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Epidural in labor

Piya Chaemsaithong, Angel H W Kwan, Wing Ting Tse, Wen Teng Lim, Winnie W Y Chan, Ka Chun Chong, Tak Yeung Leung, Liona C Poon
BACKGROUND: The traditional approach to assessing labor progress is by digital vaginal examination, however, it is subjective and imprecise. Recent studies have investigated the role of transperineal ultrasonographic assessment of fetal head descent by measuring angle of progression and head-perineum distance. OBJECTIVE: The objective of this study was to evaluate factors that affected labor progress, defined by the transperineal ultrasonographic parameters, in women achieving vaginal delivery...
February 5, 2019: American Journal of Obstetrics and Gynecology
Safinaz Abdelrahman, Nooraldaem Yousif
BACKGROUND: Mitral stenosis is one of the most commonly encountered valvular heart diseases during pregnancy, the majority are rheumatic in origin and poorly tolerated due to cardio circulatory changes that occur during pregnancy, labor and postpartum. OBJECTIVE: The distinctive physiological events that arise during pregnancy and labor and the influence of mitral stenosis are tackled in this article. METHOD: Through PUBMED and MEDLINE searches, we reviewed the literature of the last decade as well as the recommendations from guidelines of high-impact worldwide...
February 7, 2019: Reviews on Recent Clinical Trials
Jincheng Zhou, James S Hodges, M Fareed K Suri, Haitao Chu
Noncompliance to assigned treatment is a common challenge in analysis and interpretation of randomized clinical trials. The complier average causal effect (CACE) approach provides a useful tool for addressing noncompliance, where CACE is defined as the average difference in potential outcomes for the response in the subpopulation of subjects who comply with their assigned treatments. In this article, we present a Bayesian hierarchical model to estimate the CACE in a meta-analysis of randomized clinical trials where compliance may be heterogeneous between studies...
January 28, 2019: Biometrics
Stacey E Iobst, Rachel B Breman, Debra Bingham, Carla L Storr, Shijun Zhu, Meg Johantgen
BACKGROUND: Admission in early labor is associated with increased likelihood of cesarean birth, but the context in which this occurs is unclear. Previous research has explored the relationship between dilatation at admission and the use of single intrapartum interventions; however, the majority of women in the United States receive multiple intrapartum interventions. The objective of this study was to examine the associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women with spontaneous onset of labor...
January 28, 2019: Birth
K Shea, L Choi, D Jagannathan, K Elterman, J Robinson, B Kodali, C C Huang, A Palanisamy
BACKGROUND: The effect of accidental dural puncture during labor epidural analgesia on obstetric outcomes remains unexplored. In this retrospective cohort study, we tested the hypothesis that accidental dural puncture is associated with prolonged second stage of labor. METHODS: Anesthetic and obstetric data from nulliparous parturients who suffered an accidental dural puncture at term labor (n=89) during the years 2006-2012 were compared with randomly selected parturients with uncomplicated epidural analgesia (n=232)...
December 12, 2018: International Journal of Obstetric Anesthesia
Nitu Puthenveettil, Anish Mohan, Sunil Rajan, Jerry Paul, Lakshmi Kumar
Background: Optimal labor analgesia can be provided with epidural by addition of opioid to the local anesthetic. Aims: The aim of this study is to compare the efficacy of labor epidural bolus regimes 20 mL of 0.1% ropivacaine with 40 μg fentanyl versus 15 mL of 0.1% ropivacaine with 15 μg fentanyl as epidural bolus dose. Settings and Design: This was prospective double-blinded randomized study. Materials and Methods: After approval from the Institutional Ethical Committee, 50 consenting parturients in active labor were allotted into two groups by closed envelope technique...
October 2018: Anesthesia, Essays and Researches
Rajesh Kesavan, Sunil Rajan, Lakshmi Kumar
Background: Labor analgesia has been shown to have few undesirable effects on the course and outcome of the labor as well as on the fetal well-being. Aims: This study aims to assess neonatal outcome following lumbar epidural analgesia with intermittent boluses of 0.1% bupivacaine with fentanyl. The secondary objectives included assessment of maternal analgesia, complications, and outcome of labor. Setting and Design: Prospective observational study conducted at a tertiary care teaching institute...
