Comparison of Patient-Controlled Epidural Analgesia (PCEA) with Basal Infusion and Programmed Intermittent Epidural Bolus (PIEB) with PCEA in Labour Analgesia – A One-Year Retrospective Study

Introduction: For the past thirty years, patient-controlled epidural analgesia (PCEA) with basal infusion regimen has successfully improved the variable intensity of labour pain due to its advantage in allowing self-titration by the parturient. However, a recent review on programmed intermittent epidural bolus (PIEB) with PCEA regimen proved to be superior compared to PCEA with basal infusion, in terms of higher maternal satisfaction with longer duration of analgesia and lower local anaesthetic consumption. Following the introduction of PIEB at our institution, we did a study to compare maternal satisfaction, mode of delivery and neonatal outcome between these two methods of epidural labour analgesia. Methodology: We conducted a one-year retrospective analysis of data from obstetric analgesia service (OAS) record sheet and hospital information system evaluating outcomes after labour analgesia delivered by PCEA with basal infusion regimen (PCEA + basal infusion) and PIEB with PCEA regimen (PIEB+PCEA). The primary outcome was maternal satisfaction towards their labour analgesia. Other outcome parameters were the mode of delivery and neonatal Apgar scores. Outcomes were compared using independent t-test and Chi-square test. Result: There was no significant difference in maternal satisfaction between the two groups (P=0.398). However, a higher percentage of excellent satisfaction was found in the PIEB + PCEA group compared to that in the PCEA + basal infusion group (PIEB+PCEA 146/172 (84.9%) vs PCEA + basal infusion 138/171 (80.7%) respectively). There was no significant difference in the mode of delivery (P=0.296). However, PIEB+PCEA group had a higher percentage of spontaneous vaginal deliveries (PIEB+PCEA 87/172 (50.6%) vs PCEA + basal infusion 70/171 (40.9%) respectively) and a lower percentage of Caesarean deliveries (PIEB + PCEA 71/172 (41.3%) vs PCEA + basal infusion 87/171 (50.9%) respectively). Despite statistically significant differences found in Apgar scores in 1 minute (P=0.036), there was no significant difference in the scores at 5 minutes (P=0.107). Apgar scores and mean (SD) at 1 minute and 5 minutes for PIEB + PCEA were 7.77(0.85) and 8.91(0.55) respectively, and for PCEA + basal infusion the scores at 1 minute and 5 minutes were 7.92(0.39) and 8.98(0.19) respectively. Conclusion: PIEB with PCEA regimen is a newer epidural delivery technique for labour analgesia in our centre, which produced a comparable outcome to PCEA with basal infusion regimen.

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LABOUR ANALGESIA BY NEUROAXIAL BLOCKADE TECHNIQUE AND ITS LABOUR OUTCOME

10.36106/paripex/3500473 ◽

2021 ◽

pp. 10-13

Author(s):

R.Shanthi Malar ◽

V. Vijayalakshmi ◽

P. Thenmozhi

Keyword(s):

Epidural Analgesia ◽

Apgar Score ◽

Mode Of Delivery ◽

Fold Increase ◽

Study Groups ◽

Labour Analgesia ◽

Control Group ◽

Second Stage ◽

Second Stage Of Labour ◽

Significant Difference

BACKGROUND:Pain relief during labour is an important component of modern obstetric care and can be produced by neuraxial, systemic or inhalational analgesia. Recent meta-analyses have supported epidural analgesia as the most efficacious technique.A good labour analgesia should aim at good pain relief during delivery process,at the same time not causing foetal acidosis,ensures safe for both mother and the baby. AIM OF THE STUDY:To study the influence of epidural analgesia on maternal and neonatal outcome MATERIALS AND METHODS:The study was conducted in the depar tment of Obstet r ics and Gynecology,GOVT.Stanley Medical College,Govt.RSRM LYING IN HOSPITAL,CHENNAI over a period of eight months from July 2019 to February 2021. The study was performed in 120 selected subjects. The study subjects were divided based on intervention – labour analgesia into 2 study groups. In this study,change in vital parameters,fetal heart rate,assessment of pain score,Duration of first and second stage of labour,mode of delivery,APGAR score and the need for NICU admission were noted and recorded.Any complications during the course of labour were also recorded. RESULTS:In this study,there was no significant difference in the mean duration of first and second stage of labour in both the study and control groups.The mean Apgar score of babies at one minute was 7.02 and at 5 minutes was 8.07 in the labour analgesia group and showed no significance.Maternal satisfaction for the effect of epidural analgesia,60.00% of the patients of epidural analgesia, the incidence of satisfactory/very satisfactory experience was meaningfully and significantly more in labour analgesia group subjects compared to control group subjects by 30 % with a 2 fold increase. CONCLUSION: As per this study labour analgesia using neuroaxial blockade technique are more likely to encounter increasing maternal satisfaction and good quality labour pain reduction.

