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Epidural in labor

Jinfeng Xiao, Wei Yi, Lingling Wu
PURPOSE: To compare the pain scores and rates of complications in the labor analgesia process between the two groups. METHODS: There were 127 participants being recruited in this research, and randomly divided into 2 groups according to the anesthetic technique: CSEA with PCEA with EA group (group 1), CSEA with PCEA group (group 2). Group 1 was first operated CSEA and PCEA, then EA at Hegu (LI4), Neiguan (PC6), Zusanli (ST36) and Sanyinjiao (SP6) by HANS-200A device for 25 min...
November 13, 2018: Archives of Gynecology and Obstetrics
Netanella Miller, Michel Pelleg, Nasrean Hag-Yahia, Yair Daykan, Yael Pasternak, Tal Biron-Shental
PURPOSE: Normal labor curves have not been assessed for women undergoing a trial of labor after cesarean delivery (TOLAC). This study examined labor patterns during TOLAC in relation to epidural analgesia use. METHODS: Retrospective cohort study of deliveries of women undergoing TOLAC at a single, academic, tertiary medical center. Length of first, second and third stages of labor was compared between 424 women undergoing TOLAC in the current labor with no previous vaginal delivery (VD) and 357 women with at least one previous VD and current TOLAC...
November 1, 2018: Archives of Gynecology and Obstetrics
Masato Kinugasa, Mayu Miyake, Hanako Tamai, Maki Tamura
AIM: To evaluate the safety, effect on breastfeeding and efficacy of a combination of pethidine and levallorphan (Pethilorfan) for pain relief during labor. METHODS: We compared maternal or neonatal morbidities, suckling difficulties in newborns and breastfeeding rates between 177 women who received 50-200 mg (as pethidine) of Pethilorfan during labor (Pethilorfan group) and 354 women who delivered their infants without analgesic drugs immediately before or after each woman in the Pethilorfan group (control group) from January 1, 2005 to December 31, 2016...
October 25, 2018: Journal of Obstetrics and Gynaecology Research
Cihun-Siyong Alex Gong, Huang-Chang Lee, Yin Chang, Chien-Kun Ting, Po-Hsun Tu
Purpose: Technology of reflectance spectroscopy incorporated with auto-fluorescence spectroscopy were employed to increase the safety of epidural placement in regional anesthesia which is generally used for surgery, epidural anesthesia, post-operative pain control and painless childbirth. Method: Ex vivo study of auto-fluorescence spectroscopy was performed for the para-vertebral tissues contained fat, interspinous ligament, supraspinous ligament and ligamentumflavum by multimode microplate reader at wavelength 405 nm for the purpose of tissue differentiation...
October 23, 2018: Sensors
Kyoko Wada, Louis C Charland, Geoff Bellingham
There are reasons to believe that decision-making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women's decisional capacity. Decision-making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to 'understanding' alone. A systematic literature search identified a total of 20 empirical studies focused on women's decision-making about epidural analgesia for labor pain...
October 25, 2018: Bioethics
Ilke Kupeli, Nur Gozde Kulhan
Objective: To establish a relationship between the Visual Analog Scale for pain (VAS) in the recovery time of epidural analgesia and the Perfusion Index (PI) values at that time and to test the possibility of using PI as an objective tool for pain assessment. Methods: Thirty women were included in the study. After inserting epidural catheter, the initial applicationtime of epidural analgesia was taken as 0th minute. Hemodinamics, VAS, and PIvalues were recorded at 5th , 10th , 30th , 60th minutes and every two hours until the birth and the 30th minute after the birth...
September 2018: Pakistan Journal of Medical Sciences Quarterly
Melissa D Avery, Carrie E Neerland, Melissa A Saftner
INTRODUCTION: A physiologic approach to labor and birth is preferred for most women. The United States spends more on birth than any other country. Cesarean rates are currently 32%, and approximately 23% of women with a singleton pregnancy experience induction or augmentation of labor. Most physiologic birth research has focused on care during labor and birth. The purpose of this study was to describe women's perceptions of the care processes, support, and information received during pregnancy that helped them feel confident for physiologic labor and birth...
