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labour epidural

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https://www.readbyqxmd.com/read/27884664/bacterial-contamination-of-saline-used-for-epidural-procedures-in-an-obstetric-setting-a-randomised-comparison-of-two-drawing-up-techniques
#1
M Onofrei, M Y Wee, B Parker, N Wee, S Hill
BACKGROUND: There is little evidence to inform practice regarding the optimum aseptic technique of drawing up saline for epidural insertion. Our regional practice is to draw up saline from a non-sterile packaged plastic ampoule, therefore introducing the risk of bacterial contamination. Usually, the anaesthetist draws up saline directly from the vial held by an assistant using a needle (needle technique). Alternatively, the saline vial is emptied onto a sterile tray by an assistant and then drawn up by the anaesthetist (tray technique)...
October 8, 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27855515/influence-of-obstetrical-events-on-satisfaction-and-anxiety-during-childbirth-a-prospective-longitudinal-study
#2
Lucia Floris, Olivier Irion, Delphine Courvoisier
The aim of this study was to investigate the feelings of anxiety and satisfaction among 79 primiparas who had uncomplicated pregnancies, at the time of hospital admission and after birth, considering the mode of delivery, analgesia, and pain levels. Questionnaires were completed at admission to the hospital and two months after delivery, using the State-Trait Anxiety Inventory (STAI) state scale and the Labour Agentry Scale. The mean (SD) STAI state score was higher at admission (36.7 (10.7)) than 4 months after childbirth (32...
November 17, 2016: Psychology, Health & Medicine
https://www.readbyqxmd.com/read/27849306/eisenmenger-syndrome-in-pregnancy
#3
Shi-Min Yuan
Eisenmenger syndrome is very rare in pregnant women. Debates remain concerning the management of Eisenmenger syndrome in this patient population and the prognosis is unclear in terms of maternal and fetoneonatal outcomes. Epidural analgesia is preferred for Cesarean section as it alleviates perioperative pain and reduces the pulmonary and systemic vascular resistances. Maternal mortality in the presence of Eisenmenger syndrome is reported as 30-50% and even up to 65% in those with Cesarean section. The major causes of death could be hypovolemia, thromboembolism and preeclampsia...
July 2016: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27821464/safety-of-labour-and-delivery-following-closures-of-obstetric-services-in-small-community-hospitals
#4
Jennifer A Hutcheon, Corinne A Riddell, Erin C Strumpf, Lily Lee, Sam Harper
BACKGROUND: In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities. METHODS: We used maternal postal codes to identify delivery records (1998-2014) of women residing in a community affected by service closure. The records were obtained from the British Columbia Perinatal Data Registry...
November 7, 2016: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
https://www.readbyqxmd.com/read/27816738/epidural-analgesia-during-labour-routinely-or-on-request-a-cost-effectiveness-analysis
#5
Kimberley Bonouvrié, Anouk van den Bosch, Frans J M E Roumen, Sander M van Kuijk, Jan G Nijhuis, Silvia M A A Evers, Martine M L H Wassen
OBJECTIVE: To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. STUDY DESIGN: Women delivering of a singleton in cephalic presentation beyond 36+0 weeks' gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum...
September 22, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/27799176/i-v-paracetamol-as-an-adjunct-to-patient-controlled-epidural-analgesia-with-levobupivacaine-and-fentanyl-in-labour-a-randomized-controlled-study
#6
K Gupta, S Mitra, S Kazal, R Saroa, V Ahuja, P Goel
BACKGROUND: Use of i.v. paracetamol for postoperative pain is well documented, but it is unclear if it can reduce the consumption of opioids during patient-controlled epidural analgesia (PCEA) in labouring parturients. METHODS: In this randomized, double-blind, placebo-controlled clinical trial conducted in a tertiary care hospital, (80)parturients were randomly assigned to two groups of 40 each, to receive either 1000 mg (100 ml) i.v. paracetamol or 100 ml normal saline as placebo, 30 min before the procedure...
November 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27750477/patient-controlled-epidural-analgesia-for-labour-in-a-patient-after-ross-procedure-for-congenital-bicuspid-aortic-valve
#7
Satoshi Toyama, Yugo Tagaito, Megumi Shimoyama
No abstract text is available yet for this article.