October 2018: Anesthesia, Essays and Researches
Gennadiy A Katsevman, Ryan C Turner, Cletus Cheyuo, Charles L Rosen, Matthew S Smith
Posterior reversible encephalopathy syndrome (PRES) is an uncommon but potentially devastating syndrome if not recognized and treated appropriately. As the name implies, recognition of the condition and proper management may reverse the clinical and radiological findings. However, diagnosis is not always straightforward. We present the case of a 24-year-old female who was 4 days post-partum and presented with headache, neck pain, and new-onset seizures. She had undergone epidural anesthesia during labor, and initial imaging was suggestive of intracranial hypotension versus pachymeningitis...
January 18, 2019: Acta Neurochirurgica
Jonathan A Niconchuk, Michael G Richardson
A pregnant patient with chronic regional pain syndrome (CRPS) and indwelling spinal cord stimulator presented with twin gestation for induction of preterm labor due to preeclampsia. Intravenous magnesium was initiated and a lumbar epidural catheter was placed uneventfully for labor analgesia. The patient reported complete relief of her CRPS-associated pain during and for 24 hours after delivery, while receiving intravenous magnesium, with her pain symptoms returning shortly after discontinuing magnesium. To our knowledge, there are no case reports that describe CRPS-associated pain relief while on peripartum magnesium therapy...
January 11, 2019: Regional Anesthesia and Pain Medicine
Chung Hun Lee, Sang Sik Choi, Mi Kyoung Lee, Jung Eun Kim, Dong Ik Chung, Mido Lee
BACKGROUND: The failure rate of epidural anesthesia using the loss of resistance technique is 13-23%. OBJECTIVES: To investigate the efficacy of epidural electric stimulation-guided epidural analgesia in vaginal delivery. STUDY DESIGN: An open label randomized prospective study. METHODS: Laboring women were randomized to two groups: epidural catheter insertion using only a loss of resistance technique or a loss of resistance technique with confirmation by electric stimulation...
2019: PloS One
Philip Rosinsky, Shay Mandler, Niv Netzer, Meital Ady, Danielle Elmaliache, Shaul Sagiv, Peleg Ben-Galim
Background: The study aimed to assess the effectiveness of antibiotic treatment for spondylodiscitis, its failure rates, and the need for surgical intervention. Methods: This is a retrospective study of patients who presented with spontaneous deep spinal infections and spondylodiscitis between 2011 and 2013. Clinical, bacteriologic, and radiographic data during hospitalization were analyzed. Results: A total of 16 patients presented with deep spinal infections during the study period; 15 of them presented with spontaneous pyogenic spondylodiscitis, and 1 presented with epidural abscess...
December 2018: International Journal of Spine Surgery
Naama Srebnik, Omri Barkan, Misgav Rottenstreich, Alexander Ioscovich, Rivka Farkash, Keren Rotshenker-Olshinka, Arnon Samueloff, Sorina Grisaru-Granovsky
OBJECTIVE: We aimed to evaluate the impact of epidural analgesia on the mode of delivery of nulliparous women with a term single fetus in vertex presentation (NTSV) that attained the second stage of labor. STUDY DESIGN: A single-center retrospective study provided a strict and constant department protocol for epidural analgesia practice and obstetric interventions, between 2005 and 2014. Epidural users were compared to nonusers. The primary outcome was the mode of delivery...
January 4, 2019: Journal of Maternal-fetal & Neonatal Medicine
Hongying Wu, Jiayi Yue
BACKGROUND: We examined the influence of pre-pregnancy body weight on the rates of attempted and successfully assisted-vaginal delivery. METHODS: We used 2008-2016 inpatient records including 3408 women who had singleton gestations and needed operative delivery assistance to conduct a retrospective cohort study. Patients were categorized based on pre-pregnancy BMI (normal weight = 18.5 to less than 25 or obese = 30 or greater). We used logistic regression to estimate odds ratios and 95% confidence intervals of attempted and successful forceps or vacuum-assisted vaginal delivery by body weight adjusted for marital status, age, gestational age, induction of labor, episiotomy, diabetes, and birth weight...
