for pregnant women and their newborns.
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Affiliation(s)
- María Del Carmen Carrascosa
- Mallorca Primary Health Care, Balearic Islands Health Services, Calle Escuela Graduada, 3, Palma 07002, Spain.
| | - Araceli Navas
- Hospital Comarcal de Inca, Servei de Salut de les Illes Balears (Ib-salut), Carretera Vella de Llubí, s/n, Inca 07300, Spain
| | - Catalina Artigues
- Mallorca Primary Health Care, Balearic Islands Health Services, Calle Escuela Graduada, 3, Palma 07002, Spain.
| | - Silvia Ortas
- Mallorca Primary Health Care, Balearic Islands Health Services, Calle Escuela Graduada, 3, Palma 07002, Spain
| | - Elena Portells
- Mallorca Primary Health Care, Balearic Islands Health Services, Calle Escuela Graduada, 3, Palma 07002, Spain.
| | - Aina Soler
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Calle Escuela Graduada, 3, Palma 07002, Spain; Insitut d'Investigació Sanitària Illes Balears (IdISBa), Carretera de Valldemossa, 79, Palma 07120, Spain.
| | - Miquel Bennasar-Veny
- Insitut d'Investigació Sanitària Illes Balears (IdISBa), Carretera de Valldemossa, 79, Palma 07120, Spain; Nursing and Physiotherapy Department, Balearic Islands University, Carrertera de Valldemosa, Km 7,5, Palma 07122, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid 28029, Spain.
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Calle Escuela Graduada, 3, Palma 07002, Spain; Insitut d'Investigació Sanitària Illes Balears (IdISBa), Carretera de Valldemossa, 79, Palma 07120, Spain.
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Petersen JM, Ranker LR, Barnard-Mayers R, MacLehose RF, Fox MP. A systematic review of quantitative bias analysis applied to epidemiological research. Int J Epidemiol 2021; 50:1708-1730. [PMID: 33880532 DOI: 10.1093/ije/dyab061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Quantitative bias analysis (QBA) measures study errors in terms of direction, magnitude and uncertainty. This systematic review aimed to describe how QBA has been applied in epidemiological research in 2006-19. METHODS We searched PubMed for English peer-reviewed studies applying QBA to real-data applications. We also included studies citing selected sources or which were identified in a previous QBA review in pharmacoepidemiology. For each study, we extracted the rationale, methodology, bias-adjusted results and interpretation and assessed factors associated with reproducibility. RESULTS Of the 238 studies, the majority were embedded within papers whose main inferences were drawn from conventional approaches as secondary (sensitivity) analyses to quantity-specific biases (52%) or to assess the extent of bias required to shift the point estimate to the null (25%); 10% were standalone papers. The most common approach was probabilistic (57%). Misclassification was modelled in 57%, uncontrolled confounder(s) in 40% and selection bias in 17%. Most did not consider multiple biases or correlations between errors. When specified, bias parameters came from the literature (48%) more often than internal validation studies (29%). The majority (60%) of analyses resulted in >10% change from the conventional point estimate; however, most investigators (63%) did not alter their original interpretation. Degree of reproducibility related to inclusion of code, formulas, sensitivity analyses and supplementary materials, as well as the QBA rationale. CONCLUSIONS QBA applications were rare though increased over time. Future investigators should reference good practices and include details to promote transparency and to serve as a reference for other researchers.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynsie R Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ruby Barnard-Mayers
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Baker SG. CACE and meta-analysis (Letter to the Editor). Biometrics 2020; 76:1383-1384. [PMID: 32108321 DOI: 10.1111/biom.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Stuart G Baker
- Biometry Research Group, National Cancer Institute, Bethesda, Maryland
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10
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Lee N, Gao Y, Lotz L, Kildea S. Maternal and neonatal outcomes from a comparison of spontaneous and directed pushing in second stage. Women Birth 2018; 32:e433-e440. [PMID: 30377072 DOI: 10.1016/j.wombi.2018.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/14/2023]
Abstract
AIM To compare the effect of directed or spontaneous maternal pushing effort on duration of second stage labour, perineal injury and neonatal condition at birth. METHODS A retrospective cross-sectional design provided data for term women with singleton, cephalic presentation experiencing a non-operative vaginal birth without regional analgesia from January 2011 to December 2017 (n=69,066) Participants matching the inclusion criteria (n=19,212) were grouped based upon spontaneous or directed pushing. Propensity score matching was used to select equally sized cohorts of similar characteristics (n=10,000). The associations with outcomes of interest were estimated using odds ratios obtained by multivariate analysis. FINDINGS Directed pushing was associated with a longer duration of second stage labour for nulliparous (mean 14.4min [12.0-16.8]) and multiparous (mean 8.0min [6.8-9.2]) women, and an increased risk of prolonged 2nd stage of labour in multiparous women. The use of episiotomy in the directed pushing group was significantly higher both prior to and following PS matching and adjustment. Directed pushing was also associated with an significantly increased risk of neonatal resuscitation and nursery admission. There was no difference in rates of Apgar <7 recorded at 5min of age. CONCLUSION Directed pushing is associated with an increased duration of second stage labour and risk of adverse neonatal outcomes. Our study suggests that in the absence of regional analgesia women should be supported to follow their own expulsive urges.
