Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome]

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.     

Neonatal Outcome after Trial of Labor Compared with Elective Repeat Cesarean Section

ABSTRACT: Background: Trial of labor after cesarean section has been an important strategy for lowering the rate of cesarean delivery in the United States, but concerns regarding its safety remain. The purpose of this study was to evaluate the outcome of newborns delivered by elective repeat cesarean section compared to delivery following a trial of labor after cesarean. Methods: All low‐risk mothers with 1 or 2 previous cesareans and no prior vaginal deliveries, who delivered at our institution from December 1994 through July 1995, were identified. Neonatal outcomes were compared between 136 women who delivered by elective repeat cesarean section and 313 women who delivered after a trial of labor. To investigate reasons for differences in outcome between these groups, neonatal outcomes within the trial of labor group were then compared between those mothers who had received epidural analgesia (n = 230) and those who did not (n = 83). Results: Infants delivered after a trial of labor had increased rates of sepsis evaluation (23.3% vs 12.5%, p = 0.008); antibiotic treatment (11.5% vs 4.4%, p = 0.02); intubation to evaluate for the presence of meconium below the cords (11.5% vs 1.5%, p < 0.001); and mild bruising (8.0% vs 1.5%, p = 0.008). Within the trial of labor group, infants of mothers who received epidural analgesia were more likely to have received diagnostic tests and therapeutic interventions including sepsis evaluation (29.6% vs 6.0%, p = 0.001) and antibiotic treatment (13.9% vs 4.8%, p = 0.03) than within the no‐epidural analgesia group. Conclusions: Infants born to mothers after a trial of labor are twice as likely to undergo diagnostic tests and therapeutic interventions than infants born after an elective repeat cesarean section, but the increase occurred only in the subgroup of infants whose mothers received epidural analgesia for pain relief during labor. The higher rate of intervention could relate to the well‐documented increase in intrapartum fever that occurs with epidural use. (BIRTH 30:2 June 2003)     

Epidural analgesia and fetal head malposition at vaginal delivery

OBJECTIVE: To determine if nulliparas who delivered with on-demand epidural analgesia are more likely to have malpositioning of the fetal vertex at delivery than women delivered during a period of restricted epidural use. METHODS: A retrospective cohort of nulliparous women with spontaneous labor delivered during a 12-month period immediately before the availability of on-demand labor epidural analgesia was compared with a similar group of nulliparas delivered after labor epidural analgesia was available on request. The primary outcome variable was a non-occiput anterior position or malpositioned fetal head at vaginal delivery. RESULTS: The frequency of epidural use increased from 0.9% before epidural analgesia became available on demand to 82.9% afterward. Fetal head malpositioning at vaginal delivery occurred in 26 of 434 (6.0%) women delivered in the before period compared with 29 of 511 (5.7%) in the after period (relative risk 0.95, 95% confidence interval 0.6, 1.6). No statistically significant difference in the incidence of fetal head malpositioning was present after patients were stratified by mode of delivery (Mantel-Haenszel weighted relative risk 0.94, 95% confidence interval 0.6, 1.4). The study sample size provided 85% power to detect a two-fold increase in the incidence of fetal malpositioning from a baseline rate of 6% associated with on-demand epidural use. CONCLUSION: Providing on-request labor epidural analgesia to nulliparas in spontaneous labor did not result in a clinically significant increase in the frequency of fetal head malpositioning at vaginal delivery.     

NO FREE LUNCH ON LABOR DAY: The Risks and Benefits of Epidural Analgesia During Labor*

Epidural analgesia provides effective pain relief for women during labor. However, like all medical interventions, it also has potential side effects such as longer labor and a higher rate of intrapartum fever and operative vaginal delivery. A recent meta-analysis of randomized studies by Halpern et al concluded there was no association between epidural use and cesarean delivery. A critique of that meta-analysis, included in this paper, concludes that there are currently insufficient data to determine whether epidural analgesia leads to increased rates of cesarean delivery. This paper also presents results from several recent studies related to epidural analgesia conducted at Brigham and Women's Hospital in Boston. One study demonstrates a significant influence of prenatal planning on use of epidural during labor. Additional studies examine the strong association of epidural analgesia with intrapartum fever and the consequences of that fever for mother and infant. Epidural analgesia should remain an option available to women during labor. A more complete understanding of the risks and benefits that accompany its use is essential so that women and their care providers can make informed choices about pain relief during labor. J Nurse Midwifery 1999;44:394–8 © 1999 by the American College of Nurse-Midwives.     

