RESUMEN
OBJECTIVE: The effects of epidural and combined spinal-epidural analgesia on uterine contraction parameters are unclear, although as many as 80% of laboring women use neuraxial analgesia. We explored the effects of epidural and combined spinal-epidural analgesia on all uterine contraction parameters using a retrospective analysis of selected parturients, who required Intrauterine Pressure Catheter (IUPC) instrumentation for clinical management. Additionally, we analyzed the effects of parity, Pitocin dose, and mode of neuraxial anesthesia, i.e. epidural verses combined spinal-epidural on uterine contractility. DESIGN: Using a retrospective within and between repeated measure design we compared uterine contraction parameters at 4 time points (epochs): (1) baseline, (2) pre-epidural fluid bolus, (3) immediate and (4) secondary post-epidural/combined spinal-epidural analgesia to detect differences in contractility over time comparing two types of epidural interventions. METHODS: Eighteen healthy parturients at term gestation were admitted to the labor unit for induction, augmentation, or spontaneous labor. Contraction parameters including frequency, duration, peak intensity, resting intensity and duration, and Montevideo Units (MVUs) were collected using fetal monitor strip data with intrauterine pressure catheter (IUPC) instrumentation. FINDINGS: Parametric and non-parametric tests showed no significant differences within or between the two Epidural intervention groups for frequency, duration, peak intensity, resting intensity and duration, and MVUs at all epochs at the .05 alpha level. Compared with Nulliparous women, multiparous women had significantly lower contraction intensity and longer contraction duration. Based on multilevel modeling (MLM), neither Pitocin dose nor type of epidural intervention revealed significant differences on any contraction parameters. CONCLUSIONS: When parity, other demographic variables and Pitocin dose were statistically controlled, no uterine contraction parameter changed from baseline through 90 min following either epidural or combined spinal-epidural analgesia. Obstetrical care providers should consider the preciseness their contraction monitoring instrumentation and their clinical management preferences as well parity as before prescribing Pitocin after neuraxial analgesia intervention.
Asunto(s)
Analgesia Epidural , Analgesia Obstétrica , Trabajo de Parto , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Contracción UterinaRESUMEN
BACKGROUND: The first stage of labor is significantly longer with epidural analgesia use, implying an alteration in uterine contractility. Although the pre-epidural fluid bolus is used with every epidural and affects as many as 80% of laboring women, its effects on uterine contraction parameters are unknown. DESIGN: Using a retrospective descriptive repeated measures design, we compared uterine contraction parameters including frequency, duration, peak intensity, resting tone, and Montevideo units at baseline and during the intravascular pre-epidural fluid bolus (Bolus) epochs for healthy laboring women at term gestation undergoing augmentation or induction. METHOD: Contraction parameters were compared using data from fetal monitor strips with intrauterine pressure catheter instrumentation. RESULTS: No significant differences were found between epochs for women receiving constant Pitocin dosages (n = 10) using Wilcoxon signed rank tests at .05 α level, but all parameters trended in the direction of improved contractility except frequency, which was unchanged. CONCLUSIONS: These pilot study findings do not support the proposal that the pre-epidural fluid bolus is a contributor to decreased uterine contractility in any parameter. It is possible that the bolus improved myometrial perfusion and metabolic function in the contracting and resting states in less hydrated women.
Asunto(s)
Analgesia Epidural/métodos , Fluidoterapia/métodos , Trabajo de Parto/fisiología , Contracción Uterina/fisiología , Adulto , Femenino , Humanos , Oxitocina/administración & dosificación , Dolor , Proyectos Piloto , Embarazo , Estudios RetrospectivosRESUMEN
Midwives have been involved formally and informally in the training of medical students and residents for many years. Recent reductions in resident work hours, emphasis on collaborative practice, and a focus on midwives as key members of the maternity care model have increased the involvement of midwives in medical education. Midwives work in academic settings as educators to teach the midwifery model of care, collaboration, teamwork, and professionalism to medical students and residents. In 2009, members of the American College of Nurse-Midwives formed the Medical Education Caucus (MECA) to discuss the needs of midwives teaching medical students and residents; the group has held a workshop annually over the last 4 years. In 2014, MECA workshop facilitators developed a toolkit to support and formalize the role of midwives involved in medical student and resident education. The MECA toolkit provides a roadmap for midwives beginning involvement and continuing or expanding the role of midwives in medical education. This article describes the history of midwives in medical education, the development and growth of MECA, and the resulting toolkit created to support and formalize the role of midwives as educators in medical student and resident education, as well as common challenges for the midwife in academic medicine. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.
Asunto(s)
Curriculum , Educación Médica/métodos , Docentes , Relaciones Interprofesionales , Partería/educación , Enfermeras Obstetrices , Femenino , Humanos , Internado y Residencia , Embarazo , Estudiantes de MedicinaRESUMEN
This paper describes a multidisciplinary project of curriculum development and implementation at one university. Universal learning concepts for six health care disciplines in women's health, including nurse-midwifery, are being piloted in an online classroom environment. This multidisciplinary team approach to education distributes the work load, invites experts to share resources, and avoids the duplication of resources across the university departments and schools. This project provides midwifery faculty the opportunity to introduce a new educational paradigm and model the midwifery approach to holistic health care.