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Affiliation(s)
- Nigel Lee
- Midwifery Research Unit, Level 2 Aubigny Place, Mater Research, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia.
| | - Yu Gao
- Midwifery Research Unit, Level 2 Aubigny Place, Mater Research, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia
| | - Lauren Lotz
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia
| | - Sue Kildea
- Midwifery Research Unit, Level 2 Aubigny Place, Mater Research, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia
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11
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Knox A, Rouleau G, Semenic S, Khongkham M, Ciofani L. Barriers and facilitators to birth without epidural in a tertiary obstetric referral center: Perspectives of health care professionals and patients. Birth 2018; 45:295-302. [PMID: 29251370 DOI: 10.1111/birt.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidural rates are high in tertiary obstetric referral centers, even though many patients in tertiary settings might not want or need epidural analgesia. Epidural rates are influenced by factors including labor support and routine medical intervention. This study aimed to identify barriers and facilitators to birth without epidural in a Canadian tertiary center, from the perspectives of doctors, nurses, and patients. METHODS In this qualitative exploratory study, individual, semi-structured interviews were conducted in 2016 with 5 doctors, 5 nurses, and 4 patients who intended to birth without epidural. Interviews were audio-recorded, transcribed, and analyzed using inductive qualitative thematic analysis. RESULTS Several contextual factors in the tertiary center facilitated or were barriers to birth without epidural. The following themes emerged: (1) differing perceptions of pain, (2) being ready for things to go wrong, (3) labor support is more labor intensive, and (4) having insufficient resources for birth without epidural. CONCLUSIONS Reconciling patient birth goals with staff focus on patient safety is challenging in the tertiary context. Discrepancies between health care professional and patient attitudes about childbirth pain may influence decision-making about epidural use. Maintaining labor support skills is challenging for health care professionals who have limited exposure to birth without epidural. There is a need to allocate dedicated resources to better support birth without epidural. Specifically, support could be improved through the implementation of guidelines for assessment and management of labor pain, provision of a variety of pain management options, and labor support training for health care professionals.
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Affiliation(s)
- Alyssa Knox
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,Women's Health Mission, McGill University Health Centre, Montreal, QC, Canada
| | - Malisa Khongkham
- Women's Health Mission, McGill University Health Centre, Montreal, QC, Canada
| | - Luisa Ciofani
- Women's Health Mission, McGill University Health Centre, Montreal, QC, Canada
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12
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Ahmed B, Zoega H, Havard A. Renin-angiotensin system blockers in early pregnancy among women with chronic hypertension: getting to the heart of the risk-benefit equation. Int J Epidemiol 2018; 47:683-686. [DOI: 10.1093/ije/dyy066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bilal Ahmed
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Alys Havard
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
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13
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Navas A, Artigues C, Leiva A, Portells E, Soler A, Cladera A, Ortas S, Alomar M, Gual M, Manzanares C, Brunet M, Julià M, López L, Granda L, Bennasar-Veny M, Carrascosa MC. Effectiveness and safety of moderate-intensity aerobic water exercise during pregnancy for reducing use of epidural analgesia during labor: protocol for a randomized clinical trial. BMC Pregnancy Childbirth 2018; 18:94. [PMID: 29642862 PMCID: PMC5896064 DOI: 10.1186/s12884-018-1715-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/23/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Epidural analgesia during labor can provide effective pain relief, but can also lead to adverse effects. The practice of moderate exercise during pregnancy is associated with an increased level of endorphins in the blood, and this could also provide pain relief during labor. Aerobic water exercises, rather than other forms of exercise, do not negatively impact articulations, reduce edema, blood pressure, and back pain, and increase diuresis. We propose a randomized controlled trial (RCT) to evaluate the effectiveness and safety of a moderate water exercise program during pregnancy on the need for epidural analgesia during labor. METHODS A multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. We will randomised 320 pregnant women (14 to 20 weeks gestation) who have low risk of complications to a moderate water exercise program or usual care. DISCUSSION The findings of this research will contribute toward understanding of the effects of a physical exercise program on pain and the need for analgesia during labor. TRIAL REGISTRATION ISRCTN Registry identifier: 14097513 register on 04 September 2017. Retrospectively registered.