No free lunch on labor day. The risks and benefits of epidural analgesia during labor.

Epidural analgesia provides effective pain relief for women during labor. However, like all medical interventions, it also has potential side effects such as longer labor and a higher rate of intrapartum fever and operative vaginal delivery. A recent meta-analysis of randomized studies by Halpern et al concluded there was no association between epidural use and cesarean delivery. A critique of that meta-analysis, included in this paper, concludes that there are currently insufficient data to determine whether epidural analgesia leads to increased rates of cesarean delivery. This paper also presents results from several recent studies related to epidural analgesia conducted at Brigham and Women's Hospital in Boston. One study demonstrates a significant influence of prenatal planning on use of epidural during labor. Additional studies examine the strong association of epidural analgesia with intrapartum fever and the consequences of that fever for mother and infant. Epidural analgesia should remain an option available to women during labor. A more complete understanding of the risks and benefits that accompany its use is essential so that women and their care providers can make informed choices about pain relief during labor.     

蛛网膜下腔-硬膜外联合阻滞麻醉用于分娩镇痛206例分析

目的　探讨分娩镇痛的效果及对产程、母婴状况的影响。方法　采用蛛网膜下腔 -硬膜外联合阻滞(CSEA)用于分娩镇痛的产妇 2 0 6例作为观察组 ,将未采用任何分娩镇痛药物而进入产程的产妇 2 0 6例作为对照组 ,分别观察产程时间、分娩方式、产后出血、胎儿窘迫及新生儿窒息情况。结果　两组产程活跃期比较 ,有极显著性差异 (P <0 0 1) ;两组分娩方式比较有显著性差异 (P <0 0 5 ) ;两组胎儿窘迫、新生儿窒息及产后出血发生率比较 ,无显著性差异 (P >0 0 5 )。结论　CSEA用于分娩镇痛 ,疼痛阻滞完善 ,加速了产程活跃期及第二产程的进展 ,降低了剖宫产及阴道难产率 ,对母婴均无不良影响     

Trial of labor without oxytocin in patients with a previous cesarean section

In a 30-month period, 261 of 557 (46.8%) patients underwent a trial of labor. Of these, 215 patients (82.4%) achieved vaginal delivery. The major controversial issues regarding vaginal delivery in patients with a prior cesarean section are oxytocin administration, the inclusion of patients with recurring indications, and the use of epidural analgesia. Oxytocin was not used in this study. When our results were compared to those of others who used oxytocin liberally we found that oxytocin augmentation was not a major factor in increasing significantly the success and vaginal delivery rate. We believe that oxytocin usage should be reserved for selected patients with well-defined indications. When the primary cesarean section was for cephalopelvic disproportion, 66.6% delivered vaginally. This success rate justifies the inclusion of these patients in a trial of labor. Epidural analgesia proved to be a safe and efficient procedure. There was no maternal or perinatal mortality related to trial of labor.     

Effect of epidural analgesia on the primary cesarean rate

There is some concern that providing parturients with epidural analgesia increases the likelihood of cesarean delivery. Because of the widespread interest in cesarean rates and the expanding use of epidural analgesia, we believed that this contention should be assessed. Hospital records were reviewed to determine the primary cesarean rate for 1084 parturients who delivered at our institution during 15 months in which there was a 24-hour "on demand" epidural service. This was compared with our primary cesarean rate during 15 months in which epidural analgesia was not available, even on physician request. Because of the characteristics of our institution, this control group consisted of patients from the same population base managed by the same eight obstetricians using the same management techniques. For patients in labor, the primary cesarean rate overall was 9.0% before and 8.2% after the epidural service began (P = .626). When subpopulations based on parity and indication for cesarean delivery were studied, there were no significant changes in the cesarean rate. These results demonstrate that the availability of on-demand epidural analgesia for patients in labor did not increase the primary cesarean rate, either in the aggregate or for any of the subpopulations studied.     

