United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women

Butwick, Alexander J.; Bentley, Jason; Wong, Cynthia A.; Snowden, Jonathan M.; Sun, Eric; Guo, Nan

doi:10.1001/jamanetworkopen.2018.6567

Cited by 96 publications

(87 citation statements)

References 37 publications

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“…Subjects assigned to the control arm were also more likely to utilize positioning (or changes in position) during the intervention (73.7 vs. 23.8%, p ¼ 0.002) and on average had a higher heart rate following the intervention than those assigned to the VR arm (86.8 vs. 76.3, p ¼ 0.01). Other secondary outcomes did not differ (►Table 3).…”

Section: Resultsmentioning

confidence: 95%

“…2 The most recent data suggest that overall 73.1% of women will opt for neuraxial analgesia during labor, though there is significant variation by region. 3 While many women opt for pharmacologic or neuraxial analgesia pain relief, there is also significant interest by women in complementary and alternative medicine (CAM) methods for pain relief. One Australian study reported that 73% of their sample used at least one kind of complementary therapy during pregnancy, some of which were for pain relief in labor.…”

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confidence: 99%

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Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial

2020

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Objective Virtual reality (VR) represents a potential method for easing labor pain and in nonpregnant patients has been shown to achieve similar or greater analgesia than hydromorphone. Few studies of VR have been performed in pregnant women. The aim of this randomized controlled trial (RCT) is to evaluate whether VR is effective in reducing pain in laboring women. Study Design An open-label, RCT of nulliparous, term women in labor in a tertiary care hospital. We included women with a pain score level of 4 to 7 having regular contractions at least every 5 minutes. We excluded women who had received any pharmacologic pain relief including neuraxial analgesia and those with contraindications to VR. Participants were randomized to up to 30 minutes of either VR or the control arm (no additional intervention). Our primary outcome was the difference in differences from pre- to postintervention pain score. Prespecified secondary outcomes included postintervention pain scores, duration of intervention use, pharmacologic analgesia use, maternal vitals, and obstetric outcomes. Results From March 2018 to February 2019, 40 subjects were enrolled, randomized, and completed the study; 19 were randomized to control and 21 to the VR arm. Most baseline characteristics were similar between groups. For the primary outcome, those assigned to the control arm had a statistically significant increase in pain of +0.58, while the VR arm had a significant reduction in pain of −0.52 (p = 0.03). There was also a difference in the proportion who had a minimum clinically important difference in pain (0% control and 23.8% VR; p = 0.049). Postintervention maternal heart rate was higher in the control arm (86.8 vs. 76.3, p = 0.01). Most other secondary outcomes did not differ. Conclusion In our study, we found that VR was effective for reducing pain in women in labor as compared with those receiving no intervention. Key Points

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Section: Resultsmentioning

confidence: 95%

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Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial

2020

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“…The use of epidural analgesia for labor in the United States was 73.1% in 2015, and as high as 86% at an academic tertiary center. (3,4) Epidural analgesia has been deployed in Vietnam in the past decade, but the technique is not uniformly covered by Vietnamese health insurance and many women remain unaware of this option.…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic factors associated with request for labor epidural analgesia in a tertiary obstetric hospital in Vietnam

Nguyen

Farber

Phan

et al. 2020

Preprint

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Background Labor epidural pain relief remains underutilized in developing countries and may serve as a marker of health care access disparity. Here we examine the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetrics and gynecology hospital in Vietnam.Methods This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. Utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia.Results A total of 417 women had vaginal deliveries during the study period. 207 women (49.6%) utilized epidural analgesia for pain relief during labor and 210 did not. Parturients more likely to utilize labor epidurals were older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous (OR 2.8 95% CI 1.85-4.25), from an urban area, with higher income (OR 6.47, 95% CI 2.59-19.23), and with higher level of education.ConclusionsFactors related to a parturient’s request for epidural analgesia during labor at our tertiary obstetric hospital included include age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographics.

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“…Neuraxial labor analgesia is widely used to reduce pain during childbirth, ranging from 37 to 80% in the US [75]. One such neuraxial labor analgesia technique is epidural anesthesia.…”

Section: Labor Analgesiamentioning

confidence: 99%

Enabling pregnant women and their physicians to make informed medication decisions using artificial intelligence

Davidson

Boland

2020

J Pharmacokinet Pharmacodyn

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The role of artificial intelligence (AI) in healthcare for pregnant women. To assess the role of AI in women's health, discover gaps, and discuss the future of AI in maternal health. A systematic review of English articles using EMBASE, PubMed, and SCOPUS. Search terms included pregnancy and AI. Research articles and book chapters were included, while conference papers, editorials and notes were excluded from the review. Included papers focused on pregnancy and AI methods, and pertained to pharmacologic interventions. We identified 376 distinct studies from our queries. A final set of 31 papers were included for the review. Included papers represented a variety of pregnancy concerns and multidisciplinary applications of AI. Few studies relate to pregnancy, AI, and pharmacologics and therefore, we review carefully those studies. External validation of models and techniques described in the studies is limited, impeding on generalizability of the studies. Our review describes how AI has been applied to address maternal health, throughout the pregnancy process: preconception, prenatal, perinatal, and postnatal health concerns. However, there is a lack of research applying AI methods to understand how pharmacologic treatments affect pregnancy. We identify three areas where AI methods could be used to improve our understanding of pharmacological effects of pregnancy, including: (a) obtaining sound and reliable data from clinical records (15 studies), (b) designing optimized animal experiments to validate specific hypotheses (1 study) to (c) implementing decision support systems that inform decision-making (11 studies). The largest literature gap that we identified is with regards to using AI methods to optimize translational studies between animals and humans for pregnancyrelated drug exposures.

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United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women

Cited by 96 publications

References 37 publications

Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial

Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial

Sociodemographic factors associated with request for labor epidural analgesia in a tertiary obstetric hospital in Vietnam

Enabling pregnant women and their physicians to make informed medication decisions using artificial intelligence

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