Mathematical Modeling of the Pain and Progress of the First Stage of Nulliparous Labor

Debiec, J.; Conell-Price, Jessamyn; Evansmith, Jennifer; Shafer, Steven L.; Flood, Pamela

doi:10.1097/aln.0b013e3181ba3f28

Cited by 39 publications

(9 citation statements)

References 30 publications

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“…The present study minimized bias against the impact of epidural analgesia on the cesarean delivery by conducting a prospective study by standardization of patient management such as analgesic methods. Moreover, previous lots of studies used indirect studies that evaluated pain by the number of requests for an additional analgesics [1,2,3,5,6,7,8,9,10,11,12], while this study divided into groups on the basis of only initial pain. There was also no difference among three groups in maternal, fetal and obstetric factors that could have an impact on labor pain and dystocia.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors demonstrated that epidural analgesia could increase the rate of forceps and cesarean delivery [5,6,13,14]. However, most recent studies show that epidural analgesia using a low concentration of local anesthetic and narcotics do not increase cesarean delivery rates while it can extend labor times [7,8,9,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…The increased rate of cesarean delivery in individuals who received epidural analgesia can be explained by various factors such as mother or fetus' factors, not by a direct relationship with epidural analgesia. Among them, labor pain is one of the factors to relate with the obstetric outcome and can be a confounding factor when interpreting effects of epidural analgesia on labor outcome [1,2,3,6,12]. …”

Section: Discussionmentioning

confidence: 99%

“…The frequency of receiving the cesarean delivery due to dystocia among pregnant women who received epidural analgesia was vary from 5 to 25%, which indicated that other various factors were involved beside epidural analgesia itself [1,2,3,6,12]. The labor progress is very complex and dystocia can be induced by various causes such as a fetus size, fetal presentation, the anatomy of the pelvic, a uterine malformation, maternal age, use of oxytocin, and uterine activity.…”

Section: Discussionmentioning

confidence: 99%

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The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome

Woo

Kim

Lee

et al. 2015

Korean J Anesthesiol

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BackgroundThe increased pain at the latent phase can be associated with dysfunctional labor as well as increases in cesarean delivery frequency. We aimed to research the effect of the degree of pain at the time of epidural analgesia on the entire labor process including the mode of delivery.MethodsWe performed epidural analgesia to 102 nulliparous women on patients' request. We divided the group into three based on NRS (numeric rating scale) at the moment of epidural analgesia; mild pain, NRS 1-4; moderate pain, NRS 5-7; severe pain, NRS 8-10. The primary outcome was the mode of delivery (normal labor or cesarean delivery).ResultsThere were significant differences in the mode of delivery among groups. Patients with severe labor pain had a significantly higher cesarean delivery compared to patients with moderate labor pain (P = 0.006). The duration of the first and second stage of labor, fetal heart rate, use of oxytocin and premature rupture of membranes had no differences in the three groups.ConclusionsOur research showed that the degree of pain at the time of epidural analgesia request might influence the rate of cesarean delivery. Further research would be necessary for clarifying the mechanism that the augmentation of pain affects the mode of delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome

Woo

Kim

Lee

et al. 2015

Korean J Anesthesiol

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“…While this is a classic population-based method, it is of course possible – if not likely – that many active labors are not linear in progress. 12-14 Newer sophisticated methods of analyzing labor curves should be considered when the amount and quality of data will support such analyses.…”

Section: Commentmentioning

confidence: 99%

Beta-2 adrenoceptor genotype and progress in term and late preterm active labor

Miller

Smiley

Daniel

et al. 2011

American Journal of Obstetrics and Gynecology

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OBJECTIVE To evaluate whether beta-2 adrenoceptor genotype at a functional polymorphic site encoding for amino acid residue 16 influences rate of cervical dilatation in term and late preterm active labor. STUDY DESIGN Subjects that underwent vaginal delivery at 34 or greater weeks gestational age between May, 2006, and August, 2007, were identified. Each subject had provided venous blood from which DNA was extracted for beta-2 adrenoceptor genotyping. Digital cervical examinations with paired examination times were collected from intrapartum records. Rate of cervical dilatation in active labor was determined using linear regression and rates were compared between genotype groups. RESULTS Among 401 subjects with satisfactory genotype and intrapartum data, overall rate of active labor was 0.76+/−0.01 cm/hr. When labor was compared by genotype, homozygous Arg/Arg16 subjects progressed at a slower rate (0.64+/−0.03 cm/hr) than all other pooled genotypes (0.8+/−0.02 cm/hr). CONCLUSION Homozygous beta-2 adrenoceptor genotype encoding for Arg/Arg16 was associated with slower progress in active labor.

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Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health

Souza

Cecatti

Guida

et al. 2020

Intl J Gynecology & Obste

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Objective To evaluate the use of analgesia during labor in women who had a vaginal birth and to determine the factors associated with its use. Methods A secondary analysis was performed of the WHO Multicountry Survey on Maternal and Newborn Health, a cross‐sectional, facility‐based survey including 359 healthcare facilities in 29 countries. The prevalence of analgesia use for vaginal birth in different countries was reported according to the Human Development Index (HDI). Sociodemographic and obstetric characteristics of the participants with and without analgesia were compared. The prevalence ratios were compared across countries, HDI groups, and regions using a design‐based χ2 test. Results Among the 221 345 women who had a vaginal birth, only 4% received labor analgesia, mainly epidural. The prevalence of women receiving analgesia was significantly higher in countries with a higher HDI than in countries with a lower HDI. Education was significantly associated with increased use of analgesia; nulliparous women and women undergoing previous cesarean delivery had a significantly increased likelihood of receiving analgesia. Conclusion Use of analgesia for women undergoing labor and vaginal delivery was low, specifically in low‐HDI countries. Whether low use of analgesia reflects women’s desire or an unmet need for pain relief requires further studies.

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Mathematical Modeling of the Pain and Progress of the First Stage of Nulliparous Labor

Cited by 39 publications

References 30 publications

The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome

The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome

Beta-2 adrenoceptor genotype and progress in term and late preterm active labor

Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health

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