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Analgesia, labour

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https://www.readbyqxmd.com/read/28515516/changes-in-cardiac-index-during-labour-analgesia-a-double-blind-randomised-controlled-trial-of-epidural-versus-combined-spinal-epidural-analgesia-a-preliminary-study
#1
Stephanie Yacoubian, Corrina M Oxford, Bhavani Shankar Kodali
BACKGROUND AND AIMS: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. METHODS: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia...
April 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28514779/low-back-pain-in-pregnancy-investigations-management-and-role-of-neuraxial-analgesia-and-anaesthesia-a-systematic-review
#2
Herman Sehmbi, Rohan D'Souza, Anuj Bhatia
BACKGROUND: Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regarding investigations, management strategies and considerations around performing neuraxial blocks for pregnant women with LBP. METHODS: We searched 3 databases and reviewed literature concerning LBP in pregnancy with regards to diagnostic modalities, management strategies and use of neuraxial techniques for facilitating labour and delivery...
May 18, 2017: Gynecologic and Obstetric Investigation
https://www.readbyqxmd.com/read/28511452/the-effect-of-entonox-on-labour-pain-relief-among-nulliparous-women-a-randomized-controlled-trial
#3
Parisa Parsa, Nafiseh Saeedzadeh, Ghodratallah Roshanaei, Fatameh Shobeiri, Faryar Hakemzadeh
INTRODUCTION: Labour pain is one of the most severe pain in humans. Fear of labour pain is the most dreadful reason for Caesarean Section (CS). Entonox (a mixture of nitrous oxide+oxygen) is a safe inhalational analgesia during labour pain. AIM: This study investigated the effect of entonox on pain relief and length of labour in nulliparous women. MATERIALS AND METHODS: A clinical trial study was conducted among 120 nulliparous women (60 in intervention and 60 in control group) in 2015 in Atieh Hospital, Hamadan city, Iran...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28435667/neuraxial-opioids-as-analgesia-in-labour-and-postoperative-after-caesarean-section-and-hysterectomy-a-questionnaire-survey-in-sweden
#4
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 47 anaesthesiologists at 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/28419420/reliability-of-pressure-waveform-analysis-to-determine-correct-epidural-needle-placement-in-labouring-women
#5
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
https://www.readbyqxmd.com/read/28418067/a-case-series-of-vital-signs-controlled-patient-assisted-intravenous-analgesia-vpia-using-remifentanil-for-labour-and-delivery
#6
W L Leong, B L Sng, Q Zhang, N L R Han, R Sultana, A T H Sia
Intravenous remifentanil patient-controlled analgesia can be used during labour as an alternative to epidural analgesia. Adverse effects of opioids, including hypoxia and bradycardia, may lead to maternal morbidity and mortality. We devised an interactive feedback system based on a clinical proportional algorithm, to continuously monitor for adverse effects to enhance safety and better titrate analgesia. This vital signs-controlled, patient-assisted intravenous analgesia with remifentanil used a prototype delivery system linked to a pulse oximeter that evaluated maternal oxygen saturation and heart rate continuously...
April 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28411530/the-influence-of-intrapartum-opioid-use-on-breastfeeding-experience-at-6-weeks-post-partum-a-secondary-analysis
#7
Julie-Anne Fleet, Meril Jones, Ingrid Belan
OBJECTIVE: To examine breastfeeding experiences up to 6 weeks postpartum for mothers administered intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for intrapartum analgesia. DESIGN: A secondary analysis was undertaken using the per-protocol dataset to examine the third phase of a larger randomised controlled trial. This phase of the study examined breastfeeding intention and experience from the first hour of birth to 6 weeks postpartum. Medical records were audited and women were contacted at 6 weeks postpartum to complete a telephone questionnaire...
April 3, 2017: Midwifery
https://www.readbyqxmd.com/read/28407220/patient-controlled-analgesia-with-remifentanil-versus-alternative-parenteral-methods-for-pain-management-in-labour
#8
REVIEW
Stephanie Weibel, Yvonne Jelting, Arash Afshari, Nathan Leon Pace, Leopold Hj Eberhart, Johanna Jokinen, Thorsten Artmann, Peter Kranke
BACKGROUND: Multiple analgesic strategies for pain relief during labour are available. Recently remifentanil, a short-acting opioid, has recently been used as an alternative analgesic due to its unique pharmacological properties. OBJECTIVES: To systematically assess the effectiveness of remifentanil intravenous patient-controlled analgesia (PCA) for labour pain, along with any potential harms to the mother and the newborn. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 December 2015), ClinicalTrials...
April 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28391147/influence-of-a-pelvic-floor-training-programme-to-prevent-perineal-trauma-a-quasi-randomised-controlled-trial
#9
Fatima Leon-Larios, Isabel Corrales-Gutierrez, Rosa Casado-Mejía, Carmen Suarez-Serrano
BACKGROUND: perineal injury is common after birth and may be caused by tears or episiotomy or both. Perineal massage has been shown to prevent episiotomies in primiparous women. On the other hand, pelvic floor exercises might have an influence by shortening the first and second stages of labour in the primigravida. AIM: the aim of this study was to investigate the effects of a pelvic floor training following a birth programme on perineal trauma. DESIGN: a single-blind quasi-randomized controlled trial with two groups: standard care and intervention...
March 27, 2017: Midwifery
https://www.readbyqxmd.com/read/28363328/cerebrospinal-fluid-cutaneous-fistula-following-obstetric-epidural-analgaesia-case-report
#10
J J Fedriani de Matos, A V Quintero Salvago, M D Gómez Cortés
Cutaneous fistula of cerebrospinal fluid is a rare complication of neuroaxial blockade. We report the case of a parturient in whom an epidural catheter was placed for labour analgesia and 12h after the catheter was removed, presented an abundant asymptomatic fluid leak from the puncture site, compatible in the cyto-chemical analysis with cerebrospinal fluid. She was treated with acetazolamide, compression of skin orifice of the fluid leakage, antibiotic prophylaxis, hydration and rest, and progressed satisfactorily without requiring blood patch...
