The effect of intraspinal blocking analgesia on delivery quality and puerperal pelvic floor function of primipara / 中国医师进修杂志

Objective:To explore the effects of intraspinal blocking analgesia on the delivery quality and puerperal pelvic floor function of primiparas.Methods:A total of 99 primiparas who delivered in the Second People′s Hospital of Wuhu City from January 2021 to April 2022 were enrolled in this study, 54 patients received intraspinal blocking analgesia (study group) and 45 patients received conventional treatment, without intraspinal blocking analgesia (control group). The delivery quality between the two groups was compared, and the pelvic floor function was evaluated and compared by pelvic floor rehabilitation therapy instrument and pelvic floor ultrasound at 6-8 weeks after delivery.Results:Vaginal delivery were successful in both groups. The total labor duration in the study group was longer than that in the control group: (8.03 ± 2.94) h vs. (6.89 ± 3.49) h, there was statistical difference ( P<0.05). The maximum value of pelvic floor rapid contraction stage, rising time and average value of continuous contraction stage in the study group were higher than those in the control group: (32.85 ± 10.13) μV vs. (14.73 ± 3.25) μV, (0.28 ± 0.06) s vs. (0.22 ± 0.05) s, (30.26 ± 5.24) μV vs. (16.74 ± 4.00) μV, there were statistical differences ( P<0.05). There were no statistical differences in other indicators such as the pre-resting stage, rapid contraction phase recovery time and post-resting stage between the two groups ( P>0.05). The rate of pelvic floor class Ⅰ and class Ⅱ muscle abnormalities at 6-8 weeks after delivery in the study group were lower than those in the control group, but there were no statistical differences ( P>0.05). The maximum Valsalva state hiatus area of levator ani muscle, maximum Valsalva state bladder posterior urethral angle, hiatus area of levator ani muscle at rest state and bladder neck degree in the study group were smaller than those in the control group: (19.09 ± 4.82) cm 2 vs. (23.00 ± 5.34) cm 2, (138.59 ± 23.14)° vs. (148.47 ± 20.38)°, (9.96 ± 2.63) cm 2 vs. (11.60 ± 2.75) cm 2, (20.13 ± 4.37) mm vs. (28.05 ± 6.52) mm, there were statistical differences ( P<0.05). Conclusions:Although intraspinal block analgesia can prolong the total labor time of primipara, but it can reduce the damage of pelvic floor function, possibly by increasing systolic period to protect pelvic floor muscles.

Effects of epidural labor analgesia on early neonatal sucking and breastfeeding / 中华围产医学杂志

Objective:To investigate the effects of epidural labor analgesia on neonatal sucking ability and breastfeeding.Methods:This was a prospective cohort study. Convenience sampling was used to enroll women who delivered with or without epidural analgesia (epidural analgesia and non-analgesia groups) in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January 2022 to December 2022. Intra-oral negative pressure values during breastfeeding were measured by a pressure measuring instrument within 3 d after birth (0-24 h, >24-48 h, and >48-72 h), and the mean, maximum, and minimum pressure values were recorded. The Infant Breastfeeding Assessment Tool (IBAT) (Chinese version) was used to evaluate sucking posture. Breastfeeding status during hospitalization and within 1, 4, and 6 months after discharge were followed up. Two independent samples t-test, Chi-square (Fisher's exact) test, and generalized estimating equations were used for data analysis. Results:A total of 156 mother-infant pairs were analyzed in this study, with 78 pairs in the epidural analgesia group and 78 pairs in the non-analgesia group. The whole, first, and second stages of labor were longer in the analgesia group than those in the non-analgesia group [ M( P25- P75), total: 430 min (353-541 min) vs. 300 min (235-422 min), Z=－5.65; first stage: 385 min (310-490 min) vs. 260 min (205-347 min), Z=－5.81; second stage: 40 min (26-67 min) vs. 33 min (18-45 min), Z=－2.33; all P<0.05], and more women in the analgesia group accepted oxytocin and doula before delivery [94.8% (74/78) vs. 43.6% (34/78), χ2=48.15; 42.3% (33/78) vs. 19.2% (15/78), χ2=9.75; both P<0.05]. There was no significant difference in scores on the Fatigue Scale-14, Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Life Events Scale for Pregnant Women between the two groups. After adjusting for confounding factors by generalized estimating equations, the mean intra-oral negative pressure values in the epidural analgesia group were lower than those in the non-analgesia group at 0-24 h, >24-48 h, and >48-72 h after birth [5.14 (3.39-6.52) vs. 6.39 (4.95-9.15) kPa, 5.07 (3.94-7.38) vs. 6.20 (5.08-8.54) kPa, and 6.19 (4.64-8.36) vs. 6.81 (5.88-8.05) kPa, Wald χ2=5.59, P=0.018]; the peak value in the epidural analgesia group was also lower than that in the non-analgesia group [15.81 (9.74-21.68) vs. 16.21 (13.58- 24.88) kPa, 13.50 (9.83-16.50) vs. 17.62 (14.01-22.40) kPa, and 14.66 (10.47-18.71) vs. 18.04 (15.33- 19.85) kPa, Wald χ2=7.25, P=0.007]; there were no significant differences in the trough value between the two groups. The daily IBAT scores for the sucking position of neonates in the epidural analgesia group were all lower than those in the non-analgesia group in the first three days after delivery [10 (9-10) vs. 10 (10- 11) scores, 10 (9-11) vs. 11 (10-11) scores, and 10 (10-11) vs. 11 (11-12) scores, Wald χ2=17.05, P=0.001]. The rates of early exclusive breastfeeding within postpartum 3 d were also lower in the epidural analgesia group than those in the non-analgesia group [67.9% (53/78) vs. 75.6% (59/78), 41.0% (32/78) vs. 44.9% (35/78), and 38.5% (30/78) vs. 55.1% (43/78), Wald χ2=4.21, P=0.040]. No significant differences were found in the exclusive breastfeeding rates between the two groups at 1, 4, and 6 months after delivery. Conclusion:Epidural labor analgesia can lead to decreased early intra-oral negative pressure in neonates, affect neonatal sucking posture, and reduce the rate of exclusive breastfeeding during hospitalization, but has no significant correlation with the exclusive breastfeeding rate within six months after delivery.

