Obstetric analgesia in labor and its association with neonatal outcomes.

OBJETIVE: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. METHOD: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. RESULTS: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. CONCLUSION: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

Obstetric analgesia in labor and its association with neonatal outcomes / Analgesia obstétrica en el trabajo de parto y su asociación con resultados neonatales / Analgesia obstétrica no trabalho de parto e sua associação com desfechos neonatais

ABSTRACT Objetives: To investigate the association between analgesia during labor and occurrence of neonatal outcomes. Methods: Retrospective cohort study with medical records of 850 parturient. The exposure variable of interest was receiving pharmacological analgesia during labor and neonatal outcomes were: one- and five-minute Apgar, resuscitation maneuvers and referral of the newborn to Neonatal ICU. A logistic regression was carried out to obtain Odds Ratios and 95% confidence interval, with adjustment for confounding factors. Results: Among the women studied, 35% received analgesia and this use was associated with a greater chance of neonatal outcomes such as one-minute Apgar < 7 (p <0.0001), resuscitation maneuvers (p <0.001) and referral to the Neonatal ICU (p = 0.004), mostly were among low-risk pregnant women, even after adjustments. Conclusions: The use of pharmacological analgesia during labor is associated with one-minute Apgar < 7, resuscitation maneuvers and referral to the Neonatal ICU.

RESUMEN Objetivos: Investigar la asociación entre la analgesia en el trabajo de parto y la aparición de resultados neonatales. Métodos: Estudio de cohorte retrospectivo con datos de 850 parturientas. La exposición fue recibir analgesia farmacológica en el trabajo de parto, resultados: Apgar del primer y quinto minuto < 7, maniobras de reanimación y derivación a la UCIN. La regresión logística se utilizó para obtener el Odds Ratio (OR) y el intervalo de confianza del 95% (IC95%), ajustado por variables de confusión. Resultados: De las mujeres estudiadas, el 35% recibió analgesia y su uso se asoció con una mayor probabilidad de resultados como: Apgar en el primer minuto < 7 (p<0,0001), maniobras de reanimación (p<0,001) y derivación a la UCIN (p=0,004). Conclusiones: el uso de analgesia farmacológica durante el trabajo de parto se asoció con Apgar < 7 en el primer minuto, maniobras de reanimación y derivación a la UCIN.

RESUMO Objetivos: Investigar a associação entre analgesia no trabalho de parto e ocorrência de desfechos neonatais. Métodos: Estudo de coorte retrospectiva com dados de prontuários de 850 parturientes. A exposição foi receber analgesia farmacológica no trabalho de parto e os desfechos: Apgar do primeiro e quinto minuto < 7, manobras de reanimação e encaminhamento para Unidade de Terapia Intensiva Neonatal (UTI). Utilizou-se regressão logística para obter Odds Ratio (OR) e intervalo de 95% de confiança (IC95%), sendo ajustados por confundidores. Resultados: Das mulheres estudadas, 35% receberam analgesia e seu uso esteve associado a maior chance de desfechos, como: Apgar do primeiro minuto < 7 (p<0,0001), manobras de reanimação (p<0,001) e encaminhamento para UTI Neonatal (p=0,004), principalmente entre gestantes de risco habitual, mesmo após ajustes. Conclusões: O uso de analgesia farmacológica durante o trabalho de parto foi associado a Apgar do primeiro minuto < 7, manobras de reanimação e encaminhamento para UTI neonatal.

Exploring Obstetrical Interventions and Stratified Cesarean Section Rates Using the Robson Classification in Tertiary Care Hospitals in the United Arab Emirates.

OBJECTIVE: The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. METHODS: Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). RESULTS: The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS. The rate of vaginal birth after cesarean was 261 (6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. CONCLUSION: The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

Exploring obstetrical interventions and stratified cesarean section rates using the Robson classification in tertiary Care hospitals in the united arab emirates

Abstract Objective The objective of the present study was to explore obstetric management in relation to clinical, maternal and child health outcomes by using the Robson classification system. Methods Data was collected from obstetrics registries in tertiary care hospitals in Dubai, United Arab Emirates (UAE). Results The analysis of > 5,400 deliveries (60% of all the deliveries in 2016) in major maternity hospitals in Dubai showed that groups 5, 8 and 9 of Robson's classification were the largest contributors to the overall cesarean section (CS) rate and accounted for 30% of the total CS rate. The results indicate that labor was spontaneous in 2,221 (45%) of the women and was augmented or induced in almost 1,634 cases (33%). The birth indication rate was of 64% for normal vaginal delivery, of 24% for emergency CS, and of 9% for elective CS.The rate of vaginal birth after cesarean was 261(6%), the rate of external cephalic version was 28 (0.7%), and the rate of induction was 1,168 (21.4%). The prevalence of the overall Cesarean section was 33%; with majority (53.5%) of it being repeated Cesarean section. Conclusion The CS rate in the United Arab Emirates (UAE) is higher than the global average rate and than the average rate in Asia, which highlights the need for more education of pregnant women and of their physicians in order to promote vaginal birth. A proper planning is needed to reduce the number of CSs in nulliparous women in order to prevent repeated CSs in the future. Monitoring both CS rates and outcomes is essential to ensure that policies, practices, and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes.