March 28, 2017: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/28351386/midwife-led-maternity-care-in-ireland-a-retrospective-cohort-study
#11
Anna Dencker, Valerie Smith, Colette McCann, Cecily Begley
BACKGROUND: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites...
March 28, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28349526/pushing-bearing-down-methods-for-the-second-stage-of-labour
#12
REVIEW
Andrea Lemos, Melania Mr Amorim, Armele Dornelas de Andrade, Ariani I de Souza, José Eulálio Cabral Filho, Jailson B Correia
BACKGROUND: Maternal pushing during the second stage of labour is an important and indispensable contributor to the involuntary expulsive force developed by uterine contraction. There is no consensus on an ideal strategy to facilitate these expulsive efforts and there are contradictory results about the influence on the mother and fetus. OBJECTIVES: To evaluate the benefits and possible disadvantages of different kinds of techniques regarding maternal pushing/breathing during the expulsive stage of labour on maternal and fetal outcomes...
March 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28342158/the-incidence-of-and-risk-factors-for-a-repeat-obstetric-anal-sphincter-injury-oasis-in-the-vaginal-birth-subsequent-to-a-first-episode-of-oasis-a-hospital-based-cohort-study
#13
Angeliki Antonakou, Dimitrios Papoutsis, Karen Henderson, Zahid Qadri, Andrew Tapp
PURPOSE: To identify the incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in women who sustained an OASIS in their first vaginal delivery and have a subsequent vaginal birth. METHODS: Data were collected retrospectively for women having had singleton cephalic presentation vaginal deliveries between 2007 and 2015. Women with breech deliveries, stillbirths, foetal congenital abnormalities and multiple pregnancies were excluded. RESULTS: Over the study period, we identified 11,191 women who had a first vaginal birth, of which 603 (5...
March 24, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28263154/-asymptomatic-spontaneous-rupture-of-the-uterus-without-previous-sectio
#14
Stine Kretzschmar Nielsen, Lars Høj
Rupture of the uterus is rare but catastrophic. Rupture often results in fetal bradycardia, abdominal pain, haemodynamic changes and vaginal bleeding. A 36-year-old healthy woman, gravida 3, para 1, went into spontaneous labour at gestation age 39 + 4, and at orificium 7 cm she received epidural analgesia. Following the epidural, the fetal heartbeat could not be registered by external cardiotocography, and caput could not be palpated. Spontaneous birth was attempted, but a caesarean section was necessary. The baby was found in the abdomen...
February 27, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28250488/barriers-for-labour-analgesia-in-south-india-knowledge-and-attitude-of-relevant-stakeholders-a-hospital-based-cross-sectional-study
#15
S Syed Thahir Hussain, P Maheswari
No abstract text is available yet for this article.
February 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28238320/-oxytocin-administration-during-spontaneous-labour-guidelines-for-clinical-practice-guidelines-short-text
#16
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: Gynecologie, Obstetrique, Fertilite & Senologie
https://www.readbyqxmd.com/read/28231607/position-in-the-second-stage-of-labour-for-women-with-epidural-anaesthesia
#17
REVIEW
Marion Kibuka, Jim G Thornton
BACKGROUND: Epidural analgesia for pain relief in labour prolongs the second stage of labour and results in more instrumental deliveries. It has been suggested that a more upright position of the mother during all or part of the second stage may counteract these adverse effects. This is an update of a Cochrane review first published in 2013. OBJECTIVES: To assess the effects of different birthing positions (upright and recumbent) during the second stage of labour, on important maternal and fetal outcomes for women with epidural analgesia...
February 24, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28191626/intermittent-auscultation-ia-of-fetal-heart-rate-in-labour-for-fetal-well-being
#18
REVIEW
Ruth Martis, Ova Emilia, Detty S Nurdiati, Julie Brown
BACKGROUND: The goal of fetal monitoring in labour is the early detection of a hypoxic baby. There are a variety of tools and methods available for intermittent auscultation (IA) of the fetal heart rate (FHR). Low- and middle-income countries usually have only access to a Pinard/Laënnec or the use of a hand-held Doppler device. Currently, there is no robust evidence to guide clinical practice on the most effective IA tool to use, timing intervals and length of listening to the fetal heart for women during established labour...
February 13, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28157275/continuous-cardiotocography-ctg-as-a-form-of-electronic-fetal-monitoring-efm-for-fetal-assessment-during-labour
#19
REVIEW
Zarko Alfirevic, Declan Devane, Gillian Ml Gyte, Anna Cuthbert
BACKGROUND: Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. OBJECTIVES: To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour...
February 3, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28102539/determination-of-the-median-effective-dose-ed50-of-spinal-chloroprocaine-in-labour-analgesia
#20
M Coppens, S Anssens, A Parashchanka, K Roelens, E Deschepper, S De Hert, P F Wouters
The primary goal of this study was to determine the median effective dose (ED50 ) of spinal chloroprocaine for labour analgesia. Thirty-eight parturients requesting neuraxial analgesia were enrolled. Doses of 1% chloroprocaine were determined by the technique of up-down sequential allocation, with an initial dose of 20 mg and steps of 2 mg. The chloroprocaine spinal dose was given as the spinal component of a combined spinal-epidural, which was then supplemented with an epidural dose of 7.5 μg sufentanil in 7 ml saline...
January 19, 2017: Anaesthesia
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