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EPIDURAL ANALGESIA IN LABOUR

The Professional Medical Journal ◽

10.29309/tpmj/2008.15.01.2689 ◽

2008 ◽

Vol 15 (01) ◽

pp. 9-12

Author(s):

HUMAIRA TABASSUM ◽

SOHAIL SHAHZAD ◽

SHAHIDA SHERAZ ◽

Muhammad Boota

Keyword(s):

Data Analysis ◽

Epidural Analgesia ◽

Apgar Score ◽

Analytical Study ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Outcome Study ◽

Maternal Satisfaction ◽

Apgar Scores ◽

Labour Time

To evaluate the effects of epidural analgesia on the painrelief and maternal and fetal outcome. Study design: Comparative & analytical study. Place and Duration: In MilitaryHospital Rawalpindi fromOct 1998 to Oct 1999. Patients and Method: 100 full term healthy primigravida admitted forinduction of labour. Fifty patients were given epidural analgesia and 50 served as control to whom no analgesia wasgiven. Outcome measures observed were duration of labour, mode of delivery; Apgar score of the newborn; untowardreaction and intra-partum complications. Results: The data analysis revealed that epidural analgesia significantlyprolonged labour time and was associated with increased instrumental delivery rate. Significant reduction in intra-partumfetal complications was seen, while C-section rate was not effected by epidural analgesia. Apgar scores were higherin analgesia group as compared to control. Conclusion: Although accused of prolonging labour time, it’s benefits interms of great maternal satisfaction and reduced intra-partum complications still makes it an option for labouringpatients.

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Comparative study between levobupivacaine with clonidine and levobupivacaine with fentanyl in epidural labour analgesia in rural set up

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173988 ◽

2017 ◽

Vol 5 (9) ◽

pp. 4087

Author(s):

Prashant K. Mishra ◽

Anand K. Singh ◽

Pragati Divedi

Keyword(s):

Epidural Analgesia ◽

Rating Scale ◽

Breakthrough Pain ◽

Numerical Rating Scale ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Labour Analgesia ◽

Significant Difference ◽

Group 2 ◽

Group 1

Background: Neuraxial techniques are the gold standard for intrapartum labour analgesia. Neuraxial labour analgesia using new local anaesthetics such as levobupivacaine has become very popular by virtue of the safety and lesser motor blockade caused by these agents. Multiple randomized controlled trials comparing epidural analgesia with systemic opioids, nitrous oxide or both have demonstrated lower internal pain scores and higher maternal satisfaction with neuraxial analgesia. The purpose of this study is to compare fentanyl and clonidine combination with levobupivacaine in terms of effect of epidural labour analgesia on fetal outcome and incidence of instrumental or caesarean delivery and duration of second stage of labour.Methods: A total of 50 primiparous with singleton pregnancy and vertex presentation and cervical dilatation of 3-5 cm were enrolled for the study in our hospital in department of obstetrics and gynecology. They were divided into group 1 and group 2 (25 patients in each group). Group 1 received 10 ml. of 0.125% isobaric levobupivacaine with 25µg fentanyl and group 2 received 10 ml of 0.125% isobaric levobupivacaine with 60 µg clonidine. Parturients were given epidural analgesia on numerical rating scale (NRS) Score >3. Breakthrough pain supplemented with 3-5 ml of 0.125% levobupivacaine. Data collected were demographic profile of the patients, analgesic qualities, 1st and 2nd stage labour duration, side effects and feto-maternal outcome.Results: Post treatment mean NRS were almost similar between two groups at all periods except at 15 minutes when it was significantly lower for group 2 (2.64±0.49). Onset of analgesia was earlier in group 2 (13.68±0.94) in comparison to group 1 (15.36±1.18) and was statistically significant.Conclusions: In conclusion Group 2 (levobupivacaine with clonidine) showed significant difference in early onset of analgesia but did not show any significant difference in duration of labour, maternal and fetal outcome and mode of delivery.