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Affiliation(s)
- Araceli Navas
- Baleares Health Services-IbSalut, Hospital de Son Espases, 07005 Palma, Spain
| | - Catalina Artigues
- Pont D’Inca- Marratxí Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca. Baleares Health Services-IbSalut, 07005 Palma, Spain
- Instituto de Investigación Sanitaria de Palma(IdISPa), 07010 Palma, Spain
| | - Elena Portells
- Muntanya- Marratxí Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Aina Soler
- Primary Care Research Unit of Mallorca. Baleares Health Services-IbSalut, 07005 Palma, Spain
- Instituto de Investigación Sanitaria de Palma(IdISPa), 07010 Palma, Spain
| | - Antonia Cladera
- Santa María Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Silvia Ortas
- S’Excorxador Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Margarita Alomar
- Can Pastilla Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Marina Gual
- Soller Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | | | - Marina Brunet
- Santa Ponça Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Magdalena Julià
- Alcudia Health Care Center. Baleares Health Services-IbSalut, 07005 Palma, Spain
| | - Lidia López
- Baleares Health Services-IbSalut, Hospital Comarcal de Inca, 07005 Palma, Spain
| | - Lorena Granda
- Baleares Health Services-IbSalut, Hospital de Manacor, 07005 Palma, Spain
| | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy, Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, 07122 Palma, Spain
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14
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Golalizadeh Bibalan F, Shobeiri F, Ranjbar A, Hagian P. The Effect of Epidural-Spinal Anesthesia on Labor Outcome and Satisfaction in Parturient Mothers: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF BASIC SCIENCE IN MEDICINE 2017. [DOI: 10.15171/ijbsm.2017.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: One of the health system concerns is the use of medications for pain relief during labor and its side effects. Therefore, the aim of this study was to investigate the effect of epiduralspinal anesthesia (combined anesthesia [CA]) on labor outcome and satisfaction in pregnant women. Methods: In this randomized controlled trial study, we included 80 nulliparous women who had been admitted to Fatemieh hospital (Hamadan, Iran) during 2015-2016 due to spontaneous onset of labor. They were randomly assigned into 2 groups of 40, one group with CA versus normal vaginal delivery (NVD) group. Data were collected by using of demographic questionnaire, satisfaction questionnaire, and baby truck scales. Data were analyzed by descriptive and analytical statistics in SPSS version 16.0. Results: Average maternal age (mean ± SD) in the CA group was 26.94 ± 4.34 and in the NVD group was 25.89 ±5.18, respectively. There was a significant difference between the 2 groups in terms of length of second stage of labor (P=0.001), headache (P=0.04), and Apgar score (first minute) (P=0.001). Chi-square test showed a significant difference between the 2 groups in terms of satisfaction with childbirth (P=0.004). Conclusion: In this study, labor pain relief by using the spinal-epidural anesthesia (CA) increased the labor satisfaction. Nevertheless, this approach was associated with some maternal and neonatal complications such as: headaches, length of third stage of labor, and low Apgar score. It seems that the use of this method for painless delivery requires further studies.
