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https://www.readbyqxmd.com/read/28648158/-advanced-labour-pain-relief
#1
Charlotte Krebs Albrechtsen, Kim Ekelund, Ulla Bang
Delivery and labour pain is normally the most painful event in a woman's lifetime. Physical and psychological factors may influence the severity of labour pain, and labour pain relief is an important issue for the obstetric anaesthetist. We describe the current most effective pharmacological techniques used for labour analgesia: systemically with remifentanil and regionally with epidural analgesia.
June 26, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28628578/neuraxial-anesthesia-in-obstetric-patients-receiving-thromboprophylaxis-with-unfractionated-or-low-molecular-weight-heparin-a-systematic-review-of-spinal-epidural-hematoma
#2
Lisa R Leffert, Heloise M Dubois, Alexander J Butwick, Brendan Carvalho, Timothy T Houle, Ruth Landau
Venous thromboembolism remains a major source of morbidity and mortality in obstetrics with an incidence of 29.8/100,000 vaginal delivery hospitalizations; cesarean delivery confers a 4-fold increased risk of thromboembolism when compared with vaginal delivery. Revised national guidelines now stipulate that the majority of women delivering via cesarean and women at risk for ante- or postpartum venous thromboembolism receive mechanical or pharmacological thromboprophylaxis. This practice change has important implications for obstetric anesthesiologists concerned about the risk of spinal epidural hematoma (SEH) among anticoagulated women receiving neuraxial anesthesia...
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28626856/delivery-parameters-neonatal-parameters-and-incidence-of-urinary-incontinence-6-months-postpartum-a-cohort-study
#3
Stian Langeland Wesnes, Yngvild Hannestad, Guri Rortveit
INTRODUCTION: Contradictory results have been reported regarding most delivery parameters as risk factors for urinary incontinence. We investigated the association between incidence of urinary incontinence six months postpartum and single obstetric risk factors as well as combinations of risk factors. MATERIAL AND METHOD: This study was based on the Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health during 1998-2008. This substudy was based on 7561 primiparous women who were continent before and during pregnancy...
June 19, 2017: Acta Obstetricia et Gynecologica Scandinavica
https://www.readbyqxmd.com/read/28625308/the-role-of-ultrasonography-in-obstetric-anesthesia
#4
REVIEW
Allison Lee, John P R Loughrey
Ultrasonography is increasingly being viewed as an everyday tool in obstetric anesthesia. For the administration of spinal or epidural anesthesia, it reduces needle redirection attempts in patients with difficult anatomy. In the less frequent scenario of a collapsed patient, it helps with assessment in the form of transthoracic echocardiography. Abdominal blocks require ultrasound guidance for safe and anatomically correct placement. Accurate assessment of gastric volume status with ultrasound would be a useful everyday skill if it is adopted into mainstream practice...
March 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/28616828/perinatal-and-maternal-outcomes-at-term-in-low-risk-pregnancies-according-to-nice-criteria-comparison-between-a-tertiary-obstetrical-hospital-and-midwife-attended-units
#5
Tanja Ignatov, Holm Eggemann, Serban Dan Costa, Atanas Ignatov
PURPOSE: The aim of this study was to evaluate the perinatal and maternal outcomes at term at a single tertiary, university hospital in women with low-risk pregnancies. PATIENTS AND METHODS: We performed a retrospective cohort study of women with low-risk pregnancies, who delivered at University Women's Hospital Magdeburg between January 2010 and December 2014. Data were compared with data published by Brocklehurst et al. 2011. RESULTS: Of the 6052 women investigated, 2014 were classified as low risk according to the NICE criteria and were eligible for analysis...
June 14, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28607343/failed-epidural-for-labour-what-now
#6
Emilia Guasch, Fabrizio Iannuccelli, Nicolas Brogly, Fernando Gilsanz
Labour epidural failure is a challenging situation for the obstetric anaesthetist, especially when associated to high risk of caesarean delivery, obesity, and difficult airway predictors. Labour epidural failure is still not standardly defined, consequently its incidence is uncertain: improving the knowledge of risk factors related to failure will increase epidural block success rate. Prolonged labours, previous history of epidural failure, and repeated topups needed during labour are recognized risk factors for failure...
June 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28598915/anesthetic-and-obstetric-management-of-syringomyelia-during-labor-and-delivery-a-case-series-and-systematic-review
#7
Gráinne Patricia Garvey, Vibhangini S Wasade, Kellie E Murphy, Mrinalini Balki
BACKGROUND: Syringomyelia is a rare, slowly progressive neurological condition characterized by the presence of a syrinx within the spinal cord. Consensus regarding the safest mode of delivery and anesthetic management in patients with syringomyelia remains controversial and presents management dilemmas. This study reviews the cases of syringomyelia at our institution and provides a systematic review of the literature to guide decisions regarding labor and delivery management. METHODS: A retrospective review of cases at our hospital from 2002 to 2014 and a systematic review of the literature from 1946 to 2014 were undertaken...
