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Epidural labor

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https://www.readbyqxmd.com/read/28719524/establishing-obstetric-anesthesiology-practice-guidelines-in-the-republic-of-armenia-a-global-health-collaboration
#1
Gordon Yuill, Ashot Amroyan, Simon Millar, Emil Vardapetyan, Ashraf S Habib, Medge D Owen
BACKGROUND: Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia...
August 2017: Anesthesiology
https://www.readbyqxmd.com/read/28715964/uterine-and-abdominal-muscle-electromyographic-activities-in-control-and-pcea-treated-nulliparous-women-during-the-second-stage-of-labor
#2
Xueya Qian, Pin Li, Shao-Qing Shi, Robert E Garfield, Huishu Liu
OBJECTIVE: Patient-controlled epidural analgesia (PCEA), used to relieve pain during delivery, delays labor but the mechanism is unknown. The aim was to investigate the effects of PCEA on uterine and abdominal muscles electromyographic (EMG) activity during the second stage of labor. METHODS: This study included 45 nulliparous pregnant women without PCEA, 42 women with standard PCEA treatment given during the first stage of labor and stopped near the end of the first stage, and 22 women with standard PCEA treatment with continued use throughout the first and second stages of labor...
August 2017: Reproductive Sciences
https://www.readbyqxmd.com/read/28713495/awareness-of-epidural-analgesia-among-pregnant-women-in-jeddah-saudi-arabia
#3
Abdulrahim Gari, Ala Aziz, Nourah ALSaleh, Yosra Hamour, Hanaa Abdelal, Raed Sayed Ahmed
BACKGROUND AND OBJECTIVE: Labor pain is one of the most severe forms of pain that women experience throughout their lifetime. Many pregnant women decide to have an epidural anesthesia to cope with labor pain. This study has focused on general awareness about epidural anesthesia among pregnant women in Jeddah, Saudi Arabia. METHODS: This was a cross-sectional hospital-based study using a self-administered questionnaire, conducted in King Faisal Specialist Hospital and Research Center and International Medical Centre...
May 2017: Electronic Physician
https://www.readbyqxmd.com/read/28711635/a-new-pupillary-measure-to-assess-pain-a-prospective-study
#4
David J Charier, Daniel Zantour, Vincent Pichot, Florian Chouchou, Jean-Claude M Barthelemy, Frederic Roche, Serge B Molliex
Pupillary diameter (PD) varies under the influence of both the sympathetic and parasympathetic systems, increasing proportionally to pain intensity. Such variations however should not be confused with pupillary fluctuations, which refer to the fast and permanent PD fluctuations induced by the ongoing interplay between the sympathetic and parasympathetic systems, which we propose to measure using the Variation Coefficient of Pupillary Diameter (VCPD). This study aimed first at correlating both PD, PD increase during a contraction, and VCPD, with pain as rated with the Numerical Rating Scale (NRS) during obstetrical labor, and then at comparing such correlations with one another...
July 12, 2017: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28697030/severe-postpartum-headache-and-hypertension-caused-by-reversible-cerebral-vasoconstriction-syndrome-a-case-report
#5
Ed McIlroy, Rajamani Sethuraman, Reshma Woograsingh, Catherine Nelson-Piercy, Edward Gilbert-Kawai
Reversible cerebrovascular vasoconstriction syndrome is an uncommon condition that presents as severe headache and hypertension. Recent literature suggests a 1% incidence in postpartum headache cases. It can cause subarachnoid hemorrhages, cerebral ischemia, and seizures. It is often misdiagnosed as postdural puncture headache or preeclampsia. In this case, a postpartum woman, who had received epidural anesthesia for labor, presented 5 days postpartum with severe headache that did not resolve with an epidural blood patch...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28689621/intrathecal-hematoma-and-arachnoiditis-mimicking-bacterial-meningitis-after-an-epidural-blood-patch
#6
F Roy-Gash, N Engrand, E Lecarpentier, M P Bonnet
We present a case of arachnoiditis and an intrathecal hematoma after an epidural blood patch. A 24-year-old parturient underwent an epidural blood patch three days after an accidental dural puncture during epidural labor analgesia. Four days later, the patient developed severe lower back pain, bilateral leg pain, persistent headache and fever. Bacterial meningitis was initially suspected and antibiotics started. Lumbar magnetic resonance imaging was performed and showed an intrathecal hematoma, with no blood in the epidural space...
June 1, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28688227/impact-factors-on-cervical-dilation-rates-in-the-first-stage-of-labor
#7
Jana Juhasova, Martina Kreft, Roland Zimmermann, Nina Kimmich
AIMS: To assess cervical dilation rates of nulliparous and multiparous women in the active first stage of labor and to evaluate significant impact factors. METHODS: In a retrospective cohort study between January 2007 and July 2014 at the University Hospital of Zurich in Switzerland, we analyzed 8378 women with singleton pregnancies in vertex presentation with a vaginal delivery at 34+0 to 42+5 gestational weeks. Median cervical dilation rates were calculated and different impact factors evaluated...
