Labour analgesia effects on foetal heart rate. A mini-review

Engel, Nicole M. A.; Velde, Marc Van de; Nijhuis, Jan G.; Marcus, Marianne T.

doi:10.4236/ojog.2011.13020

Cited by 6 publications

(9 citation statements)

References 67 publications

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“…In conclusion, the routine prescription and utilization of epidural analgesia by Nigerian obstetrician who is the custodian of women's health is still quite suboptimal, despite the overwhelming high level evidence which has clearly shown that many of fears, unsubstantiated risks, as well as the unfounded myths ascribed to epidural analgesia in labor are baseless and that its benefits far outweigh any risks to both mother and baby (1,8,24,25). Therefore, adequate patient education, training of personnel and subsidization of this service will go a long way in promoting the acceptability and utilization of epidural analgesia for women in labor.…”

Section: Discussionmentioning

confidence: 99%

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Anozie¹,

Lawani²,

Mamah³

et al. 2018

International Journal of Women’s Health and Reproduction Scienc

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Introduction Pain perception in labor is extremely variable among women depending on the parturient pain threshold and reaction to pain (1). For the majority of women, labor pain is considered severe and may be likened in severity to complex regional pain syndrome or amputation of a digit without anaesthesia (2). According to the American College of Obstetricians and Gynecologists and the American Society of Anaesthesiologists, there is no circumstance where it is acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under the care of a physician (2). The development of modern analgesia and in particular regional analgesia marked a major turning point in pain management during labor and delivery. Epidural analgesia is considered as the most effective method of pain relief and recommended as the first choice analgesia for women during labor and delivery (3,4). The level of awareness and practice of labor analgesia, particularly epidural analgesia in sub-Saharan Africa is still rudimentary and obstetricians undoubtedly have an important role to play in this regard. In 2012, a survey of the practice of labor analgesia a m o n g t h e obstetricians in Nigeria revealed that only 49% of the respondents offered analgesia to women in labor and of these, a paltry 2% used epidural analgesia (5). Pain management in labor is an important component of active management of labor and even though not all women request pain relief in labor, the obstetrician has a duty to discuss the options, benefits and risks associated with various methods of labor analgesia with the parturient irrespective of his or her belief (6, 7). Optimal pain control in labor is more likely to result in a satisfactory birth experience for the parturient and her care provider (8-12). A critical step in achieving this milestone is to survey the level of awareness of epidural analgesia, determinants and deterrents of its use among obstetricians practicing in Nigeria. Currently, there is no available literature documenting the utilization pattern, determinants and deterrents of epidural analgesia among obstetric care providers such as obstetricians in Nigeria. This study, therefore,

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Section: Discussionmentioning

confidence: 99%

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Anozie¹,

Lawani²,

Mamah³

et al. 2018

International Journal of Women’s Health and Reproduction Scienc

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“…Не существует единого представления о влиянии регионарной анестезии на частоту сердцебиения плода. По литературным данным, брадикардия и нарушение сердечного ритма возникают у плода при любой эффективной регионарной анестезии в родах (эпидуральной, спинальной и спинально-эпидуральной) при использовании различных местных анестетиков [9]. Некоторые исследователи отмечали кратковременное развитие брадикардии у плода [9,10].…”

Section: Discussionunclassified

“…По литературным данным, брадикардия и нарушение сердечного ритма возникают у плода при любой эффективной регионарной анестезии в родах (эпидуральной, спинальной и спинально-эпидуральной) при использовании различных местных анестетиков [9]. Некоторые исследователи отмечали кратковременное развитие брадикардии у плода [9,10]. Другие находили кратковременные колебания частоты сердцебиения плода и развитие поздних и вариабельных децелераций [11], свидетельствующих об изменении у плода газообмена и возможном развитии гипоксемии/гипоксии [9,[12][13][14].…”

