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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.
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Analgesia, Obstetrical , CathetersABSTRACT
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Labor, Obstetric/drug effects , Analgesia, Obstetrical/adverse effects , Apgar Score , Pregnancy Outcome/epidemiology , Chi-Square Distribution , Logistic Models , Odds Ratio , Retrospective Studies , Risk Factors , Cohort Studies , Analgesia, Obstetrical/methodsABSTRACT
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.
Subject(s)
Adolescent , Adult , Female , Humans , Infant, Newborn , Pregnancy , Labor, Obstetric/drug effects , Analgesia, Obstetrical/adverse effects , Analgesia, Obstetrical/statistics & numerical data , Apgar Score , Pregnancy Complications/epidemiology , Brazil/epidemiology , Pregnancy Outcome/epidemiology , Retrospective Studies , Risk Factors , Cohort Studies , Analgesia, Obstetrical/methodsABSTRACT
Objective To summarize the experience in anesthesia management for cesarean section(CS) after failed labor in women with combined spinal and epidural analgesia and to provide evidence for more effective and safer clinical practice.Methods We included 58 singleton pregnant women who received spinal and epidural analgesia during labor but converted to CS at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from October 2017 to October 2018.When CS was indicated,10 ml of 0.125％ ropivacaine was given through the epidural catheter immediately,and 5 ml of 1％ lidocaine was given when arriving at the operating room.Five minutes later,10 ml of 1％ ropivacaine was administered.General anesthesia would be required when epidural anesthesia was considered to be failed 10 min after the usage of ropivacaine.Clinical datas were retrospectively reviewed.The management and effects of anesthesia for CS,maternal and neonatal outcomes were described.Results Of the 58 patients when CS was indicated during labor,5.2％(3/58) received general anesthesia immediately.Among the other 94.8％ (55/58) who received epidural anesthesia,3.6％(2/55) converted to general anesthesia later.Adverse effects of epidural anesthesia included reduced mean artery pressure (8/53,15.1％),nausea and vomiting (3/53,5.7％).For the neonatal Apgar score at 1 min,one out of the 58 babies (1.7％) was between 0 and 3,ten (17.2％) between 4 and 7,and 47 (81.0％) between 8 and 10.The two babies (3.4％) with Apgar score between 4 and 7 at 5 min were both referred to the department of Neonatology,and the rest 56 neonates (96.6％) scored 8-10.Conclusions Spinal and epidural analgesia in labor can be safely and effectively adjusted to anesthesia for CS.
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Objective To evaluate the efficacy of epidural analgesia in latent phase of labor for preeclamptic women undergoing vaginal delivery.Methods A prospective study was conducted on 80 nulliparae of singleton pregnancy with preeclampsia and cephalic presentation in Tianjin Central Hospital of Gynecology Obstetrics from August 2016 to July 2017.All subjects were randomly divided into two groups including labor analgesia in active phase group (labor analgesia was commenced at cervical dilation over ≥ 4 cm,n=40,group 1) and the whole labor analgesia in latent phase group (labor analgesia was comenced at the onset of labor,n=40,group 2).Visual analogue score (VAS) was used to evaluate pain intensity at different time points.Maternal venous blood samples were collected at the time of parturient and fetal delivery to determine the serum concentrations of cortisol (Cor) and adrenocorticotropic hormone (ACTH) by enzyme-linked immunosorbent assay (ELISA).Clinical data was statistically analyzed using t-test or Chisquare test.Results (1) Compared with group 1,the duration of the first stage of labor [(521.3±103.5) vs (570.3 ±116.2) min,t=0.366,P＜0.05],the VAS scores immediately after analgesic administration and at cervical dilation of 2 and 3 cm [4.1±1.1 vs 7.3±1.2,3.5±0.9 vs 7.6±1.7,3.7±0.7 vs 8.1±1.4;t=4.387,9.652,5.321;all P＜0.05],the mean arterial pressure at cervical dilation of 2 and 3 cm [(98.3±9.1) vs (125.3±10.6) mmHg (1 mmHg=0.133 kPa),(98.6±10.4) vs (127.5±9.6) mmHg;t=8.014,5.496;both P＜0.05] and the cesarean delivery rate [15.0％ (6/40) vs 27.5％ (11/40),x2=4.012,P＜0.05] were all lower in group 2.(2) The serum levels of Cor [(565±76) vs (231 ±64) nmol/L,(457±79) vs (233±55) nmol/L;t=6.028,5.126;both P＜0.05] and ACTH [(81 ± 14) vs (38±11) pg/ml,(71 ± 16) vs (39±10) pg/ml,t=5.984,6.028;both P＜0.05]in group 1 and group 2 were both increased significantly after delivery as compared with those at the time of parturient,and they also showed significant differences between the two groups after delivery (t=5.009,3.862;both P＜0.05).Conclusions Epidural analgesia in latent phase of labor can be implemented in preeclamptic women attempting vaginal delivery through alleviating labor pain as sooner and earlier as possible,reducing their stress responses and maintain hemodynamic stability.
