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https://www.readbyqxmd.com/read/28938298/safety-and-efficacy-of-epidural-analgesia
#1
Elke M E Bos, Markus W Hollmann, Philipp Lirk
PURPOSE OF REVIEW: Epidural analgesia remains a widely used analgesic technique. This article aims to assess the safety of epidural analgesia by balancing efficacy and complications, of epidural analgesia for acute, labor and chronic pain. RECENT FINDINGS: Main indications for epidural analgesia include major open abdominal surgery, thoracotomy and labor analgesia. Past and current literature show that epidural analgesia leads to statistically significant, but possibly clinically less meaningful, reductions in pain scores compared with intravenous analgesia...
September 21, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28930940/the-relationship-between-women-s-intention-to-request-a-labor-epidural-analgesia-actually-delivering-with-labor-epidural-analgesia-and-postpartum-depression-at-6-weeks-a-prospective-observational-study
#2
Sharon Orbach-Zinger, Ruth Landau, Avi Ben Harousch, Oren Ovad, Liron Caspi, Evgeniya Kornilov, Alexander Ioscovich, Danielle Bracco, Atara Davis, Shlomo Fireman, Moshe Hoshen, Leonid A Eidelman
BACKGROUND: Postpartum depression (PPD) is associated with pain during and after delivery, with studies showing reduced rates among women delivering with labor epidural analgesia (LEA). We hypothesized that women who intend to deliver with LEA but do not receive it are at higher risk for PPD at 6 weeks due to the combined experience of untreated labor pain and unmatched expectations during labor, and evaluated the interaction between labor plans related to LEA, satisfaction with pain control when actually delivering with LEA, and PPD at 6 weeks after delivery...
September 19, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28926443/recovery-after-nulliparous-birth-a-detailed-analysis-of-pain-analgesia-and-recovery-of-function
#3
Ryu Komatsu, Brendan Carvalho, Pamela D Flood
BACKGROUND: The majority of parturients in the United States first return for evaluation by their obstetric practitioner 6 weeks after delivery. As such, there is little granular data on the pain experience, analgesic requirements, and functional recovery during the postpartum period. This prospective observational study was performed to evaluate these factors to provide expectations for patients. METHODS: A total of 213 nulliparous women were enrolled and assessed daily until they completed 3 outcomes: (1) pain resolution; (2) opioid cessation; and (3) self-assessed functional recovery from delivery...
October 2017: Anesthesiology
https://www.readbyqxmd.com/read/28915858/risk-of-obstetric-anal-sphincter-injury-increases-with-maternal-age-irrespective-of-parity-a-population-based-register-study
#4
Ulla Waldenström, Cecilia Ekéus
BACKGROUND: Obstetric anal sphincter injury (OASI) is a rare but serious outcome of vaginal birth. Based on concerns about the increasing number of women who commence childbearing later than previous generation, this study aimed at investigating age-related risk of OASI in women of different parity. METHODS: A population-based register study including 959,559 live singleton vaginal births recorded in the Swedish Medical Birth Register 1999 to 2011. In each parity group risks of OASI at age 25-29 years, 30-34 years, and ≥35 years compared with age < 25 years were investigated by logistic regression analyses, adjusted for year of birth, education, region of birth, smoking, Body Mass Index, infant birthweight and fetal presentation; and in parous women, history of OASI and cesarean section...
September 15, 2017: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/28898687/outcomes-of-mifepristone-usage-for-cervical-ripening-and-induction-of-labour-in-full-term-pregnancy-randomized-controlled-trial
#5
Oleg R Baev, Valentina P Rumyantseva, Oleg V Tysyachnyu, Olga A Kozlova, Gennady T Sukhikh
OBJECTIVE: The most commonly used approved indications for mifepristone in obstetrics include: termination of early pregnancy, cervical dilatation prior to abortion, labour induction in case of fetal death in utero. Fewer studies have been conducted on the effect of mifepristone on cervical ripening and induction of labour in term pregnancy with a live fetus. The aim of our study was to evaluate efficacy and safety of mifepristone use for cervical ripening and induction of labour versus expectant management in full-term pregnancy...