Section: Discussionunclassified

“…Известно, что изменение ЧСС у плодов может быть опосредовано увеличением тонуса матки и интенсивностью ее сокращений. По данным разных авторов, большинство эпизодов брадикардии у плода сочетается с повышением тонуса матки через 15-20 мин после инъекции местного анестетика и особенно в тех случаях, когда ЭА сопровождается гипотензией у матери или при положении роженицы на спине [6,9,13,14].…”

Section: Discussionunclassified

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The Influence of the Bupivacaine Regional Anesthesia on the Contractile Activity of the Uterus and the Functional State of the Fetus

Ev¹,

et al. 2013

ARAMS

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Научно-исследовательский институт акушерства и гинекологии им. Д.О. Отта, Санкт-Петербург, Российская Федерация Влияние регионарной анестезии бупивакаином на сократительную активность матки и функциональное состояние плода Исследование проведено в хроническом опыте на 26 беременных самках кролика в индуцированных окситоцином на 30-й день беременности родах. Изучали влияние эпидуральной анестезии (ЭА) бупивакаином (0,5%-1 мл) на сократительную активность матки, функциональное состояние самок и их плодов. На 28-й день беременности под тиопенталовым наркозом плодам вводили ЭКГ-электроды; в миометрийэлектроды для регистрации электрической активности матки. С целью регистрации механической активности матки применяли оригинальный резиновый датчик в виде манжетки, заполненной графитом, который помещали вокруг одного рога матки. Сократительную активность миометрия оценивали по количеству маточных сокращений, продолжительности и амплитуде одного маточного сокращения за каждый 5-минутный интервал, функциональное состояние плодов и самки-по изменению частоты их сердечных сокращений. У 12 самок в динамике эксперимента наблюдалось родоразрешение. Регистрацию сокращений матки, частоты сердечных сокращений самки и плодов проводили непрерывно и синхронно в течение опыта. Результаты показали, что в стандартных условиях опыта ЭА не вызывала изменений параметров сократительной активности матки самки кролика, находящейся в естественном положении, и не влияла на частоту сердечных сокращений плодов (3-факторный дисперсионный анализ ANOVA). Через 10 минут после ЭА у самок кролика возникало кратковременное учащение сердечных сокращений (на 9%) по отношению к исходному уровню, что может быть связано с транзиторной гипотонией. Таким образом, ЭА, выполненная бупивакаином (0,5%-1,0 мл) в индуцированных родах самкам кролика, в условиях нашего опыта не оказывала значимого влияния на сократительную активность матки и функциональное состояние плодов. Зарегистрирована кратковременная адаптивная тахикардия у самок.

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“…Despite the clear benefit of pain reduction, management measures should not interfere with the normal birth process. The literature has become increasingly focused on the maternal and fetal effects of intrapartum analgesia 5 , 6 , 7 , although little is known still about the use of i. v. PCA with remifentanil in a German population 8 .…”

Section: Introductionmentioning

confidence: 99%

Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome

Ortiz

Hammerl

Wasmaier

et al. 2019

Geburtshilfe Frauenheilkd

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Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p < 0.001, respectively) and epidural analgesia (90 [92] vs. 44 [55] min, p = 0.004, and 22.5 [73] vs. 10 [11] min, p = 0.003, respectively) compared with the controls. The length of the pushing stage was similar among primiparas in all groups but prolonged compared with the controls in multiparas with patient-controlled intravenous analgesia with remifentanil (15 [17] vs. 5 [7] min, p = 0.001) and epidural analgesia (10 [15] vs. 5 [7] min, p = 0.006). The Apgar, umbilical arterial pH and base excess values were similar between the groups, as were the rates of acidosis and neonatal intensive care unit admission. Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.

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Labour analgesia effects on foetal heart rate. A mini-review

Cited by 6 publications

References 67 publications

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

Epidural Analgesia for Management of Labour Pain: Determinants and Deterrents Among Obstetricians in Nigeria

The Influence of the Bupivacaine Regional Anesthesia on the Contractile Activity of the Uterus and the Functional State of the Fetus

Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome

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