Effects of Epidural Labour Analgesia in Mother and Foetus

Deshmukh, Varsha; Ghosh, S.; Yelikar, Kanan; Gadappa, Shreeniwas N

doi:10.1007/s13224-017-1063-7

Cited by 14 publications

(23 citation statements)

References 14 publications

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“…Although some of the previous studies have reported a higher rate of LSCS with EA, 52 the vast majority of studies showed that EA is not associated with an increase in the LSCS rate. 14,49,[53][54][55] Low cord arterial pH is a significant risk factor for neonatal mortality, hypoxic-ischemic encephalopathy, intraventricular hemorrhage, and periventricular leucomalacia. 55 We did not find any association between EA and cord arterial pH <7.1 (P=0.75, OR 0.90, 95% CI 0.49 to 1.64).…”

Section: Discussionmentioning

confidence: 99%

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Salameh¹,

Paraparambil²,

Abedin³

et al. 2020

IJWH

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Background: Epidural Analgesia (EA) is the most effective and most commonly used method for pain relief during labor. Some researchers have observed an association between EA and increased neonatal morbidity. But this observation was not consistent in many other studies. Objectives: The primary objective of the study was to examine whether exposure to epidural analgesia increased the risk of NICU admission. The secondary objectives included the risks of clinical chorioamnionitis, instrumental delivery, neonatal depression, respiratory distress, birth trauma, and neonatal seizure during the first 24 hours of life. Methods: This was a retrospective cohort study involving 2360 low-risk nulliparous women who delivered at AWH, Qatar, during the two years between January 2016 December and 2017. Short-term neonatal outcomes of the mothers who received EA in active labor were compared with a similar population who did not receive EA. As secondary objectives, labor parameters like maternal temperature elevation, duration of the second stage of labor, and instrumental delivery were compared. Results: Significantly higher numbers of neonates were admitted to the NICU from the EA group (P<0.001, OR 1.89, 95% CI 1.45 to 2.46). They were more likely to have respiratory distress (P=0.01, OR 1.49, 95% CI 1.07 to 2.07), birth injuries (P=0.02, OR =1.71, 95% CI 1.06 to 2.74), admission temperature>37.5°C (P=0.04, OR 3.40, 95% CI 1.00 to 11.49), need for oxygen on the first day (P=0.04, OR 1.44, 95% CI 1.01 to 2.07) and receive antibiotics (P<0.001, OR 2.06,95% CI 1.47 to 2.79). There was no difference in the Apgar score at 1 minute (P=0.12), need of resuscitation at birth (P=0.05), neonatal white cell count (P=0.34), platelet count (P=0.38) and C reactive protein (P=0.84). Mothers who received EA had a lengthier second stage (P<0.001), temperature elevation >37.5°C (P<0.001, OR 7.40, 95% CI 3.93 to 13.69) and instrumental delivery (P<0.001, OR 2.13, 95% CI 1.69 to 2.68). Conclusion: EA increases NICU admission, antibiotic exposure, neonatal birth injuries, need for positive pressure ventilation at birth, and respiratory distress in the first 24 hours of life. Mothers on epidural analgesia have prolonged second stage of labor, a higher rate of instrumental delivery, meconium-stained amniotic fluid, fetal distress, and temperature elevation.

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Section: Discussionmentioning

confidence: 99%

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Salameh¹,

Paraparambil²,

Abedin³

et al. 2020

IJWH

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“…Including in a study by Deshmukh on pregnant women, investigators compared the effect of epidural analgesia with control group and concluded that epidural analgesia had no effect on labor duration, but with excellent analgesia, along with improved neonatal APGAR score. They suggested that the epidural method was suitable for painless delivery (24). Karn et al also considered the epidural method as the most effective method of analgesia for labor (2).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Effect of Dexmedetomidine Intravenous Infusion on Labor Pain Management in Primipar Term Pregnant Women

