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Protocols for analgesia in labour

Kelly Madden, Philippa Middleton, Allan M Cyna, Mandy Matthewson, Leanne Jones
BACKGROUND: This review is one in a series of Cochrane reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. This review updates an earlier version of the review of the same title. OBJECTIVES: To examine the effectiveness and safety of hypnosis for pain management during labour and childbirth. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2015) and the reference lists of primary studies and review articles...
2016: Cochrane Database of Systematic Reviews
Rebecca-Lea Smith, Naveed Siddiqui, Tamara Henderson, James Teresi, Kristi Downey, Jose C A Carvalho
OBJECTIVE: To compare the efficacy between intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) in women undergoing medically induced second trimester termination of pregnancy (TOP). METHODS: We conducted a randomized trial in a Canadian quaternary care hospital. We included in the study women of gestational age 12 weeks to 23+6 weeks who were undergoing second trimester induction of labour between June 2012 and January 2014...
February 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Joanna Solek-Pastuszka, Edyta Zagrodnik-Ulan, Romuald Bohatyrewicz, Zbigniew Celewicz
Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine...
2015: Anaesthesiology Intensive Therapy
Aaron Budden, Lily J Y Chen, Amanda Henry
BACKGROUND: When women require induction of labour, oxytocin is the most common agent used, delivered by an intravenous infusion titrated to uterine contraction strength and frequency. There is debate over the optimum dose regimen and how it impacts on maternal and fetal outcomes, particularly induction to birth interval, mode of birth, and rates of hyperstimulation. Current induction of labour regimens include both high- and low-dose regimens and are delivered by either continuous or pulsed infusions, with both linear and non-linear incremental increases in oxytocin dose...
2014: Cochrane Database of Systematic Reviews
M M L H Wassen, L J M Smits, H C J Scheepers, M A E Marcus, J Van Neer, J G Nijhuis, F J M E Roumen
OBJECTIVE: To assess the effect on mode of delivery of the routine use of labour epidural analgesia (EA) compared with analgesia on request. DESIGN: Randomised non-inferiority trial. SETTING: One university and one non-university teaching hospital in The Netherlands. POPULATION: Women with a singleton pregnancy in cephalic presentation beyond 36 + 0 weeks' gestation. METHODS: Participants were randomly allocated to receive either routine EA or analgesia on request...
February 2015: BJOG: An International Journal of Obstetrics and Gynaecology
Simone M I Kuppens, Alice Brugman, Tom H M Hasaart, Eileen K Hutton, Victor J M Pop
OBJECTIVE: To investigate the impact on obstetric outcome in nulliparous women of changing labour management from an expectant approach to proactive support of labour. METHODS: We conducted a retrospective cohort study in a teaching hospital in the Netherlands among 858 women ≥ 37 weeks' gestation with a singleton fetus in cephalic position and spontaneous labour who planned to have a vaginal birth in the hospital under the care of an obstetrician. Exclusion criteria were gestational age < 37 weeks, induction of labour, primary Caesarean section, non-cephalic position, and non-Caucasian ethnicity...
June 2013: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Ellen D Hodnett, Robyn Stremler, Stephen H Halpern, Julie Weston, Rory Windrim
Background. Caesarean birth rates in North America continue to rise, in the absence of benefit for mothers and babies. One reason may be that hospitalized labouring women spend most of their labours in recumbent or semi-recumbent positions. Although hands-and-knees position has theoretical advantages, efforts to encourage its adoption in practice are severely hampered by the lack of compelling evidence that it is beneficial. Before a definitive, large scale trial, with spontaneous vaginal birth as the primary outcome, could be justified in terms of time, effort, and expense, several feasibility and acceptability questions had to be addressed...