Clinical observation of pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)in the treatment of postpartum urinary retention after labor analgesia / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)for postpartum urinary retention after labor analgesia and its effect on bladder urination function. Methods:A total of 154 patients with postpartum urinary retention after labor analgesia were randomly divided into a Western medication group and a herb-insulated moxibustion group,with 77 cases in each group.In the Western medication group,neostigmine sulfate was injected into Zusanli(ST36).In the herb-insulated moxibustion group,after pressing-kneading manipulation at Shuidao(ST28),herb-insulated moxibustion was applied to Shuidao(ST28)with self-made Tong Quan San.Both groups were treated once,and the clinical efficacy was evaluated 5 h after treatment.The first urination time,first urination volume,average urinary flow rate,bladder residual urine volume,hospitalization days,and costs were recorded. Results:The total effective rate and markedly effective rate of the herb-insulated moxibustion group were higher than those of the Western medication group(P<0.05),the time to the first urination and residual urine volume in the bladder of the herb-insulated moxibustion group were shorter or smaller than those of the Western medication group(P<0.01),the first urination volume and average urine flow rate of the herb-insulated moxibustion group were larger than those of the Western medication group(P<0.01).There were no significant differences in the hospitalization days and costs between the two groups(P>0.05). Conclusion:Pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)can effectively treat postpartum urinary retention after labor analgesia and improve bladder urination function.

Efficacy of different administration methods for labor analgesia / 中国基层医药

Objective:To investigate the clinical efficacy of different administration methods for labor analgesia.Methods:This randomized controlled study was conducted on 152 parturient women who underwent vaginal delivery at the Xinxiang Central Hospital from February to June 2023. These women were divided into a control group and an observation group, with 76 women per group. Women in the control group received 3 mL of 0.1% ropivacaine hydrochloride after routine epidural catheterization, followed by 3 mL of analgesic drugs after 3 minutes. For those without any special reactions, an analgesic pump containing 9 mL of medication was used after 3 minutes until the end of labor. In the observation group, 3 mL of 0.1% ropivacaine hydrochloride was administered as a trial dose before the epidural catheter was inserted into the epidural space. After 3 minutes, the postpartum woman lay flat and was given another 3 mL of analgesic pump medication. After 3 additional minutes, an additional 9 mL of the medication was administered. The analgesic pump was connected and turned on until the catheter was removed after delivery. The epidural catheter failure rate was assessed in each group. Before epidural puncture (T 1), within 30 minutes after the onset of anesthesia (T 2), and at the time of full dilation of the cervix (T 3), Visual Analogue Scale scores, the number of patient attempts to additionally use an analgesia pump, maternal satisfaction, the number of cases requiring cesarean section conversion, the incidence of adverse reactions (such as nausea, vomiting, and fever), and Apgar scores for newborns were recorded in each group. Results:The epidural catheter failure rate in the observation group was 1.3% (1/76), which was significantly lower than 10.5% (8/76) in the control group ( χ2 = 5.79, P < 0.05). At T 2 and T 3, the Visual Analogue Scale score in the observation group was (0.89 ± 0.08) points and (2.1 ± 0.07) points, respectively, which were significantly lower than (2.55 ± 0.07) points and (3.35 ± 0.07) points in the control group ( t = 238.54, 133.17, both P < 0.001). The number of patient attempts to additionally use an analgesia pump in the observation group was (1.00 ± 0.84) counts, which was significantly less than (4.00 ± 0.65) counts in the control group ( t = 29.47, P < 0.001). Maternal satisfaction in the observation group was 100% (76/76), which was significantly higher than 92.1% (70/76) in the control group ( χ2 = 6.25, P < 0.05). The number of cases requiring cesarean section conversion in the observation group was 0 (0/76), which was significantly lower than 52.6% (4/76) in the control group ( χ2 = 4.10, P < 0.05). Conclusion:Administering a trial dose (3 mL) of 0.1% ropivacaine hydrochloride before placing the epidural catheter during labor analgesia can greatly increase the placement success rate of the catheter and enhance pain relief effectiveness. This has a certain clinical application value.