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Affiliation(s)
- Faegheh Golalizadeh Bibalan
- Department of Midwifery, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Shobeiri
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Department of Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Pooran Hagian
- Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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15
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Biel FM, Marshall NE, Snowden JM. Maternal Body Mass Index and Regional Anaesthesia Use at Term: Prevalence and Complications. Paediatr Perinat Epidemiol 2017; 31:495-505. [PMID: 28833337 PMCID: PMC5805391 DOI: 10.1111/ppe.12387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by pre-pregnancy BMI categories among term deliveries. METHODS Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics. RESULTS In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose-response fashion (adjusted risk ratio [RR] 1.10, 95% confidence interval [CI] 1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95% CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95% CI 1.37, 4.02 for primiparous women). CONCLUSION Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia. Rates of anaesthesia complications were highest among women in the highest BMI category.
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Affiliation(s)
- Frances M. Biel
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Nicole E. Marshall
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR
| | - Jonathan M. Snowden
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR,Oregon Health and Science University-Portland State University School of Public Health, Portland, OR
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16
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Felisbino-Mendes MS, Santos LO, Amorim T, Costa IN, Martins EF. O uso de analgesia farmacológica influencia no desfecho de parto? ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo: Investigar associação entre analgesia farmacológica e desfechos do parto. Métodos: Estudo transversal que utilizou amostra representativa dos partos realizados em 2013, em uma maternidade de Belo Horizonte, Minas Gerais. Foram incluídos dados de 978 partos, excluindo-se as cesarianas eletivas. A exposição principal foi o uso de analgesia farmacológica durante o trabalho de parto e o desfecho classificado como parto vaginal, vaginal instrumentalizado e cesariana. Verificou-se a associação entre analgesia e os desfechos do parto por meio de regressão logística multinominal para obter as estimativas de Odds Ratio (OR) com seus respectivos intervalos de 95% de confiança, e o modelo final foi ajustado por idade da mulher, número de partos anteriores, presença de acompanhante ou doula e dilatação cervical no momento da analgesia. Resultados: Do total de nascimentos, 87,1% foram vaginais e 12,9% cesariana. A prevalência do uso de analgesia farmacológica foi 34,2% e do parto instrumentalizado de 8,4%. Cerca de 70% das mulheres tiveram gestação de risco habitual. Mesmo após ajuste por confundidores, o uso da analgesia aumentou em 3,5 vezes a chance de parto instrumentalizado (p<0,0001) e para as mulheres com gestação de alto risco esse aumento foi ainda superior (OR=4,62; p<0,0001). Não houve associação do uso da analgesia com a cesariana (p=0,320). Conclusão: O uso de analgesia farmacológica modifica o desfecho do parto, aumentando as chances de parto instrumentalizado, principalmente em mulheres com gravidez de alto risco. Nesse contexto considera-se importante orientar as mulheres quanto aos potenciais riscos e benefícios da analgesia para uma escolha segura.
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17
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Toohill J, Sidebotham M, Gamble J, Fenwick J, Creedy DK. Factors influencing midwives' use of an evidenced based Normal Birth Guideline. Women Birth 2017; 30:415-423. [PMID: 28434673 DOI: 10.1016/j.wombi.2017.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 12/17/2022]
Abstract
Problem or issue Rates of elective and unplanned caesarean section
continue to increase in high income countries. Evidence-based clinical guidelines aim to promote and
support normal birth but are rarely evaluated. What is already known The Queensland Normal Birth Guideline was developed in
consultation with stakeholders and disseminated to public
and private hospitals and released in 2012. Impact of the
Guideline on practice has not been investigated. What this paper adds Although most midwives (90%) were aware of the
guideline, only 71% reported that it routinely guided
practice.
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Affiliation(s)
- Jocelyn Toohill
- School of Nursing and Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia; Menzies Health Institute Queensland, Griffith University, Griffith Health Centre, Gold Coast Campus, QLD 4222, Australia.
| | - Mary Sidebotham
- School of Nursing and Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia; Menzies Health Institute Queensland, Griffith University, Griffith Health Centre, Gold Coast Campus, QLD 4222, Australia.
| | - Jennifer Gamble
- School of Nursing and Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia; Menzies Health Institute Queensland, Griffith University, Griffith Health Centre, Gold Coast Campus, QLD 4222, Australia.
| | - Jennifer Fenwick
- School of Nursing and Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia; Menzies Health Institute Queensland, Griffith University, Griffith Health Centre, Gold Coast Campus, QLD 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia; Menzies Health Institute Queensland, Griffith University, Griffith Health Centre, Gold Coast Campus, QLD 4222, Australia.
