Continuing epidural analgesia during the second stage and ACOG definition of arrest of labor on maternal-fetal outcomes.

BACKGROUND: Despite an increase in the rates of epidural labor analgesia, continuation of epidural labor analgesia in the second stage of labor (CEADSSOL) was interrupted by care providers due to fears of increased risk of operative delivery and adverse neonatal outcomes. Therefore, we evaluated the effect of CEADSSOL and the newer American College of Obstetricians and Gynecologists (ACOG) definition of arrest of labor on the length of secondary stage of labor, newborn outcomes, and mode of delivery. METHODS: This is a retrospective cohort study. Data collection began during March 2014 and ended in May 2015, 1 year after implementation of both interventions. The primary outcome was the length of secondary stage of labor, mode of delivery and neonatal outcome (Apgar < 7, at 5 minutes). The implementation of continuing epidural analgesia during the second stage of labor was performed with 0.08%-0.15% ropivacaine and 0.1-0.2 µg/mL sufentanil. RESULTS: There were a total 10 414 deliveries during the study period. The length of the second stage of labor has no significant differences among groups. The cesarean delivery rate decreased 4.1% (36% vs 40.1%, P = .0038). Moreover, no significant difference was found in neonatal Apgar scores less than 7 at 5 minutes between two phases. Maternal outcomes remained unchanged. Post-intervention neonatal parameters including NICU admissions (P < .001), incidences of antibiotics usage (P < .0001), intubation (P = .0003), and 7 days mortality (P = .0020) were remarkably reduced compared to pre-interventions. CONCLUSION: The important finding of this study was the improvement in neonatal outcomes by implementing two simultaneous interventions without a cost of increased operative delivery.

The effect of labor epidural analgesia on maternal-fetal outcomes: a retrospective cohort study.

PURPOSE: To evaluate the impact of labor epidural analgesia on maternal-fetal safety outcomes in a signal Chinese academic medical center. METHODS: A single-intervention impact study was conducted at The Second Affiliated Hospital, Wenzhou Medical University. The study period was divided into three phases: (1) baseline phase: from January 1 and June 30, 2009 when no analgesic method was routinely employed during labor; (2) phase-in period: the epidural analgesia was implemented 8 a.m.-5 p.m. during weekdays; and (3) the post-No Pain Labor N'Delivery phase when the labor epidural was applied 24 h a day, 7 days a week, from June 1, 2010 and June 30, 2011. The maternal-fetal safety outcomes of delivery were compared between the different periods. RESULTS: There were 15,415 deliveries with 42.3% of nulliparous parturients in the 31-month study period. As the primary outcomes, the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5% after full implementation. As the secondary outcomes, the rate of episiotomy and severe perineal injury after the implementation periods were significant decreased. The rate of postpartum oxytocin administration was decreased by 17.8%. No significant difference between the baseline and implementation periods was found in the rate of postpartum hemorrhage, Apgar scores less than 7 at both 1 and 5 min, 7-day mortality, and the overall neonatal intensive care unit admission rate. CONCLUSION: Implementation of labor epidural analgesia increased the vaginal delivery rate and use of labor epidural analgesia is safe to parturients and fetus.

[The best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy].

OBJECTIVE: To investigate the best concentration ratio of propofol controlled-infusion combined with sevoflurane in anesthesia for patients undergoing laparoscopy. METHODS: One hundred patients undergoing cholecystectomy under laparoscopy were randomly divided into 5 equal groups treated with propofol controlled plasma at the concentrations of 1, 2, 3, 4, and 5 microg/ml respectively (Group 1-5). Bispectral index (BIS) was maintained at a range of 50 +/- 5 by adjusting sevoflurane inhalation. The end-tidal concentration of sevoflurane (ETsevo), systolic pressure, diastolic pressure, recovery time, awareness, and post-operative nausea and vomiting (PONV) within 24 h after operation were recorded. The best concentration ratio of propofol controlled-infusion combined with sevoflurane with the definition as the highest ETsevo without PONV decrease along with the increase of propofol concentration. RESULTS: ETsevo was negatively correlated with and propofol concentration. There were nit significant differences in the systolic pressure, diastolic pressure, and recovery time among different groups. No incidence of intra-operative awareness was found. The PONV rates of Group 1 and 2 were both 60%, significantly higher than those of the other 3 groups (all P < 0.05) without significant differences in PONV rate among Group 3 - 5. The best concentration ratio of propofol controlled-infusion combined with sevoflurane was propofol controlled-infusion at the concentration of 1 microg/ml with ETsevo at the concentration as 1 minimal alveolar concentration (MAC). CONCLUSION: Propofol controlled-infusion at the concentration of 1 microg/ml with ETsevo at the concentration as 1 MAC is the best concentration ratio with low PONV rate and a possibility to prevent intra-operative awareness.

[Intermediate and long term clinical effects of uterine arterial embolization with sodium alginate microspheres in treatment of diffuse adenomyosis].

OBJECTIVE: To study intermediate and long term efficacy of uterine arterial embolization (UAE) with sodium alginate microspheres (KMG) at diameters 500-00 microm in treatment of diffuse adenomyosis. METHODS: Totally 40 patients with standard diffuse adenomyosis were enrolled and treated with UAE. KMG at diameters 500-700 microm for vascular embolization were used to embolize the arteries. The degree of dysmenorrhea, amount of menorrhea and uterine volume, as well as the level of serum CA125, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) were investigated before and after UAE. RESULTS: The follow up rates were 100% (40/40), 100% (40/40), 80% (32/40), 68% (27/40), 58% (23/40) after uterine arterial UAE 12, 24, 36, 48 and 60 months respectively. The early, intermediate and long-term effective rates were 90% (36/40), 88% (28/32), 83% (19/23). The degree of dysmenorrhea, the amount of menorrhea and the uterine volume, as well as serum CA125 all decreased significantly 3 months after UAE at varying degrees (P < 0.05). Compared with other follow-up time, the degree of dysmenorrhea and the amount of menorrhea declined to their lowest point at 6 month after UAE (P < 0.01). Paralleled with the decrease of volume of uterine, serum CA125 also decreased significantly and reached the lowest level 12 months later compared with other follow-up times (P < 0.01). Even at the 12th month after UAE serum CA125 was not normal and FSH, LH and E2 did not change all the times after UAE, (P > 0.05). No recurrence was found during the 60 months after UAE. CONCLUSION: KMG used in UAE at diameters 500-700 microm has good intermediate and long term effectiveness in treatment of diffuse adenomyosis with no side effects.