Analgesia neuroaxial no trabalho de parto: efeitos sobre desfechos maternos e neonatais / Anestesia neuroaxial en el trabajo de parto: efectos sobre desenlaces maternos y neonatales / Neuroaxial analgesia in labor: effects on maternal and neonatal outcomes

Resumo Objetivo Comparar os desfechos maternos e neonatais de mulheres que usaram e não usaram analgesia neuroaxial durante o trabalho de parto. Métodos Estudo transversal comparativo, documental, com coleta retrospectiva de dados, realizado em uma maternidade terciária de referência no Ceará. O tamanho da amostra foi calculado pela diferença entre duas proporções: partos vaginais com e sem analgesia, sendo 130 mulheres para cada grupo, totalizando 260 prontuários. A coleta de dados ocorreu entre julho de 2019 e fevereiro de 2020. Foram usados os testes t de Student, U de Mann-Whitney, qui-quadrado de Pearson, exato de Fisher e o programa IBM SPSS. Resultados O grupo com analgesia apresentou maior média de consultas pré-natal (8,24; p<0,001), maior exposição à indução (74; 56,9%; p<0,001), com uso de ocitocina (57; 43,8%; p<0,001), maior duração do trabalho de parto ativo (média: 392 min; p<0,001) e do período expulsivo (média: 85,3 min; p<0,001), maior frequência de episiotomia (7; 7,9%; p=0,03), de parto cesárea (41; 31,5%; p<0,001), e pariram bebês mais pesados (média: 3,28 kg; p=0,007). Conclusão O uso de analgesia está associado à maior frequência de intervenções obstétricas, bem como ao aumento na duração do trabalho de parto. Quanto aos desfechos neonatais, o grupo com analgesia pariu recém-nascidos mais pesados; além disso, não foi observada associação com o escore de Apgar, nem encaminhamentos para unidades de risco.

Resumen Objetivo Comparar los desenlaces maternos y neonatales de mujeres que recibieron anestesia neuroaxial durante el trabajo de parto y las que no recibieron. Métodos Estudio transversal comparativo, documental, con recopilación retrospectiva de datos, realizado en una maternidad de tercer nivel de referencia en el estado de Ceará. El tamaño de la muestra se calculó mediante la diferencia entre dos proporciones: partos vaginales con y sin anestesia, con 130 mujeres en cada grupo, 260 historias clínicas en total. La recopilación de datos se realizó entre julio de 2019 y febrero de 2020. Se utilizaron las pruebas t de Student, U de Mann-Whitney, ji cuadrado de Pearson, exacto de Fisher y el programa IBM SPSS. Resultados El grupo con anestesia presentó un mayor promedio de consultas prenatales (8,24; p<0,001), una mayor exposición a la inducción (74; 56,9 %; p<0,001), con uso de oxitocina (57; 43,8 %; p<0,001), una duración mayor del trabajo de parto activo (promedio: 392 min; p<0,001) y del período expulsivo (promedio: 85,3 min; p<0,001), una mayor frecuencia de episiotomía (7; 7,9 %; p=0,03), de parto por cesárea (41; 31,5 %; p<0,001), y parieron bebés más pesados (promedio: 3,28 kg; p=0,007). Conclusión El uso de anestesia está asociado a una mayor frecuencia de intervenciones obstétricas, así como también al aumento de la duración del trabajo de parto. Respecto a los desenlaces neonatales, el grupo con anestesia parió recién nacidos más pesados. Además, no se observó relación con el puntaje de Apgar, ni derivaciones a unidades de riesgo.

Abstract Objective To compare maternal and neonatal outcomes of women who used and did not use neuraxial analgesia during labor. Methods A cross-sectional, comparative, documentary study, with retrospective data collection, carried out at a tertiary reference maternity hospital in Ceará. Sample size was calculated by the difference between two proportions: vaginal births with and without analgesia, with 130 women for each group, totaling 260 medical records. Data collection took place between July 2019 and February 2020. Student's t test, Mann-Whitney U test, Pearson's chi-square test, Fisher's exact test and the IBM SPSS program were used. Results The group with analgesia had a higher mean number of prenatal consultations (8.24; p<0.001), greater exposure to induction (74; 56.9%; p<0.001), with use of oxytocin (57; 43.8%; p<0.001), longer duration of active labor (mean: 392 min; p<0.001) and expulsive period (mean: 85.3 min; p<0.001), higher frequency of episiotomy (7; 7.9%; p=0.03), by cesarean section (41; 31.5%; p<0.001), and heavier babies were born (mean: 3.28 kg; p=0.007). Conclusion The use of analgesia is associated with a greater frequency of obstetric interventions as well as an increase in the duration of labor. Regarding neonatal outcomes, the group with analgesia gave birth to heavier newborns; Furthermore, no association was observed with the Apgar score, nor referrals to high-risk units.