October 18, 2016: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/27726918/anaesthetic-management-of-parturients-with-univentricular-congenital-heart-disease-and-the-fontan-operation
#8
R S Monteiro, D P Dob, M R Cauldwell, M A Gatzoulis
Women with a single ventricle circulation palliated with the Fontan operation require specialist multidisciplinary management. We report 14 such cases with successful pregnancies and detail the pathophysiology encountered. A combined obstetric and cardiac service between Chelsea and Westminster Hospital and Royal Brompton Hospital provides care for women with heart disease, and maintains a prospective database of referred women. We searched this database for women with a known Fontan circulation and reviewed the case notes and electronic patient records between January 1994 and December 2015...
December 2016: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/27718435/suspected-total-spinal-in-patient-having-emergent-caesarean-section-a-case-report-and-literature-review
#9
H Virgin, E Oddby, J G Jakobsson
INTRODUCTION: Epidural analgesia is commonly used for management of pain during childbirth. Need for emergent Caesarean section e.g. because of signs of foetal distress or lack of progress is however not an uncommon event. In females having an established epidural; general anaesthesia, top-up of the epidural or putting a spinal are all possible options. Dosing of the spinal anaesthesia in females having epidural is a matter of discussion. PRESENTATION OF CASE: We describe a healthy 32 years, 0 para mother in gestation week 36 having labour epidural analgesia but due to foetal distress scheduled for an emergent Caesarean section category 2 that developed upper extremity weakness and respiratory depression after administration of standard dose high density bupivacaine/morphine/fentanyl intrathecal anaesthesia...
2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27701372/may-pre-procedure-neuroaxial-ultrasound-improve-the-identification-of-potential-epidural-space-when-compared-with-anatomical-landmarks-a-prospective-randomized-study
#10
Paolo Perna, Antonio Gioia, Riccardo Ragazzi, Carlo A Volta, Massimo Innamorato
BACKGROUND: Regional epidural analgesia is considered the gold standard for pain treatment in labour but the epidural catheter placement may be a difficult procedure because of the difficulty in anatomical landmarks palpation. These difficulties increase in pregnant women. Pre-procedure neuroaxial ultrasound may facilitate the procedure. METHODS: Prospectic randomized controlled study conducted in the Labour Ward. We randomized two groups of women undergoing epidural analgesia: Group A (28 patients), with loss of resistance technique and Group B (30 patients) with US assisted procedure...
October 4, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27668095/epidural-analgesia-with-ropivacaine-during-labour-in-a-patient-with-a-scn5a-gene-mutation
#11
A L M J van der Knijff-van Dortmont, M Dirckx, J J Duvekot, J W Roos-Hesselink, A Gonzalez Candel, C D van der Marel, G P Scoones, V F R Adriaens, I J J Dons-Sinke
SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27608347/anaesthetists-experiences-with-the-early-labour-epidural-recommendation-for-obese-parturients-a-qualitative-study
#12
V A Eley, L K Callaway, A A J van Zundert, J Lipman, C Gallois
Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015...
September 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27608337/anaesthetic-management-of-obese-parturients-what-is-the-evidence-supporting-practice-guidelines
#13
V A Eley, A A J van Zundert, J Lipman, L K Callaway
Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m(2) and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care...
September 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27607410/foetal-fentanyl-exposure-and-ion-trapping-after-intravenous-and-transdermal-administration-to-the-ewe
#14
Emma M Heikkinen, Kokki Hannu, Heikkinen Aki, Ranta Veli-Pekka, Räsänen Juha, Voipio Hanna-Marja, Kokki Merja
Opioids given to pregnant and parturient women are relatively freely transferred across the placenta. Spinal, epidural and intravenous fentanyl have been studied in pregnant women and neonates, but foetal safety of fentanyl dosing with transdermal patch during pregnancy and labour is not sufficiently studied. Foetal pH is physiologically lower than maternal pH, and thus, opioids, that are weak bases, are ionized and may cumulate to foetus. Foetal asphyxia may further worsen acidosis and ion trapping induced by low pH is assumed to increase the foetal exposure to opioids...