2013: PeerJ
Li Thies-Lagergren, Linda J Kvist, Kyllike Christensson, Ingegerd Hildingsson
BACKGROUND: The aim of this study was to compare maternal labour and birth outcomes between women who gave birth on a birth seat or in any other position for vaginal birth and further, to study the relationship between synthetic oxytocin augmentation and maternal blood loss, in a stratified sample. METHODS: A re-analysis of a randomized controlled trial in Sweden. An on-treatment analysis was used to study obstetrical outcomes for nulliparous women who gave birth on a birth seat (birth seat group) compared to birth in any other position for vaginal birth (control group)...
2012: BMC Pregnancy and Childbirth
Kelly Madden, Philippa Middleton, Allan M Cyna, Mandy Matthewson, Leanne Jones
BACKGROUND: This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and childbirth. This review updates the findings regarding hypnosis from an earlier review of complementary and alternative therapies for pain management in labour into a stand-alone review...
2012: Cochrane Database of Systematic Reviews
Petr Stourac, Hana Suchomelova, Marta Stodulkova, Martin Huser, Ivo Krikava, Petr Janku, Olga Haklova, Lubomir Hakl, Roman Stoudek, Roman Gal, Pavel Sevcik
INTRODUCTION: Epidural analgesia (EA) has significant contraindications including coagulation disorders and parturient refusal. One alternative is intravenous self-administered analgesia using the ultra short-acting opioid remifentanil (rPCA). We compared the efficiency and safety of standard epidural analgesia with parturient-controlled intravenous analgesia using remifentanil as well as personal satisfaction. MATERIALS AND METHODS: We enrolled twelve ASA I classified women with singleton pregnancy who delivered vaginally in the period 3/2010-5/2010 and who received rPCA (n=12) in standard analgesic protocol: 20 µg boluses using PCA pump with a lockout interval of 3 min...
June 2014: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
J-L Hanouz, T Simonet, C Marliot, A Mayaud, A Girard, N Rakotnirina, J-L Fellahi, J-L Gérard
OBJECTIVES: The last French survey on alternatives to neuraxial anaesthesia for labour pain was published in 1997. However, intravenous remifentanil has become increasingly used as an option for labour analgesia. We evaluated the use of remifentanil as an alternative to epidural analgesia in level 2 and 3 French maternities in 2009. STUDY DESIGN: This was an internet-based French survey performed in 2009 including all level 2 and 3 maternities. Data recorded were maternity unit characteristic, alternatives to neuraxial analgesia used, and remifentanil administration protocols...
September 2012: Annales Françaises D'anesthèsie et de Rèanimation
Leanne Jones, Mohammad Othman, Therese Dowswell, Zarko Alfirevic, Simon Gates, Mary Newburn, Susan Jordan, Tina Lavender, James P Neilson
BACKGROUND: The pain that women experience during labour is affected by multiple physiological and psychosocial factors and its intensity can vary greatly.  Most women in labour require pain relief. Pain management strategies include non-pharmacological interventions (that aim to help women cope with pain in labour) and pharmacological interventions (that aim to relieve the pain of labour). OBJECTIVES: To summarise the evidence from Cochrane systematic reviews on the efficacy and safety of non-pharmacological and pharmacological interventions to manage pain in labour...
2012: Cochrane Database of Systematic Reviews
I F Russell
BACKGROUND: After accidental dural puncture in labour it is suggested that inserting an intrathecal catheter and converting to spinal analgesia reduces postdural puncture headache and epidural blood patch rates. This treatment has never been tested in a controlled manner. METHODS: Thirty-four hospitals were randomised to one of two protocols for managing accidental dural puncture during attempted labour epidural analgesia: repeating the epidural procedure or converting to spinal analgesia by inserting the epidural catheter intrathecally...
January 2012: International Journal of Obstetric Anesthesia
N Brogly, R Schiraldi, B Vazquez, J Perez, E Guasch, F Gilsanz
BACKGROUND: Continuous infusion associated with patient-controlled epidural analgesia (PCEA) is used in many maternal units. This randomized controlled study evaluated the effect of a 10 mL/h background infusion associated with a 10 mL-20 minutes lockout time demand-only PCEA protocol using L-bupivacaine plus fentanyl in terms of local anaesthetic consumption, pain management and maternal satisfaction. METHODS: Forty consenting parturients were randomly assigned to receive a 0...