September 1, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28892762/risk-factors-and-symptoms-associated-with-maternal-and-neonatal-complications-in-women-with-uterine-rupture-a-16-years-multicentric-experience
#6
G A Markou, J-M Muray, C Poncelet
OBJECTIVE: high maternal and fetal morbidity and mortality levels have been associated with uterine ruptures. The aims of our study were to determine risk factors and signs for maternal and fetal complications in patients with uterine rupture. STUDY DESIGN: retrospective, population-based study, in all Val d'Oise public obstetrics departments, France, between 2000 and 2015. All patients with uterine rupture were analyzed using medical records. To identify risk factors and signs for maternal and fetal complications, patients were divided into two groups according to adverse maternal and fetal outcomes or not, and compared...
September 6, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28884414/effect-of-programmed-intermittent-epidural-boluses-and-continuous-epidural-infusion-on-labor-analgesia-and-obstetric-outcomes-a-randomized-controlled-trial
#7
Leopoldo E Ferrer, David J Romero, Oscar I Vásquez, Ednna C Matute, Marc Van de Velde
PURPOSE: Continuous epidural infusion and programmed intermittent epidural boluses are analgesic techniques routinely used for pain relief in laboring women. We aimed to assess both techniques and compare them with respect to labor analgesia and obstetric outcomes. METHODS: After Institutional Review Board approval, 132 laboring women aged between 18 and 45 years were randomized to epidural analgesia of 10 mL of a mixture of 0.1% bupivacaine plus 2 µg/mL of fentanyl either by programmed intermittent boluses or continuous infusion (66 per group)...
September 7, 2017: Archives of Gynecology and Obstetrics
https://www.readbyqxmd.com/read/28875709/continuous-epidural-infusion-versus-programmed-intermittent-epidural-bolus-for-labor-analgesia-optimal-configuration-of-parameters-to-reduce-physician-administered-top-ups
#8
Carlos Delgado, Christopher Ciliberto, Laurent Bollag, Margaret Sedensky, Ruth Landau
BACKGROUND AND OBJECTIVES: Programmed intermittent epidural bolus (PIEB) is a delivery mode associated with decreased local analgesia dosing, motor block, and physician-administered top-ups (PATU) during labor analgesia. We hypothesized that PIEB delivery at different settings will result in fewer PATU for labor analgesia than the same hourly volume of a continuous epidural infusion (CEI). METHODS: 'Before and after' study design of combined-spinal epidural (CSE) for labor, with bupivacaine 0...
September 6, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28874243/central-regional-anaesthesia-in-patients-with-aortic-stenosis-a-systematic-review
#9
Sofia Johansson, Morten Nikolaj Lind
INTRODUCTION: Aortic stenosis is a valvular lesion that poses several haemodynamic challenges for the anaesthesiologist. The use of central regional anaesthesia is traditionally regarded as contraindicated in patients with severe aortic stenosis due to its sympatholytic effect, potentially causing loss of vascular tone and ultimately diminished cardiac output. The aim of this paper was to review current literature to find evidence for or against the use of neuroaxial blockade in patients with aortic stenosis...
September 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28861414/continuous-spinal-anesthesia-for-obstetric-anesthesia-and-analgesia
#10
REVIEW
Ivan Veličković, Borislava Pujic, Charles W Baysinger, Curtis L Baysinger
The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28851782/evaluating-maternity-units-a-prospective-cohort-study-of-freestanding-midwife-led-primary-maternity-units-in-new-zealand-clinical-outcomes
#11
Celia P Grigg, Sally K Tracy, Mark Tracy, Rea Daellenbach, Mary Kensington, Amy Monk, Virginia Schmied
OBJECTIVE: To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in a freestanding primary level midwife-led maternity unit (PMU) or tertiary level obstetric-led maternity hospital (TMH) in Canterbury, Aotearoa/New Zealand. DESIGN: Prospective cohort study. PARTICIPANTS: 407 women who intended to give birth in a PMU and 285 women who intended to give birth at the TMH in 2010-2011. All of the women planning a TMH birth were 'low risk', and 29 of the PMU cohort had identified risk factors...
