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Obstetric epidural

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https://www.readbyqxmd.com/read/28333819/practice-bulletin-no-177-obstetric-analgesia-and-anesthesia
#1
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28333811/practice-bulletin-no-177-summary-obstetric-analgesia-and-anesthesia
#2
(no author information available yet)
Labor causes severe pain for many women. There is no other circumstance in which it is considered acceptable for an individual to experience untreated severe pain that is amenable to safe intervention while the individual is under a physician's care. Many women desire pain management during labor and delivery, and there are many medical indications for analgesia and anesthesia during labor and delivery. In the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28301885/geburtshilfe-kombinierte-spinal-epidural-analgesie-cse
#3
Jan Wallenborn, Thorsten Artmann, Peter Kranke
Due to intrathecal application, CSE combines rapid response with adequate analgesia with the possibility of providing unlimited neuraxial obstetrical pain relief via the indwelling epidural catheter. The superiority of CSE over EDA lies above all in its rapid action, excellent analgesia, lack of motor blockade after a single intrathecal opioid administration, lower rate of unilateral blockages and less need for subsequent epidural injections. The most common side effect is pruritus, which is harmless and usually does not require any therapeutic intervention...
March 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28282772/does-meperidine-analgesia-affect-the-incidence-of-obstetric-lacerations-at-vaginal-delivery
#4
Yossi Mizrachi, Sophia Leytes, Michal Levy, Shimon Ginath, Jacob Bar, Tiberiu Ezri, Michal Kovo
PURPOSE: To study whether meperidine analgesia affects the incidence of obstetric lacerations at normal vaginal deliveries. MATERIALS AND METHODS: A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. The incidence of various obstetric lacerations was compared between deliveries with meperidine analgesia and deliveries with no analgesia...
February 28, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28255987/a-randomised-double-blind-trial-of-phenylephrine-and-metaraminol-infusions-for-prevention-of-hypotension-during-spinal-and-combined-spinal-epidural-anaesthesia-for-elective-caesarean-section
#5
N J McDonnell, M J Paech, N A Muchatuta, S Hillyard, E A Nathan
Prophylactic vasopressor administration is commonly recommended to reduce maternal hypotension during spinal anaesthesia for caesarean section. Metaraminol has undergone limited investigation in obstetric anaesthesia for this purpose, particularly in comparison with phenylephrine. In this multicentre, randomised, double-blind, non-inferiority study, we compared prophylactic phenylephrine or metaraminol infusions, started immediately after spinal anaesthesia, in 185 women who underwent elective caesarean section...
March 3, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28238320/-oxytocin-administration-during-spontaneous-labour-guidelines-for-clinical-practice-guidelines-short-text
#6
C Dupont, M Carayol, C Le Ray, C Barasinski, R Beranger, A Burguet, A Chantry, C Chiesa, B Coulm, A Evrard, C Fischer, L Gaucher, C Guillou, F Leroy, E Phan, A Rousseau, V Tessier, F Vendittelli, C Deneux-Tharaux, D Riethmuller
OBJECTIVES: To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. METHOD: A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. RESULTS: The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5cm of cervical dilatation...
January 2017: Gynecol Obstet Fertil Senol
https://www.readbyqxmd.com/read/28235535/the-effect-of-second-stage-pushing-and-body-mass-index-on-postdural-puncture-headache
#7
Amber M Franz, Shawn Y Jia, Henry T Bahnson, Akash Goel, Ashraf S Habib
STUDY OBJECTIVE: To explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles. DESIGN: Retrospective cohort. SETTING: Obstetric ward and operating rooms at a university-affiliated hospital. PATIENTS: One hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28235511/increasing-body-mass-index-predicts-increasing-difficulty-failure-rate-and-time-to-discovery-of-failure-of-epidural-anesthesia-in-laboring-patients
#8
Ayse O Kula, Matthias L Riess, Elizabeth H Ellinas
STUDY OBJECTIVE: Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28224270/intrapartal-pelvic-floor-protection-a-pragmatic-and-interdisciplinary-approach-between-obstetrics-and-urogynecology
#9
Markus Huebner, Sara Y Brucker, Ralf Tunn, Gert Naumann, Christl Reisenauer, Harald Abele
Pelvic floor protection is an issue of increasing relevance. This article sought to summarize the session at last year's annual meeting of the German Society of Gynecology and Obstetrics (DGGG) in Stuttgart (10/2016) called "Urogynecology 2020-what is the optimal rate of cesarean section-does urogynecology have to deal with Obstetrics?". The main focus was set on the two important anatomical structures, the levator ani muscle and the anal sphincters. Operative vaginal delivery, epidural anesthesia, and episiotomy are subject to discussion...
February 21, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28215984/the-cost-of-nurse-midwifery-care-use-of-interventions-resources-and-associated-costs-in-the-hospital-setting
#10
Molly R Altman, Sean M Murphy, Cynthia E Fitzgerald, H Frank Andersen, Kenn B Daratha
INTRODUCTION: Obstetrical care often involves multiple expensive, and often elective, interventions that may increase costs to patients, payers and the health care system with little effect on patient outcomes. The objectives of this study were to examine the following hospital related outcomes: 1) use of labor and birth interventions, 2) inpatient duration of stay, and 3) total direct health care costs for patients attended by a certified nurse-midwife (CNM) compared with those attended by an obstetrician-gynecologist (OB-GYN), within an environment of safe and high-quality care...
