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Labor epidural

Marcos Augusto Bastos Dias, Rosa Maria Soares Madeira Domingues, Arthur Orlando Corrêa Schilithz, Marcos Nakamura-Pereira, Maria do Carmo Leal
BACKGROUND: The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS: This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns...
October 17, 2016: Reproductive Health
Marcelo Epsztein Kanczuk, Nicholas Martin Barrett, Cristian Arzola, Kristi Downey, Xiang Y Ye, Jose C A Carvalho
BACKGROUND: Most studies that have compared programmed intermittent epidural bolus (PIEB) with continuous epidural infusion regimens have included patient-controlled epidural analgesia and/or manual bolus as rescue analgesia for breakthrough pain. Consequently, the optimal time interval between PIEB is yet to be determined. We designed a study to establish the optimal time interval between PIEB of 10 mL of bupivacaine 0.0625% with fentanyl 2 μg/mL to produce effective analgesia in 90% of women during first stage of labor without breakthrough pain...
October 11, 2016: Anesthesia and Analgesia
Joginder Pal Attri, Reena Makhni, Savinder Sethi
BACKGROUND: Combined spinal-epidural analgesia has become the preferred technique for labor analgesia as it combines the benefits of both spinal analgesia and flexibility of epidural catheter. Study was carried out with the primary aim to compare levobupivacaine and ropivacaine with fentanyl in terms of onset and duration of sensory block and to know maternal and fetal outcome. MATERIALS AND METHODS: In a prospective randomized double-blind study, 60 primipara of the American Society of Anesthesiologists health status Class I and II with singleton pregnancy in active stage of labor were randomly allocated into two groups of 30 each...
September 2016: Anesthesia, Essays and Researches
Lynn M Yee, Grecio Sandoval, Jennifer Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, Steve N Caritis, Mona Prasad, Alan T N Tita, George Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
OBJECTIVE: To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. METHODS: This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included...
October 6, 2016: Obstetrics and Gynecology
Benjamin B Vacula, Chelsea Gray, Michael P Hofkamp, Patrick T Noonan, Russell K McAllister, Kimberly A Pilkinton, Zhiying Diao
Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred...
October 2016: Proceedings of the Baylor University Medical Center
Fen Wang, Yun-Xia Cao, Shan-Gao Ke, Tao-Hua Zhu, Miao Zhang
OBJECTIVE: To determine whether combined spinal-epidural analgesia (CSEA) during labor increases the frequency of emergency cesarean delivery among Chinese nulliparous women. METHODS: In a retrospective study, the medical records of nulliparous women with a singleton fetus in cephalic presentation who delivered at term at Tongling Maternity Hospital, China, between January 2012 and December 2014 were reviewed. Information about CSEA, mode of delivery, labor duration, oxytocin augmentation, and neonatal outcome was obtained...
August 24, 2016: International Journal of Gynaecology and Obstetrics
Sheffield Kent, Gregory Mehaffey
STUDY OBJECTIVE: To demonstrate a possible alternative treatment for postdural puncture headache (PDPH). DESIGN: Postdural puncture headache is a common complication associated with neuraxial anesthesia and unintentional dural puncture. Epidural blood patch (EBP) is the standard therapy for PDPH but has risks including pain, dural puncture, and infection. Transnasal sphenopalatine ganglion block (SPGB) has been successfully used to treat migraine, cluster headache, and trigeminal neuralgia...
November 2016: Journal of Clinical Anesthesia
David M Dickerson, Ran Dai, Barbara M Scavone, William McDade
Reports exist of severe upper back pain of unknown etiology after administration of large volumes into the epidural space. We present a case of an otherwise healthy parturient who developed severe upper back and neck pain after receiving only a small volume of epidural medication. Magnetic resonance imaging revealed a congenitally narrowed spinal canal because of short pedicle syndrome. Epidural injectate occupies and compresses a percentage of the spinal canal and its neuronal contents. This may result in pain and epidural intolerance when continued injectate reaches a critical point, a threshold that is lower with shortened pedicles or congenital spinal stenosis...
September 28, 2016: Regional Anesthesia and Pain Medicine
Dimitrios Papoutsis, Angeliki Antonakou, Adam Gornall, Chara Tzavara, Michelle Mohajer
PURPOSE: To develop a risk-assessment model for the prediction of emergency cesarean section (CS) in women having induction of labor (IOL). METHODS: This was an observational cohort study of women with IOL for any indication between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify risk factors associated with CS delivery and to construct a risk-prediction tool. RESULTS: 6169 women were identified with mean age of 28...