August 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28840194/rectus-muscle-reapproximation-at-cesarean-delivery-and-postoperative-pain-a-randomized-controlled-trial
#12
Deirdre J Lyell, Mariam Naqvi, Amy Wong, Renata Urban, Brendan Carvalho
Objective  Rectus muscle reapproximation at cesarean delivery (CD) is performed frequently by some obstetricians; however, the effect on postoperative pain is unclear. To this end, we investigated whether rectus muscle reapproximation increases postoperative pain. Materials and Methods  This is a prospective, double-blind, randomized controlled trial of women undergoing primary CD with singleton or twin pregnancy at >35 weeks' gestation. Women were randomized to rectus muscle reapproximation with three interrupted sutures or no reapproximation...
July 2017: Surg J (N Y)
https://www.readbyqxmd.com/read/28802602/labor-analgesia-we-need-to-better-understand-and-educate-our-obstetric-patients
#13
EDITORIAL
Regina Y Fragneto M D, Robert Gaiser M D
No abstract text is available yet for this article.
September 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28766691/risk-factors-for-peripheral-nerve-injuries-following-neuraxial-labour-analgesia-a-nested-case-control-study
#14
G Haller, I Pichon, F-O Gay, G Savoldelli
BACKGROUND: Post-partum lower extremity motor and sensory dysfunctions occur in 0.1-9.2‰ of deliveries. While macrosomia, lithotomy position and forceps use are well-identified causes of peripheral nerve injuries, additional contributors such as patient condition and anaesthesia care may also have to be considered. METHODS: We performed a case-control study nested in a cohort of 19,840 patients having neuraxial anaesthesia for childbirth. Cases were all patients who developed motor or sensory dysfunction of lower extremities in the post-partum period...
August 2, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28753167/informed-consent-and-nitrous-oxide-for-obstetric-analgesia
#15
Kirk J Hogan
No abstract text is available yet for this article.
September 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28750275/special-attention-to-women-experiencing-high-risk-pregnancy-delivery-care-assistance-and-neonatal-outcomes-in-two-brazilian-maternity-wards
#16
Juliana Vieira Nazareth, Kleyde Ventura de Souza, Mark Anthony Beinner, Juliana Silva Barra, Odaléa Maria Brüggemann, Adriano Marçal Pimenta
BACKGROUND: To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward. DESIGN: This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31(st), 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65)...
October 2017: Midwifery
https://www.readbyqxmd.com/read/28744777/-recent-standards-in-management-of-obstetric-anesthesia
#17
REVIEW
Maximiliaan van Erp, Clemens Ortner, Stefan Jochberger, Klaus Ulrich Klein
The following article contains information not only for the clinical working anaesthesiologist, but also for other specialists involved in obstetric affairs. Besides a synopsis of a German translation of the current "Practice Guidelines for Obstetric Anaesthesia 2016" [1], written by the American Society of Anesthesiologists, the authors provide personal information regarding major topics of obstetric anaesthesia including pre-anaesthesia patient evaluation, equipment and staff at the delivery room, use of general anaesthesia, peridural analgesia, spinal anaesthesia, combined spinal-epidural anaesthesia, single shot spinal anaesthesia, and programmed intermittent epidural bolus...
July 25, 2017: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28734732/perinatal-and-neonatal-use-of-sedation-and-analgesia
#18
REVIEW
Christopher McPherson, Terrie Inder
Optimal obstetric and neonatal care requires the provision of adequate analgesia for painful procedures. However, anesthetic and analgesic agents have the potential to adversely impact the developing fetal/neonatal brain. In this setting, clinicians must assess the risks and benefits of pharmacologic anesthesia and analgesia for specific indications in this population. General anesthesia is required for non-obstetric surgery and cesarean section in the absence of neuraxial anesthesia for the health of the mother and fetus...
October 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28719524/establishing-obstetric-anesthesiology-practice-guidelines-in-the-republic-of-armenia-a-global-health-collaboration
#19
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/28711635/a-new-pupillary-measure-to-assess-pain-a-prospective-study
#20
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
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