[Labour epidural analgesia in Martinique: evaluation of quality and accessibility to epidural analgesia by the patients in level one obstetric clinic]. / Analgésie péridurale de travail en Martinique: évaluation de la qualité et de l'accessibilité à l'analgésie péridurale par les parturientes dans une clinique obstétricale de niveau 1.

OBJECTIVES: The main aim of this study was to evaluate real-life experience and the quality of labor epidural analgesia (LEA) by the patients, from the anaesthesia consultation to leaving the clinic after childbirth. STUDY DESIGN: Descriptive study. PATIENTS AND METHODS: This study took place over a period of 8 weeks, at the level I obstetric clinic in Martinique. One hundred and thirty-four successive patients completed an anonymous questionnaire following childbirth. RESULTS: During the study period (134 patients completed the questionnaire, corresponding to 100% return) 127 women had asked for LEA (94%), which was possible in 94%, with a patient satisfaction level of 94% and an average mark for quality at 18/20. The quality of information given at the anaesthesia consultation was judged excellent for 97%, and 91% were reassured by the consultation. The delay between the demand and the LEA procedure was less than 15 min in 63%, and in 39% the procedure was done during the night. The procedure was painless in 63%, and 97% of women were ready to begin the same procedure again. CONCLUSION: This study seems to underline the fact that the needs and the acceptability of LEA are the same in Martinique as in mainland France. This study does not support the hypothesis of the cultural barrier to justify the low level of LEA in the Overseas Departments. An obvious result seems to be that good organization of anaesthesia and obstetric services results in a natural increase in LEA demand.

Dolor en obstetricia: analgesia y anestesia en obstetricia / Analgesia and anesthesia in obstetrics

A pesar de la amplia seguridad y difusión internacional que tienen las técnicas de analgesia y anestesia en obstetricia, aún persisten dudas en algunos aspectos, por lo que es importante promover el conocimiento de los conceptos básicos relacionados con el dolor de parto, sus características y mecanismos de acción, así como los fenómenos relativos a la neurotransmisión de los mismos. Para ello se hace necesario conocer los elementos anatómicos, físicos y químicos involucrados en la transmisión del dolor de parto y su repercusión sistémica, tanto materna como fetal. Igualmente importante resulta la actualización de conocimientos sobre los medios y métodos más utilizados en la actualidad, especialmente en nuestro país, para el alivio del dolor de parto y para la operación cesárea. Numerosos investigadores han demostrado la superioridad de la analgesia peridural sobre otras formas de analgesia para disminuir el dolor, el consumo de O2 y la acidosis materna y fetal. El trabajo de parto produce dolor severo en la mayoría de las mujeres. La técnica ideal de analgesia de parto debería reducir el dolor y permitir a la madre participar activamente en el nacimiento. En suma, la mejor de las técnicas de analgesia será la que produzca mínimos efectos sobre el feto y sobre la evolución del trabajo de parto. (AU)

Ensayo de la mezcla N20/02 al 50 por ciento como analgésico en obstetricia / Assay of premixed N20/02 - al 50 cent per cent as an analgesic in obstetrics

Se evaluó la analgesia lograda con N2O/O2 al 50 por ciento, premezclado (Entonox), administrada interminentemente durante el trabajo de parto y período expulsivo. Participaron 75 pacientes ASA I-II que fueron divididos en cuatro grupos. Grupo 1: 19 pacientes, recibieron meperidina 25 mg. endovenosos; grupo 2: 31 pacientes, N2O/O2 al 50 por ciento; grupo 3: meperidina y luego N2O/O2 (16 pacientes) y grupo 4: 10 pacientes que no recibieron analgésicos durante su trabajo de parto. La analgesia lograda con la mezcla N2O/O2 fue significativamente superior al empleo de meperidina. Más del 70 por ciento las pacientes obtuvo analgesia satisfactoria con N2/O2 y sólo un 15 por ciento con meperidina. Se valoró la repercusión de la mezcla gaseosa sobre la madre, el feto y neonato. Todas las pacientes permanecieron conscientes y cooperativas. Tensión arterial, frecuencia cardíaca y dinámica uterina, no se alteraron con la administración de la mezcla. La saturación de oxígeno con la hemoglobina materna fue la esperada en la casi totalidad de las pacientes, excepto en 5 donde la saturación cayó, luego de respirar la mezcla, durante la relajación uterina. El feto, estudiado a través de monitor electrónico, el neonato mediante escala de Apgar y un grupo reducido de ellos además con pH y gases en sangre de arteria umbilical, no se vieron afectados adversamente con la administración de este analgésico a la madre. La mezcla N2O/O2 al 50 por ciento se presenta como la posiblidad de ofrecer a la paciente en trabajo de parto una anlgesia superior, sin afectar adversamente a la madre, feto y neonato. (AU)