June 8, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28594775/perinatal-and-maternal-outcomes-after-training-residents-in-forceps-before-vacuum-instrumental-birth
#8
Sasha Skinner, Miranda Davies-Tuck, Euan Wallace, Ryan Hodges
OBJECTIVE: To compare the rates of attempted and successful instrumental births, intrapartum cesarean delivery, and subsequent perinatal and maternal morbidity before and after implementing a training intervention to arrest the decline in forceps competency among resident obstetricians. METHODS: This retrospective cohort study examined all attempted instrumental births at Monash Health from 2005 to 2014. We performed an interrupted time-series analysis to compare outcomes of attempted instrumental births in 2005-2009 with those in 2010-2014...
July 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28594070/labor-delivery-and-anesthesia-experiences-of-women-with-physical-disability
#9
Suzanne C Smeltzer, Amy J Wint, Jeffrey L Ecker, Lisa I Iezzoni
BACKGROUND: Although many women with physical disabilities report poor quality reproductive health care, little research has addressed labor, delivery, and anesthesia experiences of these women. This study was conducted to explore these experiences in women with significant mobility disabilities. METHODS: A qualitative descriptive study was conducted with 22 women from the United States who had delivered newborns within the prior 10 years. All had significant mobility disabilities...
June 8, 2017: Birth
https://www.readbyqxmd.com/read/28588944/onsite-midwife-led-birth-units-ombus-for-care-around-the-time-of-childbirth-a-systematic-review
#10
Qian Long, Emma R Allanson, Jennifer Pontre, Özge Tunçalp, George Justus Hofmeyr, Ahmet Metin Gülmezoglu
INTRODUCTION: To ensure timely access to comprehensive emergency obstetric care in low- and middle-income countries, a number of interventions have been employed. This systematic review assesses the effects of onsite midwife-led birth units (OMBUs) embedded within hospitals which provide comprehensive emergency obstetric and newborn care. METHODS: Both interventional and observational studies that compared OMBUs with standard medical-led obstetric care were eligible for inclusion...
August 2016: BMJ Global Health
https://www.readbyqxmd.com/read/28587365/assessment-of-different-loading-doses-of-dexmedetomidine-hydrochloride-in-preventing-adverse-reaction-after-combined-spinal-epidural-anesthesia
#11
Wanwei Jiang, Qinghui Wang, Min Xu, Yu Li, Rui Yang, Xiaoyang Song, Haixia Duan, Pengbo Zhang
We conducted the present study to investigate the effects of the different loading doses of dexmedetomidine hydrochloride in the prevention of adverse reactions after combined spinal-epidural anesthesia. A total of 200 patients that were admitted to the Department of Obstetrics at the Second Affiliated Hospital of Xi'an Jiaotong University hospital and treated with cesarean section through the use of combined spinal-epidural anesthesia from December, 2014 to June, 2016, were randomly divided into 4 groups. The therapeutic regimens of patients were shown as follows: group A was administered an intravenous pump of 10 ml/l physiological saline in surgery until the end of the delivery...
June 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28547269/effect-of-intermittent-versus-continuous-bladder-catheterization-on-duration-of-the-second-stage-of-labor-among-nulliparous-women-with-an-epidural-a-randomized-controlled-trial
#12
Abeer Suleiman, Sobhiya Mruwat-Rabah, Gali Garmi, Dorit Dagilayske, Tair Zelichover, Raed Salim
INTRODUCTION AND HYPOTHESIS: Catheterization type among women laboring with epidural analgesia who develop bladder retention has been reported to affect labor duration and mode of delivery. We aimed to compare the effect of continuous bladder catheterization (CC) with that of intermittent bladder catheterization (IC) on the duration of the second stage of labor. METHODS: In a randomized trial, term nulliparous women with singleton gestation who requested epidural analgesia and were unable to void spontaneously were eligible and randomized to either CC or IC...
May 25, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28499552/puerperal-ventral-epidural-hematoma-after-epidural-labor-analgesia
#13
I Gruzman, I Shelef, A Y Weintraub, A Zlotnik, O Erez
Serious complications in obstetric anesthesia are a rare occurrence. High neuraxial block, respiratory arrest in labor and delivery, and an unrecognized spinal catheter are among the most frequently reported serious complications. A serious complication occurs in approximately 1:3000 obstetric patients. Neuraxial hematoma after obstetric epidural analgesia or anesthesia is extremely rare. We present a case of a puerperal spinal epidural hematoma following epidural labor analgesia. The patient presented with foot drop, which resolved after conservative treatment...