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Objective To explore the effects of whole-stage labor analgesia on maternal and neonatal outcomes after the implementation of the new partogram.Methods A retrospective cohort study was performed in Peking University First Hospital.From June to December 2016,907 nulliparae with full-term singleton cephalic pregnancies that were expected to deliver vaginally and adhered to the new partogram were selected as the study group,and 982 cases that adhered to the old partogram (Friedman standard) from June to December 2012 were selected as the control group.Maternal basic characteristics and analgesic,obstetric and neonatal data were collected.Maternal and neonatal outcomes between the two groups were analyzed with independent sample t-test,rank sum test or Chi-square test (Fisher's exact test).Results (1) Maternal age and the proportion of gravidas of advanced maternal age in the study group were both higher than those in the control group [(30.2±3.0) vs (29.64-2.9) years,t=3.823;8.2％ (74/907) vs 4.2％ (41/982),x2=13.087;both P＜0.001].No statistically significant difference in the other basic characteristics was found between the two groups.(2) Women in the study group had significantly smaller cervical dilatation [M(P25-P75)] than that in the control group when analgesia was commenced [2(1-2) vs 2(1-3) cm,Z=-3.752].The intensity of pain quantified with numerical rating scale (NRS) before analgesia,and during the second stage of labor in the study group were less than that in the control group [8(8-9) vs 8(8-10) points,Z=-14.441;5(4-5) vs 6(5-7) points,Z=-16.495].The study group had longer median duration of analgesia than the control group [520(340-750) vs 300(200-453) min,Z=-17.801,P＜0.001].The overall dose of analgesics in injection pump in the study group was significantly higher compared with that used in the control group [68 (35-84) vs 30 (18-48) ml,Z=-18.004,P＜0.001].However,there was no significant difference in the incidence of analgesia-related complications (hypotension,accidental dura puncture,lower extremity numbness,pruritus and urinary retention) between the two groups.(3) The study group showed a higher percentage of spontaneous vaginal delivery,and a lower rate of converted cesarean section compared with the control group [71.8％ (651/907) vs 63.2％ (621/982),x2=15.623;13.6％ (123/907) vs 20.5％ (201/982),~=18.831;both P＜0.001].The study group had lower forceps-assisted vaginal delivery rate than the control group without statistically significant difference [14.8％ (133/907) vs 15.3％ (150/982),x2=0.093,P=0.797].The duration of the first,second and third stage of labor in the study group were all significantly longer than that of the control group [680 (470-900) vs 480 (360-660) min,Z=-12.490;56 (31-89) vs 37 (24-58) min,Z=-9.964;7 (5-10) vs 6 (5-8) min,Z=-6.673;all P＜0.001].Women in the study group had a lower rate of artificial rupture of membranes when comparing with the control group [55.2％ (501/907) vs 63.2％ (621/982),x2=12.516,P＜0.001].The incidence of fever,pathologically confirmed infection and postpartum hemorrhage were significantly higher in the study group than that in the control group [10.8％ (98/907) vs 6.4％ (63/982),x2=11.652;9.6％ (87/907) vs 3.7％ (36/982),x2=27.201;12.6％ (114/907) vs 5.7％ (56/982),x2=27.144;all P＜0.05].There was no significant difference in the rate of oxytocin use during labor or blood transfusion between the two groups.(4) Compared with the control group,the proportion of cesarean section due to arrested active stage of labor in the study group was significantly lower [5.7％ (7/123) vs 50.2％ (101/201),x2=68.173,P＜0.05],but the incidences of cesarean section due to intrauterine infection and relative cephalopelvic disproportion were higher in the study group [61.0％ (75/123) vs 30.8％ (62/201),x2=2.680;20.3％ (25/123) vs 8.0％ (16/201),x2=10.555;both P＜0.05].There was no significant difference in the proportion of fetal distress or other indications for cesarean section between the two groups.(5) There was no significant difference between the two groups in birth weight,macrosomia,fetal distress,neonatal asphyxia,or the proportion of neonatal intensive care unit admission.Conclusions After the implementation of the new partogram,analgesic pain relief covering the whole labor prolongs the average analgesic time and reduces the rate of cesarean section due to arrested active stage of labor.Although the risk of postpartum hemorrhage is slightly increased,analgesia itself does not pose additional risks on forceps-assisted delivery,maternal blood transfusion and neonatal asphyxia.