July 8, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28684143/what-s-new-in-clinical-obstetric-anesthesia-in-2015
#8
REVIEW
P E Hess
Each calendar year the Society for Obstetric Anesthesia and Perinatology invites an individual to conduct a review of the medical literature, identifying clinically relevant publications of interest to the obstetric anesthesia provider. This report of that effort covers the publications from 2015 and includes the categories of anesthesia and analgesia, complications of neuraxial procedures, and the effects of anesthesia on the fetus. Neuraxial procedures represent the foundation of obstetric anesthesia; advances in anesthesia and analgesia include novel modes of administration, and refinements in care of the medically complex patient...
March 18, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28667866/a-case-that-illustrates-the-challenges-of-managing-pregnant-patients-with-antithrombin-deficiency-more-questions-than-answers
#9
Leslie Skeith, Andrew Aw, Julia Hews-Girard, Natalia Rydz
Using an illustrative case of a patient with antithrombin (AT) deficiency who developed a recurrent venous thromboembolism (VTE) in pregnancy despite therapeutic low-molecular-weight heparin (LMWH), we highlight what is known in the literature and address areas of controversy through a series of questions around the case. The questions we address include the role of anti-Xa monitoring for patients with past VTE on antepartum LMWH, what treatment regimen is recommended for pregnant patients who develop a recurrent VTE while on therapeutic anticoagulation, the role of antepartum AT concentrate prophylaxis, and the management of labor/delivery, epidural anesthesia and postpartum anticoagulation...
June 24, 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28663623/comparison-of-epidural-butorphanol-with-neostigmine-and-epidural-sufentanyl-with-neostigmine-for-first-stage-of-labor-analgesia-a-randomized-controlled-trial
#10
Manoj Chaurasia, Ashok Kumar Saxena, Geetanjali T Chilkoti
BACKGROUND: Epidural administration of neostigmine appears to be safe in the obstetric population. Recently, few studies have concluded 10 μg sufentanil to be an effective adjuvant with epidural neostigmine in providing labor analgesia. However, no study has evaluated the analgesic effect of epidural butorphanol with neostigmine for the same. MATERIALS AND METHODS: The parturients were randomly allocated to one of the three study groups - Group A (n = 30) received butorphanol 1 mg and neostigmine 7 μg/kg...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28659122/effects-of-combined-spinal-epidural-labor-analgesia-on-episiotomy-a-retrospective-cohort-study
#11
Dandan Zhou, Hui Gong, Shan He, Wei Gao, Qiang Wang
BACKGROUND: According to some published studies, neuraxial analgesia may be associated with prolonged labor and an increased risk for instrumental vaginal delivery. However, its effects on episiotomy are unknown. This study aimed to examine the incidence of episiotomy with and without combined spinal-epidural analgesia (CSEA) during labor. METHODS: This was a retrospective cohort study, in which the computerized medical records of nulliparous women with singleton, cephalic and live births were reviewed and women with and without CSEA were matched based on their propensity scores...
June 28, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28656055/optimal-dose-of-epidural-dexmedetomidine-added-to-ropivacaine-for-epidural-labor-analgesia-a-pilot-study
#12
Zhang Wangping, Ren Ming
BACKGROUND: Dexmedetomidine combined with local anesthetics can decrease the concentration of epidural ropivacaine. However, the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain. This study investigated the effect of adding different dose of epidural dexmedetomidine to ropivacaine during epidural labor analgesia. METHODS: One hundred women were randomly assigned to one of the four groups (Groups A, B, C, and D received 0...
2017: Evidence-based Complementary and Alternative Medicine: ECAM
https://www.readbyqxmd.com/read/28653359/ultrasound-assessment-of-gastric-content-in-the-immediate-postpartum-period-a-prospective-observational-descriptive-study
#13
F Vial, N Hime, J Feugeas, N Thilly, P Guerci, H Bouaziz
INTRODUCTION: Pulmonary aspiration of gastric contents in pregnant women undergoing general anesthesia or sedation/analgesia in the peripartum period is a feared complication in obstetric anesthesia. We assessed the changes in antral cross-sectional area (CSA) with ultrasonography in laboring women and in the immediate postpartum period. PATIENTS AND METHODS: In an observational study in a university-affiliated maternity, gastric ultrasonography examinations were performed in non-consecutive laboring women, after epidural analgesia insertion and after childbirth...