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Amino acid infusion in oligohydromnios and increase in AFI and impact on perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190294 ◽

2019 ◽

Vol 8 (2) ◽

pp. 617

Author(s):

Isha Sunil ◽

Chejerla Sunitha ◽

Harkirat Kaur

Keyword(s):

Amino Acid ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Apgar Scores ◽

Acid Infusion ◽

Amino Acid Infusion ◽

Vaginal Deliveries ◽

Group A ◽

One Year ◽

Group B

Background: Decreased amniotic fluid is related to adverse maternal and perinatal outcomes. The purpose of this study was to evaluate the role of amino acid infusion in patients of oligohydromnios and compare the perinatal outcome in the two groups.Methods: This study was conducted in the Department of Obstetrics and Gynaecology, ASCOMS Hospital, Jammu for a period of one year from October 2017 to September 2018. A total of 50 women with AFI <8 cm were enrolled in the study . They were divided into two groups of 25 each. Group A were given amino acid infusion and Group B were not given any intervention. These were compared for increase in AFI and perinatal outcome.Results: In the present study, the gain in AFI in Group A was 2.32 ± 0.67 and in group B was 1.32 ± 1.03 which was statistically significant. The perinatal outcome was better Group A compared to Group B with decreased incidence of meconium stained liquor, low birth weight, low APGAR scores and NICU admissions and increase in vaginal deliveries as compared to caesarean sections.Conclusions: The present study suggests that parentral transfusion of amino acid in cases of oligohydromnios significantly increases the AFI of the patient and decreases the incidence of caesarean sections, meconium stained liquor, low APGAR scores and NICU admissions.

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Inflammatory and oxidative alterations of water immersion and epidural analgesia during the labor

Medical Science and Discovery ◽

10.36472/msd.v7i8.407 ◽

2020 ◽

Vol 7 (8) ◽

pp. 598-602

Author(s):

Ümit Yasemin Sert ◽

Özlem Uzunlar ◽

Nezaket Kadıoğlu ◽

Tuba Candar ◽

Yaprak Engin Üstün

Keyword(s):

Epidural Analgesia ◽

Water Immersion ◽

Demographic Data ◽

Total Serum ◽

Control Group ◽

Epidural Group ◽

Birth Process ◽

Apgar Scores ◽

Significant Difference ◽

And Control

Objective: Water immersion and epidural analgesia are both pain relief methods used to perceive less pain during the labor process. There are concerns about the maternal and fetal outcomes, although studies presented no significant complication directly related to these methods. We aimed to compare the IL-1 and 6 levels, Total serum oxidant (TOS), antioxidant (TAS) and catalase levels of births with epidural analgesia, water immersion and conventional birth without analgesia. Material and Methods: A total of 88 patients were included in the study (The water immersion group included 29 patients, while the epidural analgesia and control group included 30 and 29 patients respectively). Umblical cord IL-1, IL-6, catalase, TAS, TOS levels, neonatal Apgar scores, duration of birth process and demographic data were compared between three groups Results: There was no significant difference between the three groups in terms of age, Body mass index (BMI), gravidity, parity, gestational week, and birth weight (p>0.05). TOS and IL-6 levels were significantly lower in epidural group than others (p=0.031, p=0.019 respectively). Apgar scores were significantly lower in epidural group (p<0.001). Conclusion: The water immersion and epidural analgesia were found to have no adverse effect on oxidative status and infection parameters of women.

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Relationship between painless delivery and postpartum depression: The Japan Environment and Children’s Study (JECS)

10.21203/rs.3.rs-135960/v1 ◽

2021 ◽

Author(s):

Nobuhiro Suzumori ◽

Takeshi Ebara ◽

Hazuki Tamada ◽

Taro Matsuki ◽

Hirotaka Sato ◽

...

Keyword(s):

Postpartum Depression ◽

Cesarean Section ◽

Epidural Analgesia ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

First Trimester ◽

Regression Analyses ◽

One Year ◽

Spinal Epidural ◽

Paracervical Block

Abstract Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with painless delivery, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without analgesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, painless vaginal delivery was associated with a higher risk of postpartum depression (aOR: 1.218, 95% confidence interval: 1.067–1.391), compared with vaginal delivery without analgesia or cesarean section. Nevertheless, the risk disappeared one year after delivery. Among the pregnant women who requested painless delivery, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.0001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%) and cesarean delivery (3.5%) groups. Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after painless vaginal delivery, compared with vaginal delivery without analgesia or cesarean section. Requests for painless delivery continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying personality characteristics, including a tendency to worry.

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Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor

Journal of Perinatal Medicine ◽

10.1515/jpm-2018-0128 ◽

2019 ◽

Vol 47 (2) ◽

pp. 176-182 ◽

Cited By ~ 3

Author(s):

Katharina Redling ◽

Sabine Schaedelin ◽

Evelyn Annegret Huhn ◽

Irene Hoesli

Keyword(s):

