[Pain therapy in obstetrics]. / Schmerztherapie in der Geburtshilfe.

Labor pains can be stronger than pain caused by fractures and as a result of fear and stress can even have a negative effect on the course of parturition. A proportion of 75% of all women in labor use one or more supportive forms of analgesia to relieve labor pains. The procedures used range from supportive non-pharmacological measures, single intramuscular or intravenous analgesics and a prolonged inhalative analgesia up to highly efficient neuraxial blocks. Non-pharmacological interventions are considered to be generally safe but poorly effective. In contrast, pharmacological and invasive interventions are proven to be effective for analgesia but associated with potential side effects.

[Do position control methods for central venous catheters prevent complications? Hydromediastinum caused by an initially correctly placed tri-lumen subclavian catheter by using intra-atrial ECG recording--a case report]. / Schützen Lagekontrollverfahren für zentrale Venenkatheter vor Komplikationen? Hydromediastinum durch einen mittels intra-atrialer EKG-Ableitung primär korrekt platzierten Trilumen-Subclavia-Katheter--Ein kasuistischer Beitrag.

Central venous catheters (CVCs) can be associated with various complications which arise during insertion, with the catheter in situ or upon its removal. Here we report a case of secondary CVC malposition that occurred despite checks of CVC position by different methods. A subclavian triple-lumen catheter was retracted until intra-atrial ECG indicated reversal to a normal P-wave. Blood was successfully aspirated through all three lumens, and the catheter was fixed at 11 centimeters intracorporal length and used intraoperatively. A postoperative chest X-ray demonstrated an intravenous CVC length of only a few centimeters, which was accepted because of the inconspicuous results of previous monitoring. Fifteen hours after CVC insertion, the patient developed a swelling in the subclavian and right neck region, a pronounced hydromediastinum and small bilateral pleural effusions caused by paravenous infusion through the most proximal CVC lumen. After instantaneous removal of the catheter, the patient recovered without further complications. This case demonstrates that even carefully-fixed multi-lumen catheters can partially dislocate due to a patient's movements or changes of position. Therefore, repeated aspiration of blood from the most proximal lumen should be performed to detect secondary CVC malposition. Moreover, repeated chest radiographs are useful in verifying a correct CVC position and detecting late complications. In summary, CVC complications can occur with delay, are potentially life-threatening and may necessitate repeated checks of catheter position. This case report discusses different approaches to detecting malposition and reviews rare CVC complications.

[Effect of peridural analgesia on labor progress]. / Der Einfluss der Periduralanalgesie auf den Geburtsverlauf.

Epidural analgesia (EDA) is the most effective method of intrapartum pain relief. Its influence on the course of labor continues to be controversial. Although a cause-and-effect relationship has not been proven, this form of analgesia has been blamed for a host of adverse maternal/fetal events during labor, including prolonged first and second stage of labor, dystocia, malrotation of the fetal head and an increased risk of operative delivery (instrumental delivery, Caesarean section). Our own data from the Department of Obstetrics and Gynaecology at the University of Leipzig demonstrate that women with epidural analgesia had a longer duration of labor (the greater proportion taking more than 13 hours), although labor was often already protracted before the start of epidural analgesia. Early epidural analgesia with a cervical dilatation of less than 4 cm does not have any negative impact on the progress of labor. The duration of second-stage pushing and the rate of instrumental deliveries were not increased in our patients. Although the Caesarean section rate for women with an EDA was elevated, the total proportion of secondary Caesarean section remained unchanged despite increased use of EDA. Our findings suggest that women selected for intrapartal EDA already represent a population with an increased risk of an unfavourable course of labor, priming of the cervix, increased need of oxytocin and nulliparity. Pain relief in itself is sufficient indication for the use of intrapartal epidural analgesia.