Effect of esmketamine for labor analgesia on development of postpartum depression / 中华麻醉学杂志

Objective:To evaluate the effect of esmketamine for labor analgesia on the occurrence of postpartum depression (PPD).Methods:Two hundred and forty-two cases of nulliparous parturients who selected natural labor and agreed to receive labor analgesia were selected and divided into conventional labor analgesia group (C-LA group, n=119) and esmketamine-based labor analgesia group (E-LA group, n=123). The epidural labor analgesia solution contained ropivacaine 100 mg and sufentanil 30 μg in 100 ml of normal saline in C-LA group. The epidural labor analgesia solution contained ropivacaine 100 mg, sufentanil 30 μg and esketamine 50 mg in 100 ml of normal saline in E-LA group. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen parturients for depression on admission to the predelivery room and at 2 h and 1, 7 and 42 days after delivery, and EPDS scores were recorded. The patients were diagnosed as having PPD when EPDS score ≥ 9 at 7-42 days after delivery. Peripheral venous blood samples were collected on admission to the predelivery room and at 1 day after delivery to determine the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol by enzyme linked inmunosorbent assay. Results:Compared with group C-LA, the EPDS scores were significantly decreased on the 1 and 42 days after delivery( P<0.01), no significant change was found in the incidence of PPD (1.7%/0.8%, P>0.05), no significant change was found in the concentrations of serum estrogen, progesterone, 5-hydroxytryptamine and cortisol on admission to the delivery room ( P>0.05), and the concentrations of serum progesterone and cortisol were significantly increased on 1 day after delivery in group E-LA ( P<0.05). Conclusions:Combination of esketamine is helpful in reducing the risk of postpartum depression when used for epidural labor analgesia, and the mechanism is related to slowing the declines in blood levels of sex hormones and stress hormones after delivery.

Potency of epidural ropivacaine in inhibiting breakthrough pain in primiparae undergoing epidural labor analgesia / 中华麻醉学杂志

Objective:To determine the potency of epidural ropivacaine in inhibiting breakthrough pain in primiparae undergoing labor analgesia with programmed intermittent epidural bolus (PIEB).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ primiparae of full-termpregnancy, with a singleton fetus in vertex presentation, aged ≥18 yr, with body mass index < 30 kg/m 2, presenting with breakthrough pain during labor analgesia with PIEB, were enrolled in this study. Ropivacaine 10 ml was epidurally administered, and the concentration was determined by up-and-down sequential allocation. The initial concentration was set at 0.15% in the first patient in each group. Each time the concentration increased/decreased in the next patient depending on whether the patients showed breakthrough pain relief, and the ratio between the two successive doses was 0.9. The criterion of breakthrough pain relief was defined as numerical rating scale score < 4 points within 30 min after epidural injection of ropivacaine. The median effective concentration (EC 50) and 95% confidence interval of ropivacaine in inhibiting breakthrough pain were calculated by Dixon-Massey′s method. Results:Twenty-six patients were finally included in this study.The EC 50 (95% confidence interval)of ropivacaine in inhibiting breakthrough pain was 0.102% (0.088%-0.117%). Conclusions:The EC 50(95% confidence interval) of epidurally administered ropivacaine 10 ml is 0.102%(0.088%-0.117%) when used for inhibiting breakthrough pain during labor analgesia with PIEB in primiparae.

Risk factors for intrapartum fever during labor analgesia and development of a prediction model / 中华麻醉学杂志