March 31, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28494909/remifentanil-as-an-alternative-to-epidural-analgesia-for-vaginal-delivery-a-meta-analysis-of-randomized-trials
#14
Myeongjong Lee, Fang Zhu, Jessica Moodie, Zhe Zhang, Davy Cheng, Janet Martin
OBJECTIVES: Although epidural analgesia is considered the gold standard for labor pain management, its use may be restricted in some conditions due to clinical contraindications or availability, and suitable alternatives may be required. The objective of this meta-analysis was to determine whether evidence from randomized trials suggests remifentanil PCA (R-PCA) results in significant differences in maternal satisfaction, analgesic efficacy, and safety compared with conventional epidural analgesia (EA)...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28476691/oxytocin-administration-during-spontaneous-labor-guidelines-for-clinical-practice-guidelines-short-text
#15
C Dupont, M Carayol, C Le Ray, C Deneux-Tharaux, D Riethmuller
No abstract text is available yet for this article.
May 2, 2017: Journal of gynecology obstetrics and human reproduction
https://www.readbyqxmd.com/read/28452901/effect-of-pain-and-analgesia-on-compensatory-reserve
#16
Carmen Hinojosa-Laborde, Jessie Renee D Fernandez, Gary W Muniz, Corinne D Nawn, Rebecca K Burns, Thuan H Le, Kathy B Porter, John T Hardy, Victor A Convertino
BACKGROUND: The measurement of the body's capacity to compensate for reduced blood volume can be assessed with a compensatory reserve measurement (CRM). The CRM, which is calculated from changes in features of the arterial waveform, represents the integration of compensatory mechanisms during states of low tissue perfusion and oxygenation, such as hemorrhage. This study was designed to test the hypothesis that pain which activates compensatory mechanisms and analgesia that result in reduced blood pressure are associated with lower compensatory reserve...
July 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28451033/-epidural-analgesia-in-20-parturients-at-the-sylvanus-olympio-university-hospital-center-in-lom%C3%A3-togo
#17
Pilakimwé Egbohou, Tabana Mouzou, Hamza Doles Sama, Pikabalo Tchétike, Sarakawabalo Assénouwé, Gnimdou Akala-Yoba, Kadjika Tomta
We conducted a prospective and descriptive study on epidural analgesia (EA) at the Sylvanus Olympio University Hospital Center in Lomé from February to June 2014. After taking consent from pregnant women selected by simple random sampling and in the absence of contraindication for anesthesia (pre-anesthetic assessment performed in their 8th month of pregnancy), women were enrolled. Out of 29 selected women, 20 (69%) underwent EA. The average age was 30.6 ± 6.6 years: primiparas 35%, multiparas 50%, Obese women (BMI> 30)25%...
2017: Pan African Medical Journal
https://www.readbyqxmd.com/read/28435667/neuraxial-opioids-as-analgesia-in-labour-caesarean-section-and-hysterectomy-a-questionnaire-survey-in-sweden
#18
Anette Hein, Caroline Gillis-Haegerstrand, Jan G Jakobsson
Background: Neuraxial opioids improve labour analgesia and analgesia after caesarean section (CS) and hysterectomy. Undesirable side effects and difficulties in arranging postoperative monitoring might influence the use of these opioids. The aim of the present survey was to assess the use of intrathecal and epidural morphine in gynaecology and obstetrics in Sweden. Methods: A questionnaire was sent to all anaesthetic obstetric units in Sweden concerning the use and postoperative monitoring of morphine, sufentanil and fentanyl in spinal/epidural anaesthesia...
2017: F1000Research
https://www.readbyqxmd.com/read/28426160/assessment-and-support-during-early-labour-for-improving-birth-outcomes
#19
REVIEW
Shinobu Kobayashi, Nobutsugu Hanada, Masayo Matsuzaki, Kenji Takehara, Erika Ota, Hatoko Sasaki, Chie Nagata, Rintaro Mori
BACKGROUND: The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. OBJECTIVES: To investigate the effectiveness of assessment and support interventions for women during early labour...
April 20, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28419420/reliability-of-pressure-waveform-analysis-to-determine-correct-epidural-needle-placement-in-labouring-women
#20
I Al-Aamri, S H Derzi, A Moore, M F Elgueta, M Moustafa, T Schricker, D Q Tran
Pressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-of-resistance)...
April 17, 2017: Anaesthesia
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