December 27, 2018: BMC Pregnancy and Childbirth
Pierre Descargues, Catherine Battie, Cyril Huissoud, Nathalie Hoen, Yesim Dargaud, Muriel Doret, Pascal Gaucherand
OBJECTIVES: Adrenal vein thrombosis during pregnancy is a rare thromboembolic event but is not exceptional. The objective of this study was to described the symptoms, diagnosis, treatment and follow-up of patients with this condition. STUDY DESIGN: This was a retrospective descriptive study of 14 cases (13 patients, one recurrence) that occurred in the three university maternity hospitals in Lyon (France) from 2008 to 2016. RESULTS: Adrenal vein thrombosis occurred exclusively in the third trimester (gestational age > 28 weeks), with most patients presenting unilateral lumbar pain (13/14 cases, 93%) and vomiting (8 cases, 57%), mimicking renal colic...
February 2019: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Erkan Kalafat, Jose Morales-Rosello, Elisa Scarinci, Basky Thilaganathan, Asma Khalil
OBJECTIVES: Small-for-gestational-age fetuses (SGA) are at high risk of intrapartum fetal compromise requiring operative delivery. In a recent study, we developed a model using a combination of three antenatal (gestational age at delivery, parity, cerebroplacental ratio) and three intrapartum (epidural use, labor induction and augmentation using oxytocin) variables for the prediction of operative delivery due to presumed fetal compromise in SGA fetuses - the Individual RIsk aSsessment (IRIS) prediction model...
December 18, 2018: Journal of Maternal-fetal & Neonatal Medicine
T Malik, O Malas, A Thompson
BACKGROUND: Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. METHODS: One-hundred parturients requesting epidural analgesia were randomly assigned to receive ultrasound-guided L5-S1 epidural catheter placement (experimental group) or non-ultrasound-guided higher lumbar interspace placement (control group)...
November 20, 2018: International Journal of Obstetric Anesthesia
M L Meng, E Wang, C Cain, R Landau
We report the case of a normotensive 31-year-old parturient who received combined spinal-epidural analgesia for early labor, and who was then found to have an unexpectedly low platelet count (25 000/μL) with elevated liver enzymes, but without alterations in blood pressure.
November 29, 2018: International Journal of Obstetric Anesthesia
Xueya Qian, Qingning Wang, Xinxu Ou, Pin Li, Baisong Zhao, Huishu Liu
Epidural analgesia is effective in relieving pain during labor. However, concerns as to compromised labor progress and outcomes arise. This study aimed to assess the effect of patient-controlled epidural analgesia (PCEA) with ropivacaine on uterine electromyography (EMG) activities and outcomes in labor. A total of 213 pregnant women were divided into three groups: the PCEA with ropivacaine group (n = 78), the PCEA with levobupivacaine group (n = 66), and a control group that did not receive PCEA (n = 69). Uterine EMG activities were recorded during the first stage of labor...
2018: BioMed Research International
Sara L Zettervall, Andrew Amata, Jeffery S Berger, Paul Dangerfield, Ruth Derkenne, Ramon Go, Deborah Jeon, Kiera Murphy, Molly Phillips, Marian Sherman, Khashayar Vaziri
Background: The use of epidural analgesia for laboring women is generally unavailable at public hospitals in Guyana despite favorable utilization rates in private institutions. In 2014, a healthcare team completed a targeted mission aimed at neuraxial analgesia training of providers at the preeminent public hospital in Georgetown, Guyana. This study evaluates the impact of the training, including provider attitudes, use, and barriers. Methods: A prospective, mixed methods study of all obstetric, nursing, and anesthesiology providers at Georgetown Public Hospital Corporation was completed...
July 2018: Journal of Education in Perioperative Medicine: JEPM
D Shatalin, C F Weiniger, I Buchman, Y Ginosar, S Orbach-Zinger, A Ioscovich
BACKGROUND: This nationwide survey was conducted to provide data about the obstetric anesthesia services in Israeli labor and delivery units in 2016. METHODS: Prospective survey questionnaire was emailed to obstetric anesthesia unit directors/chairperson of all 25 labor and delivery services units within the jurisdiction of the Israeli Ministry of Health. RESULTS: The response rate was 100%. Nineteen (76%) units have dedicated anesthesiologist cover...
November 2, 2018: International Journal of Obstetric Anesthesia
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