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18
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Hunnicutt JN, Ulbricht CM, Chrysanthopoulou SA, Lapane KL. Probabilistic bias analysis in pharmacoepidemiology and comparative effectiveness research: a systematic review. Pharmacoepidemiol Drug Saf 2016; 25:1343-1353. [PMID: 27593968 DOI: 10.1002/pds.4076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/16/2016] [Accepted: 07/11/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE We systematically reviewed pharmacoepidemiologic and comparative effectiveness studies that use probabilistic bias analysis to quantify the effects of systematic error including confounding, misclassification, and selection bias on study results. METHODS We found articles published between 2010 and October 2015 through a citation search using Web of Science and Google Scholar and a keyword search using PubMed and Scopus. Eligibility of studies was assessed by one reviewer. Three reviewers independently abstracted data from eligible studies. RESULTS Fifteen studies used probabilistic bias analysis and were eligible for data abstraction-nine simulated an unmeasured confounder and six simulated misclassification. The majority of studies simulating an unmeasured confounder did not specify the range of plausible estimates for the bias parameters. Studies simulating misclassification were in general clearer when reporting the plausible distribution of bias parameters. Regardless of the bias simulated, the probability distributions assigned to bias parameters, number of simulated iterations, sensitivity analyses, and diagnostics were not discussed in the majority of studies. CONCLUSION Despite the prevalence and concern of bias in pharmacoepidemiologic and comparative effectiveness studies, probabilistic bias analysis to quantitatively model the effect of bias was not widely used. The quality of reporting and use of this technique varied and was often unclear. Further discussion and dissemination of the technique are warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jacob N Hunnicutt
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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19
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Brixval CS, Thygesen LC, Axelsen SF, Gluud C, Winkel P, Lindschou J, Weber T, Due P, Koushede V. Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial. BMJ Open 2016; 6:e010761. [PMID: 27288375 PMCID: PMC4908902 DOI: 10.1136/bmjopen-2015-010761] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine the effect of an antenatal education programme in small classes versus standard auditorium-based lectures. DESIGN Randomised trial using random-generated web-based 1:1 allocation. SETTING The largest birth site in the Capital Region of Denmark, from August 2012 to May 2014. PARTICIPANTS 1766 pregnant women. Inclusion criteria ≥18 years, pregnant with a single child, and able to speak and understand Danish. Women were enrolled in the trial from 10+0 to 20+0 weeks of gestation. INTERVENTIONS The intervention programme consisted of three times 2.5 hours of antenatal education in small classes (n=6-8 women), and focused on improving information and problem-solving skills for expectant parents in order to ease birth and the transition to parenthood. The control group received standard auditorium-based lectures consisting of two times 2 hours in an auditorium with participation of ∼250 people. MAIN OUTCOME MEASURES The primary trial outcome was use of epidural analgesia. Other types of pain relief and obstetric interventions were analysed as explorative outcomes. RESULTS There was no statistically significant difference in use of epidural analgesia between participants in the intervention group (30.9%) versus the control group (29.1%), adjusted OR 1.10 (95% CI 0.87 to 1.34). Also, the two groups did not differ regarding other types of pain relief or obstetric interventions. Concomitant birth preparation was common in both groups and highest in the control group, but did not seem to influence our results noticeably. CONCLUSIONS Antenatal education in small groups versus standard auditorium-based lectures did not differ regarding use of epidural analgesia, other pain relief, or obstetric interventions. TRIAL REGISTRATION NUMBER NCT01672437; Results.
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Affiliation(s)
- Carina Sjöberg Brixval
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Winkel
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tom Weber
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Pernille Due
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Vibeke Koushede
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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20
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Abstract
The controversy over whether epidurals increase the risk of cesarean has raged since the 1970s. This article provides a history of of the early observational research designed to answer this question and an in-depth analysis of the most recent randomized control trials. Based on the research, the author concludes that we cannot assure women that epidurals do not increase the risk of cesarean.
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21
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A qualitative study exploring how the aims, language and actions of yoga for pregnancy teachers may impact upon women's self-efficacy for labour and birth. Women Birth 2016; 29:3-11. [DOI: 10.1016/j.wombi.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 11/23/2022]
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