蛛网膜下腔阻滞加硬膜外阻滞对母儿预后及分娩方式的影响

目的探讨蛛网膜下腔阻滞(腰麻)加硬膜外阻滞及连续硬膜外阻滞在分娩镇痛过程中对产妇分娩方式及母儿合并症的影响。方法采用回顾性方法,将2001年8月至2004年10月施行分娩镇痛的2593例产妇,分为腰麻加硬膜外阻滞(联合麻醉组)1482例,硬膜外阻滞组1111例;未施行分娩镇痛的4078例产妇为对照组。比较3组产妇在分娩方式、母儿合并症方面的差异。结果(1)分娩方式比较:①剖宫产:联合麻醉组为423例(28.5%),硬膜外阻滞组为351例(31.6%),对照组为1847例(45.3%),3组间相互比较,差异有统计学意义(P<0.01);②产钳助产:联合麻醉组为231例(15.6%),硬膜外阻滞组为207例(18.9%),对照组为357例(8.8%),联合麻醉组及硬膜外阻滞组与对照组比较,差异有统计学意义(P<0.01);③阴道顺产:联合麻醉组为828例(55.9%),硬膜外阻滞组为553例(49.8%),对照组为1874例(46.0%),3组间相互比较,差异有统计学意义(P<0.01)。(2)母儿合并症比较:①胎儿窘迫、活跃期停滞、活跃期延长、第二产程延长发生率比较:联合麻醉组分别为33.7%(499/1482)、17.3%(256/1482)、1.8%(27/1482)、6.1%(91/1482),硬膜外阻滞组分别为29.8%(331/1111)、18.1%(201/1111)、1.7%(19/1111)、5.4%(60/1111),对照组分别为28.5%(1163/4078)、8.3%(337/4078)、0.8%(34/4078)、3.0%(124/4078),联合麻醉组及硬膜外阻滞组的母儿合并症发生率均高于对照组,两者比较,差异有统计学意义(P<0.01)。②产后出血及新生儿窒息的发生率比较:联合麻醉组分别为4.3%(63/1482)、1.0%(15/1482),硬膜外阻滞组分别为4.1%(45/1111)、0.8%(9/1111),对照组分别为3.9%(159/4078)、1.4%(56/4078),联合麻醉组及硬膜外阻滞组产后出血及新生儿窒息的发生率与对照组比较,差异无统计学意义(P>0.05)。结论产程中对产妇实施腰麻加硬膜外阻滞镇痛,可降低剖宫产率,但增加产钳助产率。分娩镇痛与发生活跃期停滞、活跃期延长、第二产程延长有关,但不增加产后出血及新生儿窒息的发生率。     

Epidural analgesia and the course of delivery in term primiparas

OBJECTIVES: Epidural analgesia provides the most effective pain control during labor. Of great concern is its influence on the course of delivery and perinatal complications. DESIGN: The aim of the study was to assess the effect of epidural analgesia on the course of delivery and perinatal outcome. MATERIALS AND METHODS: 609 deliveries among 1334 (323 women with epidural analgesia (53%) and 548 without epidural analgesia (47%)) met the following criteria: primipara, singleton, live pregnancy, > =37 weeks' gestation, cephalic presentation of a fetus, lack of contraindication for vaginal delivery. The incidence of instrumental deliveries and fetal distress, duration of the first, second and third stage of labor, perinatal outcome, perinatal complications and perinatal blood loss and were analyzed. RESULTS: The incidence of fetal distress during second stage of labor was significantly higher in the epidural group (12.69 vs. 6.99%, P=0.02). The incidence of fetal distress during first stage of labor did not differ in both groups (10.53% vs. 8.74%, NS). Cesarean sections rate was similar in epidural and non-epidural group (17.7 vs. 18.2%, NS). Among vaginal deliveries duration of the first and second stage of labor was longer in epidural group (6.5+/-2.4 vs. 5.4+/-2.5 godz., P=0,000003 and 47.3+/-34.8 vs. 29.1+/-25.8 min., P=0.000003) and this was independent of period of time between onset of first stage of labor and epidural analgesia. Oxitocin use was significantly more frequent in the epidural group (20.6 vs. 10.3%, P<0.004). There were no statistically significant differences in the rates of instrumental vaginal deliveries, 1 and 5-minute Apgar scores, length of third stage of labor and perinatal blood loss in patients with and without epidural analgesia. Perinatal outcome did not depend on previous use of epidural analgesia or mode of analgesia for the operation in cesarean section subgroup. CONCLUSION: Epidural labor analgesia is associated with slower progress of labor but has no adverse effect on perinatal outcome and perinatal complications.     

Does pain relief during delivery decrease the risk of postnatal depression?

