Asunto(s)
Analgesia Obstétrica , Anestesia Obstétrica , Anestesia Raquidea , Cesárea , Competencia Clínica , Urgencias Médicas , Femenino , Humanos , Mala Praxis , EmbarazoAsunto(s)
Analgesia Obstétrica , Anestesia Raquidea , Recuento de Plaquetas , Cesárea , Femenino , Humanos , EmbarazoRESUMEN
OBJECTIVES: To investigate the association between epidural analgesia for labour-pain relief and mode of delivery. STUDY DESIGN: The Swedish medical birth register covers 99% of all births and contains prospectively collected information from all delivery units in Sweden. The present population-based cohort study includes singleton births among nulliparae during 1998-2000, excluding deliveries with elective caesarean section, giving study population of n=94,217. The frequencies of epidural block in this population were estimated for each delivery unit. The outcomes studied were non-elective caesarean section and instrumental delivery. RESULTS: There was no clear association between frequency of epidural block and caesarean section and instrumental delivery, respectively. Delivery units with the lowest (20-29%) and the highest (60-64%) relative frequencies of epidural block had the lowest proportion of caesarean section (9.1%). For the other groups the proportion varied between 10.3 and 10.6%. Instrumental deliveries were most common, 18.8%, in delivery units with 50-59% frequency of epidural block use. The lowest incidence (14.1%) was in units using epidurals in 30-39% of cases. In the other groups (20-29, 40-49 and 60-64%) the proportion varied between 15.3 and 15.7%. CONCLUSIONS: This investigation shows no clear association between epidural use and caesarean section or instrumental delivery, indicating that there is no reason to restrict the epidural rate to improve obstetric outcome.
Asunto(s)
Analgesia Epidural/estadística & datos numéricos , Cesárea/estadística & datos numéricos , Extracción Obstétrica/estadística & datos numéricos , Analgesia Epidural/efectos adversos , Femenino , Humanos , Incidencia , Paridad , Embarazo , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Suecia/epidemiología , Resultado del TratamientoRESUMEN
OBJECTIVES: To investigate the analgesic effect and obstetric outcome after single-shot intrathecal sufentanil with bupivacaine in late labour. STUDY DESIGN: Forty multiparous women in advanced labour were given a spinal injection of sufentanil 7.5 microg and bupivacaine 2 mg. Pain intensity was recorded by the parturient on a visual analogue scale. The quality of pain relief was also rated with a verbal score directly after delivery. Side effects, such as hypotension, pruritus, sedation, nausea and motor block were noted. Obstetric parameters were followed and recorded. Apgar score and umbilical artery pH were noted. RESULTS: Median visual analogue scores after 5, 15, 30, 60, 90, 120 and 150 min were 1.5, 0.5, 0, 1, 1.5, 2 and 3, respectively. Seventy-seven percent of the parturients scored the analgesic quality as excellent. Six parturients had hypotension. Motor block, sedation and nausea were rare. Pruritus was seen in 85% of the cases. No ceasarean section was performed. Vacuum extraction was done in six (15%) cases. Oxytocin augmentation was needed in 26 (65%) of the parturients. Fetal heart rate disturbances following the spinal block were seen in four cases. Apgar scores were high. No neonate had Apgar < 7. CONCLUSIONS: Intrathecal block with sufentanil 7.5 microg in combination with bupivacaine 2 mg is a very effective pain relief in late labour. Due to its limited duration it is important to select women in rapid progress of labour, and active obstetric management is necessary. It is also very important that the obstetrician is aware of the risk of non-reassuring fetal heart rate changes after intrathecal block.