September 27, 2016: Archives of Gynecology and Obstetrics
Amit Meshi, Sharon Armarnik, Michael Mimouni, Fani Segev, Ori Segal, Hagai Kaneti, Ehud I Assia, Noa Geffen
PURPOSE: To investigate the effect of modern vaginal labor using epidural anesthesia on the intraocular pressure (IOP) and on the mean ocular perfusion pressure (MOPP) in healthy women. PATIENTS AND METHODS: In this prospective observational study, eligible candidates were healthy pregnant women for vaginal delivery with epidural anesthesia, with a singleton pregnancy, who were admitted to the delivery room in the first phase of the first stage of labor. Demographic data as well as medical and obstetric history were obtained at baseline, followed by performance of a biomicroscopic examination...
September 21, 2016: Journal of Glaucoma
Christine Vien, Paul Marovic, Brendan Ingram
Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.
2016: Case Reports in Anesthesiology
J C Tien, M J Lim, W L Leong, E Lew
BACKGROUND: The KK Women's and Children's Hospital is a tertiary obstetric unit with approximately 11000 deliveries per year. Epidural analgesia is used in about 40% of laboring women. We reviewed the incidence and management of post-dural puncture headache over a nine-year period. METHODS: A retrospective audit of labor epidural analgesia database records from 1 June 2005 to 31 May 2014 was conducted, identifying an "event" as an accidental dural puncture, an inadvertent intrathecal catheter insertion and/or development of a post-dural puncture headache...
June 30, 2016: International Journal of Obstetric Anesthesia
Atsuko Okazaki, Risa Fukushima, Sayuri Nagashima, Yusuke Mazda, Kazumi Tamura, Katsuo Terui, Motoshi Tanaka
AIM: The purpose of this study was to investigate the effects of labor epidural analgesia (LEA) on maternal and neonatal outcomes among parturients aged 40 years or older. METHODS: We retrospectively reviewed medical records of all laboring, singleton and cephalic deliveries at ≥36 weeks' gestation at the Saitama Medical Center from April 2003 to September 2012. Women aged ≥40 years who received LEA (≥40 with LEA group) were compared with women aged ≥40 years who delivered without LEA (≥40 without LEA group) and women <40 years who received LEA (<40 with LEA group)...
September 19, 2016: Journal of Obstetrics and Gynaecology Research
Kesavan Sadacharam, Mian Ahmad
No abstract text is available yet for this article.
July 2016: Journal of Anaesthesiology, Clinical Pharmacology
Yayoi Ohashi, Leyla Baghirzada, Hiroyuki Sumikura, Mrinalini Balki
Japan has seen significant developments in obstetric anesthesia in recent years, including the establishment of the Japanese Society of Obstetric Anesthesia and Perinatology. However, labor pain, which is one of the most important issues in obstetric practice, is still not treated aggressively. The rate of epidural administration for labor analgesia is very low in Japan as compared to other developed countries. Remifentanil has been used for labor analgesia, as part of general anesthesia for cesarean delivery, as well as for various fetal procedures around the world...
September 12, 2016: Journal of Anesthesia
Joana Nunes, Sara Nunes, Mariano Veiga, Mara Cortez, Isabel Seifert
BACKGROUND: There is evidence that administration of a programmed intermittent epidural bolus (PIEB) compared to continuous epidural infusion (CEI) leads to greater analgesia efficacy and maternal satisfaction with decreased anesthetic interventions. METHODS: In this study, 166 women with viable pregnancies were included. After an epidural loading dose of 10mL with Ropivacaine 0.16% plus Sufentanil 10μg, parturient were randomly assigned to one of three regimens: A - Ropivacaine 0...
September 2016: Brazilian Journal of Anesthesiology
Li Zhang, Jove H Graham, Wen Feng, Meredith W Lewis, Xiaopeng Zhang, H Lester Kirchner
BACKGROUND: Some pregnant women avoid labor epidural analgesia because of their concerns about risk of cerebral palsy in children. Although it is believed that labor epidural does not contribute to cerebral palsy, to our knowledge no study has been published to specifically address this concern. We carried out a retrospective case-control study to investigate whether labor epidural analgesia is associated with cerebral palsy in children. METHODS: This study used data that were collected and entered into the Geisinger electronic health records between January 2004 and January 2013...
September 2, 2016: Journal of Anesthesia
Mark J Lenart, Jeffrey M Carness
A 23-year-old woman at 41 weeks and 6 days estimated gestational age underwent continuous spinal analgesia for labor after a recognized, unintended dural puncture. Excellent analgesia was maintained throughout labor and vaginal delivery, the intrathecal catheter was left in situ for 24 hours postpartum, and the catheter was subsequently removed without apparent complication. On physical examination during her anesthesia postoperative visit, clear fluid was noted to be slowly draining from the catheter insertion site...
September 1, 2016: A & A Case Reports
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Melissa E Bauer, Jill M Mhyre
No abstract text is available yet for this article.
August 22, 2016: Anesthesia and Analgesia
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