BACKGROUND: To test the hypothesis that sufficient pain relief during delivery decreases the risk of postnatal depression. METHODS: As part of a prospective follow-up study of the risk factors for postnatal depression and its impact on the mother-infant interaction and child development, 185 parturients filled in the Edinburgh Postnatal Depression Scale (EPDS), first during the first postpartum week and again (n = 162) 4 months later. The incidence and the risk of high EPDS scores was calculated according to the mode of delivery and the mode of pain relief during vaginal delivery, also after adjusting for the length of labor. RESULTS: Mothers who received epidural/paracervical blockade during their delivery spent less time in the delivery room than mothers in the nitrous oxide/acupuncture group (p = 0.033) or mothers with no pain relief (p = 0.026) and had shorter length of labor than mothers without pain relief (p = 0.04). The adjusted risk of depressive scores at the first postnatal week was decreased in the epidural/paracervical group when compared with no analgesia group (OR: 0.25, 95% CI: 0.09-0.72). This difference was not shown at 4 months postpartum. Elective or emergency cesarean section did not increase the risk of high EPDS scores at the first week or at 4 months postpartum. CONCLUSION: The mode of pain relief during vaginal delivery seems to be associated with the incidence of postpartum depression, especially immediately after delivery.     

Labor epidural analgesia in pre-eclampsia: a prospective study

AIM: To assess the safety of labor epidural analgesia in subjects with pre-eclampsia. METHODS: Nulliparous laboring women were included in the prospective study. One hundred pre-eclamptic nullipara who were given epidural analgesia (group I) were compared with 100 nullipara with pre-eclampsia who were not given epidural analgesia (group II). The outcome was further compared with 200 women who were not pre-eclamptic, but who were given epidural analgesia (group III), and also with 200 women who were normotensive and who were not given epidural analgesia (group IV). RESULTS: In group I, 58% of subjects delivered normally compared with 60% in group II. The operative vaginal delivery rate was 28% in group I compared with 24% in group II (P = 0.62), and the cesarean section rate was 14% and 16% in groups I and II, respectively, (P = 0.8). The difference was not statistically significant. The incidence of a prolonged second stage of labor was also not increased in pre-eclamptic women who received epidural analgesia. Five of the neonates in group I had a 5-min APGAR score <6 compared with seven neonates in group II. The necessity of neonatal resuscitation was also not significantly increased in group I (P = 1.0). The incidences of fetal distress (P = 0.71), non-progressive second stage of labor (P = 0.66) and cephalopelvic disproportion (P = 0.90) were not statistically different in the pre-eclampsia group compared with the non-pre-eclampsia group. Similar results were noted when these outcome measures were compared with the other two groups. With regard to hypotension and tachycardia in the pre-eclamptic subjects who were given epidural analgesia, no statistical difference (P = 0.72) was seen when compared with the normotensive subjects. CONCLUSION: In the absence of coagulopathy, epidural analgesia is a safe and effective method for labor pain relief, even for subjects with pre-eclampsia.     

Effect of availability of a parturient-elective regional labor pain relief service on the mode of delivery.

BACKGROUND/PURPOSE: Regional analgesia for labor pain relief is effective and widely used. This study evaluated the controversial association between mode of operative delivery and patient-elective labor regional analgesia. METHODS: We retrospectively compared the rates of instrumental vaginal and cesarean deliveries in parturients before the introduction, in the first 15 months after, and in the subsequent 36 months after the implementation of an elective labor regional analgesia service. A total of 9779 low-risk singleton cephalic pregnancies above 36 weeks of gestation were included. The maternal and fetal outcomes for parturients before the service was implemented and in those with or without pain relief service in the two postimplementation periods were analyzed. Multivariate logistic regression analyses were used to investigate the effects of maternal age, gestational weeks and newborn weight, in addition to regional analgesia, on the mode of delivery in nulliparous women. RESULTS: After adjusting for maternal age, gestational weeks, and newborn weight, no significant association was found between regional analgesia and cesarean delivery in nulliparas. Further, this lack of association was not affected by the receipt of regional analgesia in the early period of program implementation or in the period after staff had become familiar with the service. A higher rate of instrumental vaginal delivery was noted in nulliparas given regional analgesia. CONCLUSION: Regional analgesia for pain relief increased the likelihood of instrumental vaginal delivery, but did not increase the likelihood of cesarean delivery.     