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As one of the most effective and commonly used analgesic methods during labor and delivery,epidural analgesia has been widely accepted in terms of its safety.Neurological complications following childbirth,which are most related to pregnancy and childbirth factors rather than labor analgesia,has not been well studied or recognized in China.Therefore,there are some confusions and misunderstandings of reasons for these neurological complications,and,to a certain extent,have affected the clinical implementation of epidural labor analgesia.This review analyzed the etiology and prognosis of this problem in order to help the clinicians in identifying the risk factors and causes and also to improve clinical awareness,prevention,and management for these conditions.
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As an effective analgesic method,intrathecal analgesia has been widely accepted.Though labor analgesia could relieve the labor pain,it remains controversial about its adverse effects on labor progress and delivery outcomes.With the development of labor analgesia technique,a large number of clinical studies have suggested that the protocol,dosage and analgesic methods of local anesthesia may also affect the labor and delivery outcomes.There is a growing need to explore more optimized anesthetics and analgesic methods for clinical and scientific research.
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Gravidas receiving epidural labor analgesia are at an increased risk for intrapartum fever due to unknown mechanism, which may be related to thermoregulation, non-infectious inflammatory, continued use of local anesthetic agents and trauma from epidural catheter insertion. Epidural labor analgesia-related intrapartum fever is associated with excessive obstetric interventions, higher rates of cesarean and assisted vaginal deliveries, unnecessary maternal and neonatal exposure to antibiotics, and adverse neonatal outcomes. Hence it is imperative to explore its etiology and shorten the labor with a safe and effective measure to reduce the occurrence of intrapartum fever.
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Objective To evaluate the accuracy of variation of epidural labor analgesia in predicting cesarean section.Methods A total of 1 200 parturients with a single baby who were at full term with a singleton fetus,aged 22-34 yr,weighing 60-85 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,volunteered for epidural labor analgesia for pain relief,were enrolled in the study.Epidural labor analgesia (patient-controlled epidural analgesia) was performed when uterine contraction was regular and cervical dilatation was 2-3 cm.Patient-controlled epidural analgesia solution contained the mixture of 0.1％ ropivacaine and fentanyl 2 μg/ml with a background infusion 9 ml/h,bolus dose 4 ml,lockout interval 15 min.The variation of labor analgesia was defined as the difference between the highest visual analog scale score during labor and the visual analog scale score at 30 min after epidural injection of the initial dose of local anesthetic.The receiver operating characteristic curve was used to evaluate the accuracy of variation of epidural labor analgesia in predicting cesarean section.The optimal cut-off value was determined according to the maximum Youden index.Results The area under the receiver operating characteristic curve of variation of epidural labor analgesia in predicting cesarean section was 0.795,and the maximum Youden index was 53.6％,the sensitivity 87.5％ and the specificity 66.1％ when the cut-off value was 3.Conclusion Variation of epidural labor analgesia produces better accuracy in predicting cesarean section.
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Objective To compare the efficacy of programmed intermittent epidural bolus and continuous epidural infusion of ropivacaine in labor analgesia.Methods From May 2014 to May 2017,170 patients,24 -32 years,for full-term primipara in the Maternal and Child Health Care Hospital of Quzhou were selected as study objects,and they were randomly divided into intermittent epidural injection group (T group) and continuous epidural pump group(C group) by computer random software,with 85 cases in each group.All patients were epidurally injected 2%lidocaine 3mL and 0.2% ropivacaine 2mL at the opening of the uterus,less than 3cm.T group was given programmed intermittent epidural bolus 0.1% ropivacaine 6mL/h.C group was given continuous epidural infusion 0.1%ropivacaine 6mL/h.The pain of maternal(NRS score) and motor block situation of maternal (Bromage score) were monitored.The number of PCEA,PCEA pressure times,the rate of instrumental delivery and APGAR score were also recorded.Results The number of Bromage score≥2 in C group was higher than that of T group at 4-10h after labor analgesia (3 cases vs.11 cases,3 cases vs.15 cases,4 cases vs.17 cases,4 cases vs.18 cases,6 cases vs. 19 cases,6 cases vs.21 cases,7 cases vs.22 cases;χ2＝4.982,8.947,9.182,10.230,7.926,9.907,9.354,all P＜0.05).There was no statistically significant difference in NRS score between the two groups (P＞0.05).The number of PCEA,PCEA pressure times and the rate of instrumental delivery in T group were lower than those in C group [8 cases vs.18 cases,22 cases vs.41 cases,(3.5 ±1.5) times vs.(4.9 ±2.2) times;χ2＝4.541,9.104;t＝2.666,all P＜0.05].There was no statistically significant difference in Apgar score between the two groups (P＞0.05).Conclusion Compared with continuous epidural infusion,programmed intermittent bolus of ropivacaine for labor analgesia exerts good analgesic effect,it has minor effects on exercise function and can decrease the rate of instrumental delivery .