Objective:To identify the risk factors for intrapartum fever during labor analgesia and establish the prediction model.Methods:The medical records from pregnant women with intrapartum fever during labor analgesia were retrospectively analyzed. According to whether the highest body temperature ≥38 ℃, the parturients were divided into intrapartum fever group and non-fever group. The general data from patients, duration of hospital stay before labor, induced labor, prenatal hemoglobin concentration, body msaa index (BMI) during pregnancy, artificial rupture of membranes in the incubation period, frequency of vaginal examination and etc. were collected. The risk factors of which P values were less than 0.05 would enter the logistic regression analysis to stratify intrapartum fever-related risk factors, and the weighted score regression prediction model was established. Hosmer-Lemshow Test was used to assess the fit of the model, and the receiver operating characteristic curve was drawn to evaluate the model. The nomogram was drawn for visually presenting the regression model. The clinical calibration curve, decision curve analysis and clinical impact curve were drawn to assess the created prediction model. Results:There were 99 parturients developed fever during labor analgesia, with an incidence of 34.7%. The results of logistic regression analysis showed that duration of hospital stay before labor, prenatal hemoglobin concentrations, BMI during pregnancy, induced labor, artificial rupture of membranes in the incubation period and frequency of vaginal examination were the independent risk factors for intrapartum fever during labor analgesia. The area under the receiver operating characteristic curve was 0.943, 95% confidence interval was 0.916-0.969, the sensitivity was 86.9%, the specificity was 88.6%, and the Youden index was 0.755. The prediction model of the line chart was assessed by Hosmer-Lemshow, P=0.898. Conclusions:Duration of hospital stay before labor, hemoglobin concentrations, BMI during pregnancy, induced labor, artificial rupture of membranes in the incubation period and frequency of vaginal examination are independent risk factors for intrapartum fever during labor analgesia in parturients, and the risk prediction model developed can effectively predict the occurrence of intrapartum fever during labor analgesia.

Catéter epidural seccionado: reporte de un caso y revisión de literatura / Sectioned epidural catheter: a case report and review of literature / Ruptura de cateter epidural: relato de caso e revisão da literatura

Resumen: La ruptura y retención de un fragmento de catéter peridural es una complicación poco frecuente de la analgesia epidural. Si bien generalmente requiere una conducta expectante con evolución sin mayores complicaciones, su importancia está dada por la escasa evidencia en cuanto al manejo, teniendo en cuenta que puede derivar en una intervención neuroquirúrgica, con sus riesgos y complicaciones. Exponemos el caso de una paciente que tuvo como complicación la ruptura y retención de un fragmento de catéter peridural durante la colocación del mismo para analgesia del parto.

Summary: Rupture and retention of an epidural catheter fragment is a rare complication of epidural analgesia. Although it generally requires expectant management and evolves without major complications, the event is important given the lack of evidence regarding treatment and considering it can lead to a neurosurgical intervention, what involves risks and complications. The study describes the case of a patient whose complication was the rupture and retention of a fragment of an epidural catheter during labor analgesia.

Resumo: A ruptura e retenção de um fragmento de cateter epidural é uma complicação rara da analgesia epidural. Embora geralmente exija uma gestão expectante com evolução sem grandes complicações, a importância é dada pela escassa evidência relativa ao manejo, considerando que pode levar à uma intervenção neurocirúrgica, com os correspondentes riscos e complicações. Apresentamos o caso de uma paciente cuja complicação foi a ruptura e retenção de um fragmento de cateter epidural durante sua colocação para analgesia do parto.

The effect of improved epidural catheter labor analgesia on the maternal and infant outcome of re-pregnant parturients with scar uterus / 中国医师进修杂志

Objective:To investigate the effect of improved epidural catheter labor analgesia on the maternal and infant outcome of re-pregnant parturients with scar uterus.Method:A total of 100 cases of re-pregnant women with scarred uterus admitted to Shexian Hospital from January 2019 to January 2020 were selected. According to the random number table, they were divided into the observation group (50 cases) and the control group (50 cases). Parturients in the observation group received a modified epidural catheter for labor analgesia, and parturients in the control group received conventional epidural analgesia. The complications of epidural vascular injury, difficulty in catheterization, multiple catheterization, loss of catheter resistance, urinary retention, intrauterine distress, neonatal asphyxia, postpartum hemorrhage, Apgar score, maternal and neonatal outcomes were compared between the two groups.Results:The rate of epidural vascular injury, difficulty in catheter placement, multiple catheter placement and disappearance of catheter resistancein the observation group were lower than those in the control group: 2.0%(1/50) vs. 14.0%(7/50), 2.0%(1/50) vs. 16.0%(8/50), 0 vs. 8.0% (4/50), 8.0% (4/50) vs. 24.0% (12/50), χ2 = 4.89, 5.98, 4.17, 4.76, P<0.05. The rate of urinary retention, intrauterine distress and neonatal asphyxia in the observation group were lower than those in the control group: 4.0%(2/50) vs. 16.0%(8/50), 2.0%(1/50) vs. 14.0%(7/50), 0 vs. 8.0%(4/50), χ2 = 4.00, 4.89, 4.17, P<0.05. Conclusions:Improved epidural catheter delivery analgesia for patients with scarred uterus can achieve significant results, effectively reduce the incidence of vascular injury, and improve the maternal and infant outcome.

Combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection in midwifery / 中国基层医药

Objective:To investigate the clinical efficacy of intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination in midwifery.Methods:A total of 160 primiparous women who were subjected to full-term vaginal delivery in Suqian Hospital of Nanjing Drum Tower Hospital Group between January 2019 and January 2021 were included in this study. They were randomly assigned to undergo either bilateral pudendal nerve block combined with modified perineal protection (control group, n = 80) or intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination (observation group, n = 80). Each clinical index was compared between the control and observation groups. Results:Duration of labor in the observation group was significantly shorter than that in the control group [(7.23 ± 2.11) hours vs. (9.35 ± 3.79) hours, t = 4.27, P < 0.05). Cesarean section rate in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 52.5% (42/80), χ 2 = 17.18, P < 0.05]. Incidence of perineal tears in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 32.5% (26/80), χ 2 = 15.48, P < 0.05]. Third-degree perineal tears occurred in neither group. Time of postpartum off-bed ambulation and length of postpartum hospital stay in the observation group were (1.37 ± 0.13) days and (3.22 ± 0.31) days, respectively, which were significantly shorter than those in the control group [(2.52 ± 0.22) days, (5.23 ± 0.62) days, t = 25.90, 25.94, both P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group [7.5% (6/80) vs. 23.7% (19/80), χ 2 = 8.01, P < 0.05]. There were no significant differences in incidence of neonatal asphayxia, 2-hour postpartum hemorrhage and postpartum hemorrhage between the two groups (all P > 0.05). Conclusion:During midwifery of full-term vaginal delivery, combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection can shorten duration of labor and decrease cesarean section rate.

Efficacy of Doula delivery combined with painless delivery and its effects on pregnancy outcome / 中国基层医药

Objective:To investigate the efficacy of Doula delivery combined with painless delivery and its effects on pregnancy outcome.Methods:A total of 150 parturient women who underwent delivery in the First People's Hospital of Yongkang from June 2019 to June 2020 were included in this study. They were randomly assigned to undergo either conventional delivery (control group, n = 75) or Doula delivery combined with painless delivery (observation group, n = 75). Analgesic effect, mode of delivery, duration of labor and pregnancy outcome as well as mood score before and after intervention were compared between the two groups. Results:Total analgesia-effective rate in the observation group was significantly higher than that in the control group [100.00% (75/75) vs. 65.33% (49/75), χ2 = 31.45, P < 0.05]. Vaginal delivery rate in the observation group was significantly higher than that in the control group [84.00% (63/75) vs. 66.67% (50/75), χ2 = 6.60, P < 0.05]. The length of the first stage of labor, the second stage of labor, the third stage of labor and total labor length in the observation group were (398.42 ± 35.41) minutes, (43.65 ± 5.78) minutes, (8.36 ± 1.08) minutes and (450.87 ± 37.98) minutes, which were significantly shorter than those in the control group [(543.21 ± 47.87) minutes, (76.73 ± 16.56) minutes, (9.76 ± 1.23) minutes, (629.34 ± 45.26) minutes, t = 21.05, 16.33, 7.40, 26.15, all P < 0.05]. The incidence of neonatal asphyxia, fetal distress and postpartum hemorrhage in the observation group were [1.33% (1/75), 2.67% (2/75) and 2.67% (2/75), respectively, which were significantly lower than those in the control group [13.33% (10/75), 17.33% (13/75), 18.67% (14/75), χ2 = 7.94, 8.96, 10.07, all P < 0.05]. Self-rating Anxiety Scale score and Self-Rating Depression Scale score in the observation group were (43.25 ± 4.28) points and (40.28 ± 3.45) points, which were significantly lower than those in the control group [(52.12 ± 3.95) points, (47.79 ± 3.72) points, t = 13.18, 12.81, both P < 0.05). Conclusion:Doula delivery combined with painless delivery can relieve women's emotional changes, alleviate pain, shorten labor duration, and improve pregnancy outcomes.

Efficacy of long-interval programmed intermittent epidural bolus during incubation period for labor analgesia / 中华麻醉学杂志

Objective:To evaluate the efficacy of long-interval programmed intermittent epidural bolus (PIEB) during the incubation period for labor analgesia.Methods:Seventy-eight nulliparous parturients who were at full term with a singleton fetus in vertex presentation, aged 22-35 yr, with body mass index of 18.0-30.0 kg/m 2, of American Society of Anesthesiologists physical statusⅠorⅡ, were divided into 2 groups ( n=39 each) using a random number table method: routine epidural bolus using a stepwise approach group (C group) and long-interval PIEB group (L group). Epidural puncture was performed at L 2, 3, and the analgesia solution was 0.1% ropivacaine and 0.5 μg/ml sufentanil in the two groups.The parturients in group C received 8 ml pulse dose per hour during the incubation period (cervical dilatation <3 cm), and 10 ml pulse dose per hour during the active phase (cervical dilatation ≥3 cm). In group L, the first pulse dose was 10 ml during the incubation period, 1.5 h later the anesthesia plane was detected, and 10 ml pulse dose was immediately given when the plane was lower than T 10, otherwise it was reevaluated 15 min later.After the interval time reached 2 h, a pulse dose 10 ml was given regardless of whether the plane was lower than T 10, and the pulse dose 10 ml was given at 1 h interval during the active phase.The numerical rating scale scores were recorded when the cervical dilatation was 3, 6 and 10 cm, and at the time of baby delivery.The duration of labor, total consumption of analgesics, and Bromage grade of lower extremities were recorded.The Apgar score <7 at 1 and 5 min after birth was recorded.The maternal adverse reactions and scores for satisfaction with analgesia were also recorded. Results:Thirty puerperae were finally enrolled in each group.The first stage of labor and total duration of labor were significantly shortened, and the total consumption of analgesics was decreased in group L ( P<0.01). There were no significant differences in the numerical rating scale scores at each time point, duration of second and third stages of labor, Bromage grade of lower extremities, incidence of adverse reactions, score for satisfaction with analgesia, and incidence of Apgar score < 7 after birth between the two groups ( P>0.05). Conclusions:When PIEB is used for labor analgesia, prolonging the infusion interval time of epidural bolus to 1.5-2.0 h during the incubation period can produce satisfactory analgesic effect and further decrease the consumption of analgesics and reduce the influence on labor stages when compared with administration using a stepwise approach.