Previous cesarean delivery: understanding and satisfaction with mode of delivery in a subsequent pregnancy in patients participating in a formal vaginal birth after cesarean counseling program

The objective of this study was to determine patient satisfaction with delivery experience in a pregnancy subsequent to primary cesarean and to evaluate knowledge about a trial of labor after cesarean in patients enrolled in a formal vaginal birth after cesarean educational program. During a 12-month period, women with a history of cesarean delivery who were participating in a formal counseling program regarding the risks and benefits of vaginal birth after cesarean were surveyed in the antepartum and postpartum periods. Patient demographics, past birth experience, understanding of the risks and benefits of vaginal birth after cesarean, pregnancy outcomes, and ratings of satisfaction and recovery following the current delivery were collected. Patients were divided into four groups depending on their mode of delivery in the current pregnancy: group 1 succeeded at vaginal birth, group 2 underwent repeat cesarean in labor, group 3 delivered by cesarean before labor, and group 4 chose repeat cesarean. Ninety-five patients enrolled in the study. There were 26 patients in group 1, 18 patients in group 2, 16 patients in group 3, and 35 patients in group 4. The four groups had significant differences in patient satisfaction following the current delivery compared with the previous cesarean delivery ( p = 0.001). The patients who had a successful trial of labor exhibited the largest median change in score. The patients who delivered by cesarean during labor had the smallest median change in score. Nonetheless, 92% of these patients were pleased that they had attempted a vaginal birth. When questioned about the risks associated with a trial of labor after cesarean delivery, 92% of postpartum patients answered all questions correctly. Patients participating in a formal counseling program exhibit a high level of understanding about the risks and benefits of a trial of labor. Although the most satisfied patients were those who succeeded at vaginal birth, most women valued the opportunity to attempt a vaginal birth regardless of outcome.     

脉冲波疗法用于分娩镇痛的临床效果分析

目的 探讨脉冲波疗法用于分娩镇痛的临床效果以及对产妇和新生儿的影响.方法 150例初产妇随机分成镇痛组和对照组,镇痛组在产程中使用GT-4A分娩镇痛工作站.观察两组产妇的镇痛效果、产程时间、分娩方式、产后出血及镇痛对母儿的影响,并将镇痛组与75例硬膜外自控镇痛的初产妇即PCEA组分娩方式及缩宫素使用率进行比较.结果 镇痛组镇痛前后疼痛评分差异有非常显著性(P＜0.01);镇痛组与对照组的活跃期、第一产程、第二产程时间比较差异有显著性(P＜0.005);镇痛组与对照组比较剖宫产率差异有显著性(P＜0.05),产程中缩宫素使用率差异无显著性(P＞0.05);镇痛组与对照组比较产后出血及新生儿评分等差异无显著性(P＞0.05).镇痛组与PCEA组比较缩宫素使用率及阴道助产率有显著性差异(P＜0.05),镇痛组明显低于PCEA组.结论 GT-4A分娩镇痛工作站为非药物非创伤性镇痛,具有良好的镇痛效果,可缩短产程,对母儿无不良影响,提高产妇对分娩的依从性,能降低剖宫产率,操作简单,产妇易于接受,是一种较为理想的分娩镇痛方法.     

Neuraxial analgesia versus intravenous remifentanil for pain relief in early labor in nulliparous women

Objective

To assess if there is a difference in duration of labor, the mode of delivery, average Visual Analog Scale (VAS) pain scores, maternal overall satisfaction with analgesia, side effects and neonatal outcomes in nulliparous women who received early labor analgesia with either epidural, patient-controlled IV analgesia (PCIA) with remifentanil or combined spinal–epidural (CSE) techniques.

Study design

This is a prospective randomized interventional study.

Subjects and methods

The study included 1,140 healthy nulliparous women (with term, singleton pregnancies) early in labor, requesting labor analgesia, during the period from September 2009 to August 2011 at TAIBA Hospital in Kuwait. The participants were randomized to receive either epidural analgesia (Group I), or PCIA with remifentanil (Group II) or CSE analgesia (Group III). The primary outcome was the rate of cesarean delivery.

Results

CSE analgesia was associated with a statistically highly significant decrease in labor duration (from analgesia to vaginal delivery), duration of latent and active phases of the first stage, and duration of the second stage of labor, average VAS pain scores, and a highest maternal overall satisfaction score with analgesia (P?<?0.01) as compared to epidural analgesia or PCIA with remifentanil.

Conclusion

In terms of labor duration, average VAS pain scores, and maternal overall satisfaction score with analgesia, CSE analgesia is superior to that provided by epidural analgesia or PCIA with remifentanil for pain relief in early labor in nulliparous women. However, there were no differences in the mode of delivery, side effects or neonatal outcomes between the three techniques.     

