Perineal pain in focus: reviewing topical anaesthetic treatments.

Midwives have opportunities to help postnatal mothers to minimise perineal discomfort associated with perineal trauma following vaginal birth. Perineal trauma and associated pain is common and can have a negative impact on the physical, psycho-social transition to motherhood and family life. This article considers the role local anaesthetic agents have in helping women to relieve perineal pain. Key evidence is presented with associated practice considerations, and future research areas are suggested to broaden our understanding of this important aspect of postnatal care.

Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women.

AIM: women use various labour pain management techniques during birth. The objective of this study is to investigate women׳s use of pharmacological and non-pharmacological labour pain management techniques in relation to birth outcomes. METHODS: a sub-survey of a nationally representative sample of pregnant women (n=1835) from the Australian Longitudinal Study on Women׳s Health. RESULTS: our analysis identified women׳s use of water for labour pain management as decreasing the likelihood of their baby being admitted to special care nursery (OR=0.42, p<0.004) whereas the use of epidural increased this likelihood (OR=3.38, p<0.001) as well as for instrumental childbirth (OR=7.27, p<0.001). Epidural and pethidine use decreased women׳s likelihood of continuing breast-feeding (ORs=0.68 and 0.59, respectively, both p<0.01) whereas the use of breathing techniques and massage for pain control increased the likelihood of women continuing breast-feeding (ORs=1.72 and 1.62, respectively, both p<0.01). CONCLUSIONS: our study illustrates associations between the use of both pharmacological and non-pharmacological labour pain management techniques and selected birth outcomes while controlling for confounding variables. There remain significant gaps in the evidence base for the use of non-pharmacological labour pain control methods and our findings provide a platform with which to develop a broad clinical research programme around this topic.

The efficacy of lavender oil on perineal trauma: a review of the evidence.

Anecdotal evidence suggests that some women find lavender oil effective at relieving some of the symptoms associated with perineal trauma following childbirth. This paper examines the literature detailing the efficacy of lavender oil in wound care in an attempt to place these findings into the context of perineal trauma. The discussion and findings may assist midwives to proceed in a more informed manner in the absence of scientific evidence to underpin the practice of lavender oil use in the perineal context.

The epidural trip: why are so many women taking dangerous drugs during labor?

Two million American women will take an epidural trip this year during childbirth. In most cases, they'll be ill­informed as to possible side effects or alternate methods of pain relief. In many ways, epidurals are the drug trip of the current generation. Similar to street drug pushers, most anesthesiologists in the delivery rooms maintain a low profile, avoid making eye contact and threaten to walk out if they don't get total cooperation. Women get epidurals for one of the main reasons so many women smoked pot in the 1970s­their friends are doing it. This article examines why so many women in the Western world are compelled to take powerful drugs during their labor and exposes the risks epidurals pose to both mother and baby.

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: double-blind randomised controlled trial.

OBJECTIVE: to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery. DESIGN: double-blind, randomised-controlled trial. SETTING: a birth centre, in the city of Sao Paulo, Brazil. PARTICIPANTS: from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n=16 per treatment per group). INTERVENTIONS: an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5ml) and to suture spontaneous lacerations (1ml), followed by repeated doses (1ml) until pain was completely inhibited. MEASUREMENTS AND FINDINGS: the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1ml, 95% confidence interval (CI) 0.4-1.6) and second-degree (3.7ml, 95% CI 1.6-5.8) lacerations (p=0.002 and 0.001, respectively). A 0.3ml (95% CI 1.5-2.1) average decrease in anaesthetic volume was observed with episiotomy (p=0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1-2ml in 95% and 3-4ml in 50% of first-degree lacerations, respectively, and 1-6ml in 88% and 7-15ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15ml, regardless of anaesthetic solution used. KEY CONCLUSIONS: our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy.

Edema agudo de pulmón y tratamiento secuencial con nifedipino y ritodrina en la amenaza de parto pretérmino / Acute pulmonary edema and sequential treatment with nifedipine and ritodrine in threatened premature labor

Se presenta el caso de un edema agudo de pulmón en una gestante que se diagnosticó de amenaza de parto pretérmino; se instauró tratamiento secuencialmente con nifedipino y con ritodrina al no tener una respuesta adecuada a la primera medicación. Probablemente, la hidratación, la corticoterapia y el uso secuencial de ambos medicamentos contribuyeron a la etiología del edema agudo del pulmón, que tuvo una evolución favorable, tanto en la madre como en el feto (AU)

We report the case of a pregnant woman with threatened premature labor who developed acute pulmonary edema after treatment with nifedipine with inadequate response and subsequent treatment with ritodrine. The intravenous fluids, corticosteroid treatment and the sequential use of both drugs may have contributed to the development of the pulmonary edema. Maternal and fetal outcomes were satisfactory (AU)

Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial.

OBJECTIVE: To assess the effectiveness of 600 microg oral misoprostol on postpartum haemorrhage (PPH) and postpartum anaemia in a low income country home birth situation. DESIGN: Double blind randomised controlled trial. SETTING: Twenty-six villages in rural Gambia with 52 traditional birth attendants (TBAs). SAMPLE: One thousand, two hundred and twenty-nine women delivering at home under the guidance of a trained TBA. METHODS: Active management of the third stage of labour using three 200-microg misoprostol tablets and placebo or four 0.5-mg ergometrine tablets (standard treatment) and placebo. Tablets were taken orally immediately after delivery. MAIN OUTCOME MEASURES: Measured blood loss, postpartum haemoglobin (Hb), difference between Hb at the last antenatal care visit and three to five days postpartum. RESULTS: The misoprostol group experienced lower incidence of measured blood loss > or =500 mL and postpartum Hb <8 g/dL, but the differences were not statistically significant. The reduction in postpartum (compared with pre-delivery) Hb > or = 2 g/dL was 16.4% with misoprostol and 21.2% with ergometrine [relative risk 0.77; 95% confidence interval (CI) 0.60-0.98; P= 0.02]. Shivering was significantly more common with misoprostol, while vomiting was more common with ergometrine. Only transient side effects were observed. CONCLUSIONS: Six hundred micrograms of oral misoprostol is a promising drug to prevent life-threatening PPH in this setting.

[Prevention of iron deficiency anemia--influence on the course of pregnancy, delivery and the infant's status]. / Wplyw profilaktyki niedokrwistosci z niedoboru zelaza na przebieg ciazy, porodu oraz stan pourodzeniowy noworodka.

BACKGROUND: Iron deficiency is probably the most common nutritional disturbance in the world. At the highest risk, irrespective of economical status, are women at the reproductive age--especially those who are pregnant. Retrospective analysis of a course of gestation, delivery and the infant's status depending on mothers' iron supplementation during pregnancy. Medical notes of healthy 860 pregnant women hospitalized at term in the Clinic of Perinatology and Gynaecology, Zabrze, Poland were analyzed. Patients were divided into two categories: Group I (n = 610) were those having iron subjunction and Group II (n = 250) those who did not. Mean gestational age at the delivery was significantly lower in those without the prophylaxis. These patients had significantly higher rate of preterm deliveries and caesarean sections. Macroscopic abnormalities of the afterbirth were commoner in this group as were bleeding during III labour stage and indications for postpartum curettage. insignificantly lower mean birth weight and 1st/5th minute Apgar scores had children born to women without supplementation. Routine iron supplementation in women with initially normal haemoglobin levels seems to be a safe strategy for preventing perinatal complications.