A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

Lim, Grace; Facco, Francesca; Nathan, Naveen; Waters, Jonathan H.; Wong, Cynthia A.; Eltzschig, Holger K.

doi:10.1097/aln.0000000000002182

Cited by 144 publications

(158 citation statements)

References 220 publications

(268 reference statements)

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“…The etiology of the relation between maternal fever and epidural analgesia remains unclear and whether epidural analgesia would cause adverse obstetric outcomes were controversial. Anesthesia effects on the duration of the second stage of labor, instrumental vaginal delivery, labor epidural‐associated fever and neonatal acid–base status continue to be explored . Besides, studies about the effect of duration time of epidural analgesia on maternal and neonatal outcomes were also absent.…”

Section: Introductionmentioning

confidence: 99%

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Yin

2019

J of Obstet and Gynaecol

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Aim: To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever. Methods: A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non-epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant. Results: Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55-6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 AE 33.75 vs 47.39 AE 28.36 min，P = 0.001) and longer total duration of labor (790.32 AE 433.71 vs 461.33 AE 270.39 min，P<0.001), but had no influence on mode of delivery, the amount of post-partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes. Conclusion: Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.

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Section: Introductionmentioning

confidence: 99%

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Yin

2019

J of Obstet and Gynaecol

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“…The following endpoints were measured: total bupivacaine consumption during labor (mg), comprehension of PCEA goals, satisfaction with anesthesia care, and satisfaction with the birth experience. The validity of the local anesthetic consumption endpoint is exempli ed by numerous studies that have evaluated this endpoint and its importance to obstetric outcomes; further, lower local anesthetic dose in labor has been tied to lower risk for motor block, instrumental delivery, and obstetric nerve palsies [9][10][11]13 . The patient comprehension scores were directly derived from the Group E educational intervention, in that each teaching point corresponded to a true/false question that was then completed by the patient (Supplemental Material 1).…”

Section: Methodsmentioning

confidence: 99%

“…Compared to continuous epidural infusion, PCEA is known to reduce total local anesthetic dose consumption and motor blockade during labor and delivery 8,9 . Indeed, modern labor epidural analgesia strategies emphasize these lower total doses, because they may confer advantages such as reduced risk for instrumental vaginal delivery and for obstetric nerve palsies [9][10][11] . However, to our knowledge, no study exists on how to effectively educate patients on the appropriate use of PCEA for labor epidural analgesia.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Patient Education Strategy on Resident Self-Efficacy and Maternal Outcomes (EDUCATE Study)

Yanik¹,

Pollack²,

Farrell³

et al. 2020

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Background – Patient education improves treatment plan compliance and outcomes. For anesthesiology residents, patient communication is highlighted on the obstetric subspecialty rotation. However, the clinical effectiveness of patient education on patient-controlled epidural analgesia (PCEA) dose requirements is unknown. We hypothesized that patients receiving care by residents who are formally instructed on patient education for PCEA, will have lower total local anesthetic consumption and higher satisfaction. Methods – A prospective, interrupted time series design was chosen. Residents participated in one of two sessions at the beginning of their two-month obstetric anesthesia rotation: 1) Education (E): residents taught how to educate patients on PCEA, followed by instructor-resident practice implementing a “teach-back” method for patient comprehension; 2) Control (C): no formal instruction on PCEA. Confidence in patient education was assessed at baseline and at the rotation end. The first 15–30 patients cared for by each resident after initiating epidural labor analgesia and PCEA were followed. Patient-level data included: total local anesthetic dose during labor, comprehension of PCEA goals, and satisfaction with childbirth experience using a validated questionnaire. The primary outcome was total local anesthetic medication consumed during labor. Results – A total of 285 patients (118 cared for by residents in Group E, 167 cared for by residents in Group C) were included. Local anesthetic dose consumption was similar between groups (Group E: mean bupivacaine dose (mg), 96.4 ± 58.2 vs. Group C: 105.4 ± 64.1, P = 0.23). Patient comprehension for PCEA goals and patient satisfaction with their childbirth experience were similar between groups. Residents in group E felt more comfortable teaching PCEA to patients by the end of their rotation (Group E self-efficacy scores: pre-rotation, 45.7 ± 7.5 v. post-rotation, 88.0 ± 9.2, P = 0.002). Conclusions – A resident teaching intervention to improve skills in patient education for PCEA did not reduce drug consumption or improve patient satisfaction, but educated residents felt more comfortable teaching patients by the end of their rotation. Teaching methods for patient education that improve not only clinician self-efficacy, but also clinical outcomes at the patient level, should be identified.

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“…Нейроаксиальная аналгезия родов -обезболивание родов с использованием эпидуральной (ЭА), спинальной или спинально-эпидуральной аналгезии. Эти методы обезболивания заняли прочные позиции в современном акушерстве как наиболее эффективные [1][2][3][4][5][6][7][8][9][10][11].…”

Section: определениеunclassified

Neuroxial methods of labor analgesia. Clinical guidelines

Adamyan¹,

Артымук²,

Belokrinitskaya³

et al. 2018

Anesteziologiya I Reanimatologiya

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На сегодняшний день обезболивание родов является важным аспектом родовспоможения и оказывает значительное влияние на процесс, качество, результат и стоимость медицинского обслуживания родов. C этих позиций одними из на иболее актуальных проблем являются эффективность и безопасность анестезиологического обеспечения при родоразрешении беременных через естественные родовые пути. Его основу определяют обеспечение адекватного обезболивания и его хорошая управляемость, отсутствие влияния на родовую деятельность и вредного воздействия на мать и плод. Среди применяемых на сегодняшний день фармакологических методов обезболивания родов нейроаксиальные методы являются самыми гибкими, эффективными и наименее угнетающими центральную нервную систему плода и новорожденного. Целью разработки настоящих клинических рекомендаций является обобщение современных данных о нейроаксиальных методах обезболивания самопроизвольных родов, диагностике интенсивности боли в родах, выборе метода нейроаксиальной аналгезии и особенностях его проведения, а также о профилактике осложнений анестезии в родах. Ключевые слова: роды, преждевременные роды, обезболивание родов, нейроаксиальная аналгезия, эпидуральная аналгезия, спинальная аналгезия, комбинированная спинально-эпидуральная аналгезия. Для корреспонденции: Шифман Ефим Муневич, доктор мед. наук, проф. каф. анестезиологии и реаниматологии ФУВ ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.В. Владимирского» (МОНИКИ),

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A Review of the Impact of Obstetric Anesthesia on Maternal and Neonatal Outcomes

Cited by 144 publications

References 220 publications

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Effect of a Patient Education Strategy on Resident Self-Efficacy and Maternal Outcomes (EDUCATE Study)

Neuroxial methods of labor analgesia. Clinical guidelines

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