December 2011: Minerva Anestesiologica
Mélanie Cayrac, Jean-Luc Faillie, Anaïg Flandrin, Pierre Boulot
OBJECTIVES: To evaluate the results and risks of a protocol for second- and third-trimester termination of pregnancy after prior caesarean section. STUDY DESIGN: This is a retrospective study, conducted in a level 3 (university hospital) maternity unit between January 2001 and September 2008. 67 women with a history of caesarean section underwent second- and third-trimester termination of pregnancy. The protocol was administration of 600 mg mifepristone the first day and application of laminaria tents the second day...
August 2011: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Nigel Lee, Peter Coxeter, Michael Beckmann, Joan Webster, Vanessa Wright, Tric Smith, Sue Kildea
BACKGROUND: Almost one third of women suffer continuous lower back pain during labour. Evidence from three systematic reviews demonstrates that sterile water injections (SWI) provide statistically and clinically significant pain relief in women experiencing continuous lower back pain during labour. The most effective technique to administer SWI is yet to be determined. Therefore, the aim of this study is to determine if the single injection SWI technique is no less effective than the routinely used four injection SWI method in reducing continuous lower back pain during labour...
2011: BMC Pregnancy and Childbirth
I Z Mackenzie, J Xu, C Cusick, H Midwinter-Morten, H Meacher, J Mollison, M Brock
OBJECTIVE: To assess the role of acupuncture for analgesia during labour. DESIGN: Double-blind study of manual, electro and sham acupuncture, and single-blind study comparing acupuncture with a control group for analgesia for labour induction. SETTING: A major obstetric unit in the UK. POPULATION: A cohort of 105 nulliparae undergoing labour induction at term. METHODS: Twenty-three subjects needed to be randomised to each group to have an 80% power of detecting a 50% relative reduction in epidural rate with an alpha value of 0...
March 2011: BJOG: An International Journal of Obstetrics and Gynaecology
L Gitz, O Morel, O Thiebaugeorges, J Sibiude, P Desfeux, E Barranger
UNLABELLED: The induction of labour for intra-uterine fetal death (IUFD) and termination of pregnancy (TOP) is a common obstetrical situation. The management of these specific inductions has improved. OBJECTIVES: Define a protocol that meets the several constraints of security, efficiency and cost for labor induction for IUFD and TOP. MATERIALS AND METHODS: Review. RESULTS: The protocol chosen uses the mifepristone 200mg by oral way on the first day for cervical preparation, completed by placing laminaria tents the evening of the 2nd day if the membranes are unreachable...
February 2011: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
R D Maimburg, M Vaeth, J Dürr, L Hvidman, J Olsen
OBJECTIVE: To compare the birth process in nulliparous women enrolled in a structured antenatal training programme, the 'Ready for Child' programme, with women allocated to routine care. DESIGN: A randomised controlled trial. SETTING: A Danish university hospital. PARTICIPANTS: Thousand hundred and ninety-three nulliparous women, recruited before week 22 + 0. Methods Compliance to the protocol was monitored by questionnaires sent to the women by email, and by data from the local birth cohort database...
July 2010: BJOG: An International Journal of Obstetrics and Gynaecology
Anke Schuurhuis, Frans J M E Roumen, Josien B de Boer et al.
The basic principle of the practice guideline 'Pharmaceutical pain treatment during labour' is that during labour every woman can have adequate pain treatment at her request. Most women experience severe pain during labour, but retrospective satisfaction also depends on the support of care-givers and on the extent to which the woman was involved in decisions relating to her situation. A number of medical indications require good pain management. Epidural analgesia is the safest and most effective method, preferably as patient-controlled analgesia (PCA)...
2009: Nederlands Tijdschrift Voor Geneeskunde
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