Intrathecal narcotics for obstetric analgesia in a community hospital

OBJECTIVE: Our objective was to establish whether intrathecal narcotics for obstetric analgesia offer an adequate and cost-effective alternative to epidural analgesia with minimal side effects in our small, semirural community hospital with limited anesthesia coverage. STUDY DESIGN: Low-risk patients at ≥35 gestational weeks in active labor were offered intrathecal narcotics. A retroactive chart review of every patient receiving an intrathecal injection was compared with a chart review of the next consecutive low-risk patient who did not receive an intrathecal narcotic. Age, parity, and status of labor at the time of application were noted, as was the subsequent rate of labor and the type of delivery. Side effects such as changes in vital signs, headache, vomiting, pruritis, urinary retention, and/or respiratory depression were noted. All study patients received fentanyl, 25 to 35 μg, plus 0.25 to 0.3 mg of preservative-free morphine combined with 6 to 8 mg of lidocaine. Within 15 minutes of delivery intravenous nalbuphine (Nubain), 5 mg, and oral naltrexone, 12.5 mg, were administered. Pain relief was recorded as excellent, satisfactory, or unsatisfactory (requiring additional medication). RESULTS: During the 30-month review period, 90 patients (3% of total deliveries) received intrathecal narcotics. There were three sets of twins, for a total of 93 live births. Ten patients (11%) required primary cesarean section, and of the 83 vaginal births 35 (38%) were spontaneous, two (2%) required forceps deliveries, and 46 (49%) were delivered by vacuum extraction, which was significantly higher than the 28 (31%) for controls. The rate of labor was not affected, with both groups requiring a similar rate of oxytocin (Pitocin) augmentation. Significantly more patients receiving intrathecal narcotics experienced pruritus and urinary retention compared with controls. There was no incidence of respiratory depression. Eighty-four (93%) of the 90 patients reported excellent pain relief, five patients had satisfactory relief lasting 2.5 to 6 hours, and one was unsatisfactory. CONCLUSIONS: In our hospital with limited anesthesia services intrathecal narcotics offer excellent labor pain relief with manageable side effects and without adverse obstetric outcome. (AM J Obstet Gynecol 1994;170:1643-8.)     

Obstetric pain relief and its association with remembrance of labor pain at two months and one year after birth

The association between obstetric pain relief and long-term memory of pain is poorly researched in spite of the fact that a woman's memory of childbirth may affect her emotional wellbeing and future reproduction. The aim of this study was to investigate the association between epidural analgesia and other forms of pain relief, and memory of pain at two months and one year after birth. A national sample of 2482 Swedish speaking women with vaginal delivery or emergency cesarean section preceded by labor were followed from early pregnancy to one year after birth. Data were collected by three postal questionnaires: in early pregnancy, and two months and one year after the birth. Recollection of intense pain at two months and one year was associated with high rates of pain relief, and this was most obvious regarding epidural analgesia in first-time mothers. When comparing women with the same pain score at two months postpartum who had and who did not have an epidural, the first group seemed to have greater difficulty forgetting pain 10 months later. Possible explanations of these findings are discussed.     

Obstetric pain relief and its association with remembrance of labor pain at two months and one year after birth

The association between obstetric pain relief and long-term memory of pain is poorly researched in spite of the fact that a woman's memory of childbirth may affect her emotional wellbeing and future reproduction. The aim of this study was to investigate the association between epidural analgesia and other forms of pain relief, and memory of pain at two months and one year after birth. A national sample of 2482 Swedish speaking women with vaginal delivery or emergency cesarean section preceded by labor were followed from early pregnancy to one year after birth. Data were collected by three postal questionnaires: in early pregnancy, and two months and one year after the birth. Recollection of intense pain at two months and one year was associated with high rates of pain relief, and this was most obvious regarding epidural analgesia in first-time mothers. When comparing women with the same pain score at two months postpartum who had and who did not have an epidural, the first group seemed to have greater difficulty forgetting pain 10 months later. Possible explanations of these findings are discussed.     

不同时机行椎管内阻滞分娩镇痛对镇痛效果及分娩结局的影响

目的 探讨不同时机行椎管内阻滞分娩镇痛对镇痛效果及分娩结局的影响.方法 收集2018年1月至2018年12月期间福建省泉州德诚医院收治临产后要求分娩镇痛产妇252例,随机分为对照组、实验组各126例,对照组在宫口开大3～4 cm时实施镇痛,实验组在宫口开大1～2 cm时实施镇痛,比较两组的镇痛效果及分娩结局.结果 实验...