Evaluation of efficacy of intravenous nalbuphine before epidural labor analgesia in inhibiting uterine contraction pain in primiparae / 中华麻醉学杂志

Objective:To assess the value of nalbuphine intravenously injected before epidural labor analgesia in inhibiting uterine contraction pain in primiparae.Methods:A total of 140 expectant primiparae who were suitable and willing to receive epidural labor analgesia with a singleton fetus in vertex presentation, aged 20-40 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅱ, with their cervical dilation of 2-3 cm, were divided into nalbuphine group (N group) and routine control group (C group), with 70 cases in each group.Group N received intravenous injection of nalbuphine 0.1 mg/kg (in normal saline 5 ml) at 10 min before epidural puncture, while group C received intravenous injection of the equal volume of normal saline at 10 min before epidural puncture.The epidural puncture-related items including the intensity of pain (Numeric Rating Scale [NRS] scores) and degree of sedation-agitation (Riker sedation agitation scores) during uterine contraction, duration of epidural procedure, parturients′ satisfaction with epidural puncture, successful epidural catheterization at first attempt and complications (nerve paraesthesia and inadvertent intravascular punctures) were recorded.Results:Compared with group C, the NRS scores and Riker scores for uterine contraction pain were significantly decreased during epidural procedure ( P<0.05), with NRS score <6 and Riker sedation agitation scores of 4, the duration of epidural puncture was shortened, the success rate of epidural puncture at first attempt was increased(51%/70%), and the incidence of nerve paraesthesia and inadvertent intravascular puncture was decreased(17%/6%, 14%/4%), and the parturients′ satisfaction with epidural puncture was increased in group N ( P<0.05). Conclusions:Nalbuphine 0.1 mg/kg intravenously injected before epidural labor analgesia can safely and effectively reduce uterine contraction pain without limb agitation, which is helpful in implementating epidural puncture in primiparae.

Epidural analgesia failure followed by intracranial subdural hematoma: a case report / 中华围产医学杂志

We report the diagnosis and treatment of a rare case of epidural analgesia failure followed by postpartum subdural hematoma. The patient underwent vaginal delivery under epidural analgesia at 32 +6 gestational weeks due to threatened premature labor, during which an unexpected dural rupture occurred. She gave no history of headache and there was no obvious abnormality during the pregnancy. However, on postpartum day 4, the patient complained of headache that could not be relieved when supine, but without any other neurological symptoms. A prompt cranial CT examination showed a left frontotemporal subdural hematoma. After conservative management with intravenous drip of mannitol, re-examination of cranial CT showed that the left frontotemporal subdural hematoma was mostly absorbed and the patient was discharged on postpartum day 18. The patient was healthy during follow up. Intracranial subdural hematoma after dural puncture is a rare and serious complication that requires early recognition and treatment.

Optimization efficacy of nalbuphine mixed with ropivacaine for epidural labor analgesia in primiparas: comparison with sufentanil mixed with ropivacaine / 中华麻醉学杂志