October 18, 2018: Journal of Midwifery & Women's Health
Rasha Kamel, Elisa Montaguti, Kypros H Nicolaides, Mahmoud Soliman, Maria Gaia Dodaro, Sherif Negm, Gianluigi Pilu, Mohamed Momtaz, Aly Youssef
BACKGROUND: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle co-activation. The effect of such co-activation on labor outcome in women undergoing induction of labor has not been previously assessed. OBJECTIVES: The aim of the study was to assess the effect of levator ani muscle co-activation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor...
October 12, 2018: American Journal of Obstetrics and Gynecology
Roberto Romero, Nardhy Gomez-Lopez, Juan Pedro Kusanovic, Percy Pacora, Bogdan Panaitescu, Offer Erez, Bo Hyun Yoon
Clinical chorioamnionitis is the most common infection related diagnosis made in labor and delivery units worldwide. It is traditionally believed to be due to microbial invasion of the amniotic cavity, which elicits a maternal inflammatory response characterized by maternal fever, uterine tenderness, maternal tachycardia and leukocytosis. The condition is often associated with fetal tachycardia and a foul smelling amniotic fluid. Recent studies in which amniocentesis has been used to characterize the microbiologic state of the amniotic cavity and the inflammatory response show that only 60% of patients with the diagnosis of clinical chorioamnionitis have proven infection using culture or molecular microbiologic techniques...
June 2018: Nőgyógyászati és szülészeti továbbképző szemle
Zhen-Yu Cai, Ling-Qun Hu, Francis S Stellaccio, Dong-Xin Wang
Dr Guang-Bo Zhang was the first anesthesiologist to administer and study the effects of labor epidural analgesia in China. Between September 1963 and March 1964, she conducted an observational study evaluating the effects of neuraxial analgesia for laboring women. She presented her research and prepared an article; however, due to the Great Proletarian Cultural Revolution (Cultural Revolution), which began in 1966, her work went unpublished. She successfully preserved her unpublished article, notes, and slides throughout the Cultural Revolution by hiding them in a countryside location near Beijing...
October 8, 2018: Anesthesia and Analgesia
Flora M Li, Trefan B Archibald, Laurent A Bollag
Dual epidural catheter (DEC) therapy improves postoperative pain control in scoliosis correction surgery, esophagectomies, and labor. Reports about the use of a second epidural catheter to improve pain control after abdominal surgeries are sparse. We describe the successful use of unplanned DEC therapy in 2 complex pain patients who underwent large exploratory laparotomies. In both patients, the addition of the second catheter led to improved pain control and mobility and reduced side effects from adjuvant intravenous analgesics...
October 5, 2018: A&A practice
Z L Bao, J Zhang
Objective: To summarize and analyze the methods of termination of pregnancy in the first and second trimester of pregnancy with severe cardiovascular disease. Methods: A retrospective analysis of 27 cases of termination of pregnancy in the first and second trimester of pregnancy in Beijing Anzhen Hospital from January 1, 2016 to December 30, 2017. All of these pregnant women were pregnancy complicated with severe cardiovascular disease in grade Ⅴ pregnancy risk. Results: (1) The age of 27 pregnant women was 22-40 years, gestational age was 6-27 weeks; cardiac function grade before induced labor was: 5 cases of grade Ⅱ, 15 cases of grade Ⅲ, 7 cases of grade Ⅳ...
September 25, 2018: Zhonghua Fu Chan Ke za Zhi
Berrin Gunaydin, Selin Erel
BACKGROUND AND AIM: Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population.  The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literature DISCUSSION: Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural...
October 6, 2018: Journal of Anesthesia
Vikas O'Reilly-Shah, Grant C Lynde
BACKGROUND: With the increasing occurrence of drug shortages, understanding the pharmacokinetics of alternative intrathecal opioid administration has gained importance. In particular, additional data are needed to comprehensively evaluate the analgesic properties of intrathecal hydromorphone in the laboring patient. In a phase 2 clinical trial, we set out to determine the median effective dose (ED50 ) and time to effectiveness for this drug in this population. METHODS: Using Dixon's up-and-down sequential allocation method, twenty women presenting for labor analgesia were prospectively enrolled...