June 26, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28651841/survey-of-nulliparous-parturients-attitudes-regarding-timing-of-epidural-analgesia-initiation
#14
Ghislaine C Echevarria, Gilbert J Grant, Yousun Chung, Jerome Lax
STUDY OBJECTIVE: At our hospital, although >90% of nulliparous parturients eventually choose epidural analgesia for labor, many delay its initiation, experiencing considerable pain in the interim. This survey probed parturients' views about the timing of initiation of epidural labor analgesia. DESIGN: Single-center, nonrandomized quantitative survey. SETTING: Labor and delivery suite in a large tertiary academic medical center. PATIENTS: Two hundred laboring nulliparous women admitted to the labor and delivery suite...
June 23, 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28640477/is-a-prolonged-second-stage-of-labor-too-long
#15
EDITORIAL
Sarah M Cohen, Michal Lipschuetz, Simcha Yagel
Professional guidelines define the second stage of labor as 'prolonged' at three hours for primiparous women with an epidural and two hours without, and at two hours for parous women with an epidural and one hour without(1). NICE guidelines from the UK define second stage length similarly, but take into consideration passive time at full cervical dilation and the time in active pushing(2).
June 22, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28622178/labor-analgesia-onset-with-dural-puncture-epidural-versus-traditional-epidural-using-a-26-gauge-whitacre-needle-and-0-125-bupivacaine-bolus-a-randomized-clinical-trial
#16
Sylvia H Wilson, Bethany J Wolf, Kellie N Bingham, Quiana S Scotland, John M Fox, Erick M Woltz, Latha Hebbar
BACKGROUND: Lumbar epidurals (LEs) provide excellent analgesia. Combined spinal epidural and dural puncture epidural (DPE) are 2 techniques to expedite neuraxial analgesia onset. In DPE, dura is punctured but medication is not administered in the cerebrospinal fluid. Expedited analgesia onset has been demonstrated with DPE, using 0.25% bupivacaine; however, this concentration may impede an unassisted vaginal birth and is not currently used for induction and maintenance of labor analgesia...
June 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28622143/epidural-analgesia-at-trial-of-labor-after-cesarean-tolac-a-significant-adjunct-to-successful-vaginal-birth-after-cesarean-vbac
#17
Sorina Grisaru-Granovsky, Maayan Bas-Lando, Lior Drukker, Fred Haouzi, Rivka Farkash, Arnon Samueloff, Alexander Ioscovich
INTRODUCTION: Epidural analgesia has been considered a risk factor for labor dystocia at trial of labor after cesarean (TOLAC) and uterine rupture. We evaluated the association between exposure to epidural during TOLAC and mode of delivery and maternal-neonatal outcomes. MATERIALS AND METHODS: A single center retrospective study of women that consented to TOLAC within a strict protocol between 2006 and 2013. Epidural "users" were compared to "non-users". Primary outcome was the mode of delivery: repeat in-labor cesarean or vaginal birth after cesarean (VBAC)...
June 5, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28620569/the-optimal-pain-management-approach-for-a-laboring-patient-a-review-of-current-literature
#18
REVIEW
Albert Kelly, Quang Tran
There is a general agreement that a patient in labor should be given the option to have an epidural block for pain management. Despite this consensus, there are differences in practice patterns as to when to initiate an epidural and how to minimize its impact on the duration and outcome of a patient's labor. A review of the literature suggests epidural analgesia does prolong stages one and two of labor, but not significantly. Cesarean delivery rates are not affected by the early initiation of epidural analgesia...
May 10, 2017: Curēus
https://www.readbyqxmd.com/read/28606063/on-predicting-time-to-completion-for-the-first-stage-of-spontaneous-labor-at-term-in-multiparous-women
#19
Björn Gunnarsson, Eirik Skogvoll, Ingibjörg Hanna Jónsdóttir, Jo Røislien, Alexander Kr Smárason
BACKGROUND: Labor that progresses faster than anticipated may lead to unplanned out-of-hospital births. With the aim to improve planning of transportation to birthing institutions, this study investigated predictors of time to completion for the first stage of labor conditional on cervical opening (conditional time) in multiparous women at term. METHODS: We performed a retrospective analysis of partograms for women in Robson's group 3 who delivered at one hospital from 2003 to 2013...
June 12, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28600050/labor-induction-just-after-external-cephalic-version-with-epidural-analgesia-at-term
#20
Marcos J Cuerva, Carlos S Piñel, Javier Caceres, Jose A Espinosa
OBJECTIVE: To analyze the benefits of external cephalic version (ECV) with epidural analgesia at term and labor induction just after the procedure. MATERIALS AND METHODS: This is a retrospective observational study with patients who did not want trying a breech vaginal delivery and decided trying an ECV with epidural analgesia at term and wanted labor induction or cesarean section after the procedure. We present the results of 40 ECV with epidural analgesia at term and labor induction or cesarean section just after the ECV...
June 2017: Taiwanese Journal of Obstetrics & Gynecology
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