February 15, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/28183557/parturient-recall-of-neuraxial-analgesia-risks-impact-of-labor-pain-vs-no-labor-pain
#11
Christopher M Burkle, David A Olsen, Hans P Sviggum, Adam K Jacob
STUDY OBJECTIVE: Information exchange between anesthesia providers and parturients about neuraxial analgesia risks often occurs in the presence of labor pain. This study examined whether the presence of pain impacted the level of recall of information provided to parturients regarding risks of neuraxial techniques. DESIGN: Single-center, nonrandomized study. SETTING: Labor and delivery suite and postpartum patient rooms in a large academic medical center...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28131124/anesthesiologists-in-obstetric-care-beyond-labor-epidurals-and-c-section-care
#12
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28131118/postdural-puncture-headache-an-evidence-based-approach
#13
REVIEW
Robert R Gaiser
Headache after dural puncture is a common complication accompanying neuraxial anesthesia. The proposed cause is loss of cerebrospinal fluid through the puncture into the epidural space. Although obstetric patients are at risk for the development of this headache because of female gender and young age, there is a difference in the obstetric population. Women who deliver by cesarean delivery have a lower incidence of headache after dural puncture compared with those who deliver vaginally. Treatment of postdural puncture headache is an epidural blood patch...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28121831/committee-opinion-no-687-approaches-to-limit-intervention-during-labor-and-birth
#14
(no author information available yet)
Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted, a process of shared decision making is recommended. Admission during the latent phase of labor may be necessary for a variety of reasons...
February 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121830/committee-opinion-no-687-summary-approaches-to-limit-intervention-during-labor-and-birth
#15
(no author information available yet)
Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted, a process of shared decision making is recommended. Admission during the latent phase of labor may be necessary for a variety of reasons...
February 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121757/the-perinatal-birth-environment-communication-strategies-and-processes-for-adherence-to-a-standardized-guideline-in-women-undergoing-second-stage-labor-with-epidural-anesthesia
#16
Samantha A Sommerness, Rebecca Gams, Phillip N Rauk, Ananta Bangdiwala, Daniel V Landers, Melissa D Avery, Charles Hirt, Kristi Miller, Amy Millar, Suzin Cho, Andrea Shields
Key to any perinatal safety initiative is buy-in and strong leadership from obstetric and pediatric providers, advanced practice nurses, and labor and delivery nurses in collaboration with ancillary staff. In the fall of 2007, executives of a large Midwestern hospital system created the Zero Birth Injury Initiative. This multidisciplinary group sought to eliminate birth injury using the Institute of Healthcare Improvement Perinatal Bundles. Concurrently, the team implemented a standardized second-stage labor guideline for women who choose epidural analgesia for pain management to continue the work of eliminating birth injuries in second-stage labor...
January 2017: Journal of Perinatal & Neonatal Nursing
https://www.readbyqxmd.com/read/28089318/analysis-and-evaluation-of-the-effectiveness-of-epidural-analgesia-and-its-relationship-with-eutocic-or-dystocic-delivery
#17
V Sánchez-Migallón, E Sánchez, M Raynard, A Miranda, R M Borràs
OBJECTIVE: Numerous studies have demonstrated the difference in the verbal rating scale with regard to obstructed labour and induced labour, so that obstructed labour and foetal macrosomia have been related to a greater sensation of pain during labour, particularly in the first stage. Even the epidural analgesia is linked to the need for instrumented or caesarean section due to foetal obstruction. The goal of the study is to analyze and evaluate the effectiveness of epidural analgesia in normal versus obstructed labour...
January 12, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28079555/epidural-labor-analgesia-and-maternal-fever
#18
Emily E Sharpe, Katherine W Arendt
Women receiving an epidural for labor analgesia are at increased risk for intrapartum fever. This relationship has been supported by observational, before and after, and randomized controlled trials. The etiology is not well understood but is likely a result of noninfectious inflammation as studies have found women with fever have higher levels of inflammatory markers. Maternal pyrexia may change obstetric management and women are more likely to receive antibiotics or undergo cesarean delivery. Maternal pyrexia is associated with adverse neonatal outcomes...
January 10, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28070884/a-national-survey-of-neurological-monitoring-practice-after-obstetric-regional-anaesthesia-in-the-uk
#19
E Roderick, J Hoyle, S M Yentis
Neuraxial anaesthesia is widely used in obstetrics and neurological complications are rare. However, when they occur, subsequent investigation and management are time-critical and correlate with the extent of neurological recovery. The Third National Audit Project recommended the implementation of guidelines in obstetric epidural management, including advice on monitoring for early signs of problems and acting upon concerns. However, no national guideline exists for postoperative management in the obstetric population...
January 10, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28068929/are-freestanding-midwifery-units-a-safe-alternative-to-obstetric-units-for-low-risk-primiparous-childbirth-an-analysis-of-effect-differences-by-parity-in-a-matched-cohort-study
#20
Louise Fischer Christensen, Charlotte Overgaard
BACKGROUND: Intrapartum complications and the use of obstetric interventions are more common in primiparous childbirth than in multiparous childbirth, leading to concern about out of hospital birth for primiparous women. The purpose of this study was to determine whether the effect of birthplace on perinatal and maternal morbidity and the use of obstetric interventions differed by parity among low-risk women intending to give birth in a freestanding midwifery unit or in an obstetric unit in the North Denmark Region...
January 9, 2017: BMC Pregnancy and Childbirth
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