October 5, 2018: BMC Anesthesiology
Andreas Eisenried, Naola Austin, Benjamin Cobb, Alireza Akhbardeh, Brendan Carvalho, David C Yeomans, Alexander Z Tzabazis
Purpose: Noninvasive cerebral optical spectrometry is a promising candidate technology for the objective assessment physiological changes during pain perception. This study's primary objective was to test if there was a significant correlation between the changes in physiological parameters as measured by a cerebral optical spectrometry-based algorithm (real-time objective pain assessment [ROPA]) and subjective pain ratings obtained from volunteers and laboring women. Secondary aims were performance assessment using linear regression and receiver operating curve (ROC) analysis...
2018: Journal of Pain Research
Heather C Nixon, Jillian Stariha, Jason Farrer, Cynthia A Wong, Max Maisels, Paloma Toledo
BACKGROUND: Physician educators must balance the need for resident procedural education with clinical time pressures as well as patient safety and comfort. Alternative educational strategies, including e-learning tools, may be beneficial to orient novice learners to new procedures and speed proficiency. We created an e-learning tool (computer-enhanced visual learning [CEVL] neuraxial) to enhance trainee proficiency in combined spinal-epidural catheter placement in obstetric patients and performed a randomized controlled 2-center trial to test the hypothesis that use of the tool improved the initial procedure performed by the anesthesiology residents...
October 3, 2018: Anesthesia and Analgesia
Luca De Lipsis, Rossella Belmonte, Maria Cusano, Maria Antonietta Giannetti, Carmine Franco Muccio, Mauro Mancinelli
Subdural hematoma (SDH) following labor epidural analgesia is a rare neurological complication. SDH is a late complication of this procedure; it is caused by a leak of cerebrospinal fluid that may damage the vascular structures of the brain. Persistent headache in the days after labor epidural analgesia is a nonspecific clinical symptom caused by hematoma. Preexisting vascular malformations can be a concomitant cause of headache. Clinical cases have been reported even after epidural anesthesia. The differential diagnosis includes unspecified headache, sinusitis headache, drug-induced headache, cortical vein thrombosis, fistula of the dura mater, and bacterial, viral, and aseptic meningitis...
July 2018: Asian Journal of Neurosurgery
Archana Narayanappa, Shivkumar Gurulingaswamy, Umesh Prabhakaraiah, Krishna Kempegowda, Nagarajaiah B Hanumantharayappa
Background: The practice of labor analgesia is an essential part of standard obstetric care. There are many guidelines and programs, which have been setup in labor pain management, in the developed country. In India, the practice of labor analgesia is not very popular. The role of labor analgesia providers lies in educating the parturients about the need of labor analgesia and also to develop comprehensive programs and guidelines in providing it. Aim: The aim of our study was to assess knowledge and practice of labour analgesia among anaesthesiologists across India...
July 2018: Anesthesia, Essays and Researches
Sebastián Layera, Daniela Bravo, Julián Aliste, De Q Tran
STUDY OBJECTIVE: This systematic review aimed to summarize the evidence derived from randomized controlled trials (RCTs) comparing dural puncture epidural analgesia (DPEA) and conventional lumbar epidural analgesia (LEA) for women undergoing labor. INTERVENTIONS: The MEDLINE and EMBASE databases were searched from inception to July 2018 in order to find RCTs published in the English language, which investigated DPEA in laboring women. MAIN RESULTS: Six RCTs were included in the final analysis...
September 28, 2018: Journal of Clinical Anesthesia
Olof Stephansson, Kari Johansson, Jonas Söderling, Ingmar Näslund, Martin Neovius
BACKGROUND: Obesity increases the risk of adverse delivery outcomes. Whether weight loss induced by bariatric surgery influences these risks remains to be determined. The objective was to investigate the risk of adverse delivery outcomes among post-surgery women compared with women without bariatric surgery history but with similar characteristics. METHODS AND FINDINGS: We identified 801,443 singleton live-born term births (≥37 gestational weeks) in the Swedish Medical Birth Register between 1 January 2006 and 31 December 2013, of which 1,929 were in women with a history of bariatric surgery and a pre-surgery weight available from the Scandinavian Obesity Surgery Registry...
September 2018: PLoS Medicine
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