Objective:To evaluate the optimization efficacy of ropivacaine mixed with nalbuphine for epidural labor analgesia through comparison with ropivacaine mixed with sufentanil in primiparas.Methods:Four hundred and forty primiparas with a singleton fetus in vertex presentation without abnormal fetus, aged 19-36 yr, at 37-42 weeks of gestation, who were suitable and volunteered to receive epidural labor analgesia, were selected and randomly divided into observation group (NR group, n=220) and conventional group (C group, n=220).Epidural labor analgesia solution contained nalbuphine 40 mg and ropivacaine 120 mg in 150 ml of normal saline in group NR.Epidural labor analgesia solution contained sufentanil 50 μg and ropivacaine 120 mg in 150 ml of normal saline in group C. The analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval, programmed intermittent bolus 10-15 ml/h and background infusion at 2 ml/h after an initial dose of 15 ml to maintain VAS score <3.The length of labor, adverse reactions during labor analgesia, neonatal Apgar score, parameters of umbilical artery blood gas analysis and neonatal behavioral neurological assessment score were recorded. Results:Compared with group C, the incidence of urinary retention, pruritus, nausea and vomiting and fever at birth was significantly decreased in group NR ( P<0.05).The duration of the first and second stages of labor, neonatal Apgar score, pH value of umbilical artery blood, lactate concentrations, and neonatal behavioral neurological assessment score were within the normal range in both groups, and there was no significant difference between the two groups ( P>0.05). Conclusions:Compared with conventional medication, nalbuphine mixed with ropivacaine has the same efficacy when used for epidural labor analgesia in primiparas, but it has a certain optimization efficacy in terms of safety.

Efficacy of dural puncture epidural combined with programmed intermittent epidural bolus for labor analgesia in parturients / 中华麻醉学杂志

Objective:To evaluate the efficacy of dural puncture epidural (DPE) combined with programmed intermittent epidural bolus (PIEB) for labor analgesia in parturients.Methods:A total of 200 primiparas of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who were at full-term with a singleton fetus in vertex presentation and requested natural childbirth and intraspinal analgesia were selected and divided into 2 groups ( n=100 each) according to a computer-generated random number table: epidural block alone+ PIEB group (group E) and DPE+ PIEB group (group D). After successful epidural puncture, epidural catheter was placed in the epidural cavity, and the depth was 3-4 cm in group E. In group D, spinal needle was used for intrathecal needle puncture after successful epidural puncture, the posterior epidural catheter was placed in the epidural cavity, and the depth was 3-4 cm.The epidural pulse pump (0.08% ropivacaine plus sufentanil 0.4 μg /ml) was connected and was set up to deliver a 5-ml bolus dose with initial dose 10 ml, a 20-min lockout interval and background infusion at a rate of 10 ml/h.The onset time of analgesia, development of the sensory block reaching S 2 within 30 min after administration, development of motor block, effective pressing times and consumption, requirement of ropivacaine for rescue analgesia, ropivacaine consumption and delivery mode were recorded.The development of hypotension, pruritus, nausea, vomiting, headache after puncture and fetal bradycardia were recorded.The Apgar scores at 1 and 5 min after delivery were recorded and the parturients were followed up on 1 day after delivery for the scores for satisfaction with analgesia. Results:Compared with group E, the onset time of analgesia was significantly shortened, the ratio of sensory block reaching S 2 was increased, analgesia pump pressing times and ropivacaine consumption were decreased ( P<0.05), and no significant change was found in the incidence of motor block, the requirement for rescue analgesic, the scores for parturients′ satisfaction with analgesia, delivery mode, Apgar scores of the neonates and the incidence of adverse reactions in group D ( P>0.05). Conclusion:DPE combined with PIEB for labor analgesia can shorten the onset time of analgesia and provide reliable efficacy and higher safety.

Effect of epidural labor analgesia administration methods on occurrence of postpartum urinary retention in nulliparous parturients: a comparison between programmed intermittent epidural bolus and continuous epidural infusion / 中华麻醉学杂志

Objective:To evaluate the effect of epidural labor analgesia administration methods on occurrence of postpartum urinary retention in nulliparous parturients through a comparison between programmed intermittent epidural bolus (PIEB) and continuous epidural infusion.Methods:Two hundred nulliparous parturients who were at full term with a singleton fetus in vertex presentation, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 22-35 yr, with body mass index of 22.4-42.6 kg/m 2, were divided into 2 groups ( n=100 each) using a random number table method: continuous epidural infusion group (group CEI) and group PIEB.Patient-controlled epidural analgesia (PCEA) was performed in active phase of labor (cervical dilatation≥1 cm) during the first stage of labor.The PCEA solution contained the mixture (10 ml) of 0.1% ropivacaine with 0.5 μg/ml sufentanil.The PCEA pump was set up to deliver a 5-ml bolus dose with a 30-min lockout interval.The analgesia solution contained the mixture (100 ml) of 0.08% ropivacaine and sufentanil 0.5 μg/ml.In group CEI, the drugs were given at 8 ml/h immediately after the initial dose.PIEB regimens were programmed as 8 ml over 80 s once an h after the initial bolus, and the administration was stopped after delivery of fetus.The labor time, consumption of analgesia solution and the incidence of postpartum urinary retention were recorded. Results:Compared with group CEI, the duration of the second stage of labor was significantly shortened, and consumption of analgesia solution and the incidence of postpartum urinary retention were decreased in group PIEB ( P<0.05). Conclusion:Compared with the continuous epidural infusion, the application of PIEB in labor analgesia can reduce the incidence of postpartum urinary retention in nulliparous parturients.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.