Delavari¹,

Esmailzadeh²,

Dehgan³

et al. 2020

Preprint

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Background: The pain of labor is very severe. Most women prefer painless labor to routine labor if they are aware of the methods of analgesia. The aim of this study was to evaluate the effect of Dexmedetomidine intravenous infusion on labor pain management in primipar term pregnant women. Methods: In this Non-randomized clinical trial with control group, all primipar term pregnant women were enrolled in the study. In the intervention group, after the active phase of labor, Dexmedetomidine was given according to the protocol and continued until phase two of labor. The control group received no intervention to reduce pain. Patients in both groups were evaluated for, fetal heart rate, Apgar scores, vital signs, pain intensity and sedation score. Results: There were no significant difference in primary fetal heart rate, primary maternal hemodynamics, and mean Apgar scores of 1 and 5 minutes, between the two groups (p>0.05). There was no significant difference in the mean of fetal heart rate in different stages between two groups. Intra-group analysis in the intervention group showed that mean systolic and diastolic blood pressure were significantly decreased after drug administration but were in normal range. The active phase of labor in the intervention group was significantly shorter than the control group (p = 0.002). The mean VAS score after Dexmedetomidine administration decreased significantly from 9.25 at baseline to 4.61 after drug administration, 3.88 during labor and 1.88 after placental expulsion. The mean RSS score after Dexmedetomidine administration increased significantly from 1 at baseline to 2.05 after drug administration, 2.22 during labor and 2.05 after placental expulsion. Conclusion: Based on results, it seems that administration of Dexmedetomidine to manage labor pain with careful monitoring of mother and fetus is recommended. Due to limited studies, further larger and multicenter studies are needed to be performed.Trial registration: This study was registered on Iranian registry of clinical trials, identification number IRCT20161022030421N5, registered on February 2, 2019, https://irct.ir/trial/40134.

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“…7 yaptığı çalışma ile (%80,34) benzer orandadır. Yapılan çalışmalar da doğum analjezisi yapılan grupla, kontrol grubu arasında bebek APGAR'ları arasında fark yoktur 37 .…”

Section: Discussionunclassified

“…yaptığı çalışmada rejyonel anestezi ile yapılan doğum analjezisinin eyleminin 1. evresinde uzamaya bulunmamışken, 2. evresinde ise uzama olabileceği bildirilmiştir, ancak bu süre düşük doz lokal anestezik ve opioid karışımı ile 15 dakikadan daha az bir süreye çekilebilir. Nöroaksiyel tekniklerin doğum analjezisinde yeri önemlidir29 . Doğum analjezisinin bebeğin emme refleksi üzerine olan etkileriyle ilgili sorumuza %83,8 hayır cevabını aldık.…”

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Anket Çalışması: Türkiye'deki Anestezi Uzmanlarının Doğum Analjezisi Deneyimlerine Bakış

Gültekin¹,

Cebeci²,

Çanakçı³

et al. 2020

Namık Kemal Tıp Dergisi

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Doğum sürecindeki ağrı, kadının yaşamı boyunca katlanacağı en acı deneyimlerden biri olup, fetal ve maternal tehlikelere neden olabilmektedir. Sezaryen ile doğumu tercih eden kadınların en büyük nedeni doğumda esnasındaki ağrıdır. Doğum analjezisinde rejyonel tekniklerin geliştirilmesi ile anestezi uzmanları, doğum analjezisi kontrolünün bir parçası haline gelmiştir. Bu çalışmada Anestezi uzmanlarının doğum analjezisi konusunda düşünce ve deneyimlerinin tespit edilmesi amaçlanmıştır. Materyal ve Metot: Çalışmada demografik veriler, doğum analjezisi uygulama yöntemleri, rejyonel analjezi teknikleri, kullanılan ilaçlar, rejyonel analjezi komplikasyonları ve doğum analjezisi konusundaki çekinceler hakkında sorular içeren anket formu anestezi uzmanlarına gönderilerek cevaplamaları istenmiştir. Bulgular: Çalışmaya 182 anestezi uzmanı katılmıştır. Katılımcıların %84.7'si doğum analjezisinin gerekliliğine inanırken, çalışmaya katılan 182 anestezi uzmanından 103'ü (%56.6) doğum analjezisi uyguladığını, 79'u (%43.4) doğum analjezisi uygulamadığını belirtmiştir. Doğum analjezisi için müdahalede bulunmama nedenleri içinde en sık olarak doğumhane ekibinin isteksiz olması, hasta talebinin olmaması ve deneyim yetersizliği bildirilmiştir. Doğum analjezisi için ilk tercih epidural analjezi (%77.4) olarak saptanırken, en çok tercih edilen ilaç bupivakain ve fentanildir. Sonuç: Anestezi uzmanlarının doğum analjezisine gereksinim olduğunu yüksek oranda düşünmekle beraber, doğum analjezisi uygulamalarının yetersiz olduğu saptanmıştır. Sonuç olarak doğum analjezisi kullanımını arttırıcı önlemlerinin alınmasının normal doğum oranının artışına destek olabileceğini düşünmekteyiz.

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Effects of Epidural Labour Analgesia in Mother and Foetus

Abstract: Epidural analgesia is a very promising, safe and effective method of pain relief. No major complications and a good APGAR score make it a good option of care in modern obstetrics.

Cited by 14 publications

References 14 publications

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Evaluating the Effect of Dexmedetomidine Intravenous Infusion on Labor Pain Management in Primipar Term Pregnant Women

Anket Çalışması: Türkiye'deki Anestezi Uzmanlarının Doğum Analjezisi Deneyimlerine Bakış

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