September 8, 2016: Basic & Clinical Pharmacology & Toxicology
https://www.readbyqxmd.com/read/27604767/effect-of-epidural-analgesia-on-mode-of-delivery
#15
Ivka Djaković, Senka Sabolović Rudman, Vesna Košec
Continuous epidural analgesia is considered to be the gold standard of pain relief in labour. The objective of this study was to examine the connections between epidural analgesia and the frequency of instrument-assisted deliveries. We retrospectively analysed data encompassing epidural analgesia applications during 2012 and the connections with an increased frequency of instrumental deliveries. Out of 3157 births in 2012, epidural analgesia was used in 443 (14.03 %). Epidural analgesia significantly increased the number of instrumental deliveries with vacuum extraction (χ(2) = 35...
September 7, 2016: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27566632/comparative-study-analysing-women-s-childbirth-satisfaction-and-obstetric-outcomes-across-two-different-models-of-maternity-care
#16
Ma Belén Conesa Ferrer, Manuel Canteras Jordana, Carmen Ballesteros Meseguer, César Carrillo García, M Emilia Martínez Roche
OBJECTIVES: To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). SETTING: 2 university hospitals in south-eastern Spain from April to October 2013. DESIGN: A correlational descriptive study. PARTICIPANTS: A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model...
2016: BMJ Open
https://www.readbyqxmd.com/read/27491276/simplified-and-standardized-intrapartum-management-can-yield-high-rates-of-successful-vbac-in-spontaneous-labor
#17
Mark P Hehir, Adam Mackie, Michael S Robson
OBJECTIVE: To examine the outcomes of vaginal birth after cesarean (VBAC) in women, in spontaneous labor, delivering after 37 weeks' gestation at an institution where trial of labor after a previous cesarean delivery (TOLAC) is encouraged and management of labor is standardized. METHODS: This retrospective cohort study included 3071 women with one previous cesarean only and no vaginal delivery who underwent a trial of labor from 2001 to 2011. Women were managed using the standardized "active management of labor" intrapartum protocol...
August 23, 2016: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/27459909/-assessment-of-maternal-satisfaction-with-epidural-analgesia-for-pain-control-during-labour
#18
V Marenco-Arellano, L Ferreira, E Ramalle-Gómara, A Crespo, A Rupérez, E Fraile
BACKGROUND: To determine the level of satisfaction and the sociodemographic characteristics of patients who receive epidural analgesia during labour. MATERIAL AND METHODS: A SERVQHOS questionnaire administered, with consecutive sampling, to 140 patients who had received an epidural anaesthetic for pain control during labour between January and June 2014, at the Hospital San Pedro. RESULTS: A total of 140 questionnaires were completed. The mean overall satisfaction (SERVQHOS scale) was 4...
July 23, 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
https://www.readbyqxmd.com/read/27422266/evaluation-of-failed-and-high-blocks-associated-with-spinal-anesthesia-for-cesarean-delivery-following-inadequate-labour-epidural-a-retrospective-cohort-study
#19
Lisa M Einhorn, Ashraf S Habib
PURPOSE: The purpose of this retrospective cohort study was to investigate factors associated with failed and high spinal blocks in patients who received spinal anesthesia for Cesarean delivery following a labour epidural that was inadequate for surgical anesthesia. METHODS: We searched our perioperative database for women with a labour epidural who received spinal or combined spinal-epidural anesthesia for Cesarean delivery due to the inadequacy of the existing epidural...
October 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/27421268/evaluation-of-the-effects-of-an-offer-of-a-monetary-incentive-on-the-rate-of-questionnaire-return-during-follow-up-of-a-clinical-trial-a-randomised-study-within-a-trial
#20
Pollyanna Hardy, Jennifer L Bell, Peter Brocklehurst
BACKGROUND: A systematic review on the use of incentives to promote questionnaire return in clinical trials suggest they are effective, but not all studies have sufficient funds to use them. Promising an incentive once data are returned can reduce the cost-burden of this approach, with possible further cost-savings if the offer were restricted to reminder letters only. This study aimed to evaluate the effect of promising a monetary incentive at first mailout versus a promise on reminder letters only...
2016: BMC Medical Research Methodology
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