Mode Of Delivery ◽

Case Series ◽

Neonatal Outcomes ◽

Efficacy And Safety ◽

Retrospective Case ◽

Application Form ◽

Oral Misoprostol ◽

Vaginal Deliveries ◽

Significant Difference ◽

Time To Delivery

Abstract Objectives To compare the oral application form of misoprostol with the misoprostol vaginal insert (MVI) in a Swiss cohort with special regards to the efficacy and safety. Methods We performed a retrospective case series including a historical group induced with oral misoprostol (MO, n=101) and an MVI group (n=101). The primary outcome was time to delivery. Secondary outcomes were mode of delivery, occurrence of tachysystole, use of analgesia and neonatal adverse outcome. Results A total of 202 women were included in the analysis (101 in the MVI as well as in the MO group). Time from start of induction to delivery was significantly shorter in the MVI group compared to the MO group (15.91 h vs. 37.68 h, P<0.001). Within the first 24 h, 78.2% of the women in the MVI group had given birth compared to 28.7% in the MO group (P<0.001). Tachysystole occurred more often in the MVI group (22.8% vs. 5.0%, P<0.001). Women in the MVI group more often needed opioid analgesia during the induction before onset of active labor (31.7% vs. 2.0%, P<0.001). There was no significant difference between neonatal outcomes in the two groups. Conclusion Time to delivery was significantly shorter in the MVI group with a higher rate of vaginal deliveries within the first 24 h. However, patients needed more opioids for pain relief during induction with MVI. There was no difference in neonatal outcomes.

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Labour with low dose epidural analgesia: maternal perception and fetal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20180195 ◽

2018 ◽

Vol 7 (2) ◽

pp. 689 ◽

Cited By ~ 1

Author(s):

Vasudha Sawant ◽

Archana Kumbhar

Keyword(s):

Epidural Analgesia ◽

Apgar Score ◽

Low Dose ◽

Mode Of Delivery ◽

Fetal Outcome ◽

Natural Phenomenon ◽

Second Stage ◽

Second Stage Of Labour ◽

Significant Difference ◽

Vertex Presentation

Background: Experiencing labour pains and giving birth to infant is normal physiological process. Though it is a natural phenomenon, it produces severe pain which requires analgesia to relieve pain during labour. The objective of this study was to compare effects of low dose epidural analgesia verses no analgesia during labour on mother and fetus.Methods: Here in this study we have assessed effect of epidural analgesia on mother and fetus. Total we have taken 60 women in age group of 20-26 years with full term pregnancy (37-42 weeks). Those who have entered spontaneous labour with vertex presentation, without any previous uterine surgery, clinically adequate pelvis. We had divided these women in 2 groups, 30 were given epidural analgesia and 30 without any analgesia. Variables recorded were pain score during labour using VAS, duration of labour during each stage, mode of delivery, Apgar score of newborn at 1 minute and 5 minutes.Results: Present study shows that duration of first stage of labour in epidural and non-analgesia group are same. Second stage of labour is prolonged in epidural group than non-analgesia group. Both groups had normal APGAR score. Epidural analgesia is not associated with any change in mode of delivery. Visual analogue scale is good with epidural analgesia.Conclusions: There was no significant difference in first stage of labour in both group. Second stage of labour was slightly prolonged in EA group than control, but it was less than two hours. No harmful neonatal outcome in epidural analgesia.

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Labor epidural analgesia versus without labor epidural analgesia for multiparous women: a retrospective case control study

BMC Anesthesiology ◽

10.1186/s12871-021-01355-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuzhi Luo ◽

Zhaowen Chen ◽

Xujian Wang ◽

Changyu Zhu ◽

Shili Su

Keyword(s):

Blood Loss ◽

Epidural Analgesia ◽

Group Analysis ◽

Labor Pain ◽

Retrospective Case ◽

Cervical Dilation ◽

Apgar Scores ◽

Significant Difference ◽

Multiparous Women ◽

Labor Epidural

Abstract Background Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of their obviously shortened labor length. Methods A total of 811 multiprous women were retrospective enrolled and firstly divided into two groups: LEA group or non-LEA group. And then they were divided into seven subgroups and analyzed according to the use of LEA and cervical dilation. The primary outcomes (time intervals, blood loss and Apgar scores) and secondary outcomes (maternal demographic characteristics and birth weight) were collected by checking electronic medical records. Results The prevalence of using LEA in multiprous women was 54.5 %. Using LEA significantly lengthened the duration of labor stage by 56 min (P < 0.001), increased the blood loss (P < 0.001) and lowered Apgar scores (P = 0.001). In the comparison of sub-group analysis, using LEA can obviously prolong the duration of first-second stage in women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.014), while there was no significant difference with 4 cm or more cervical dilation (P = 0.69). Using LEA can significantly increased the blood loss when the initiation of LEA in the women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.035), meanwhile there were no significantly differences in the women with 4 cm or more cervical dilation (P = 0.524). Using LEA can significantly lower the Apgar scores when the initiation of LEA in the women with 2 cm cervical dilation (P = 0.001) and 4 cm or more cervical dilation (P = 0.025), while there were no significantly differences in the women with 3 cm cervical dilation (P = 0.839). Conclusions Labor epidural analgesia for the multiparous woman may alter progress of labor, increase postpartum blood loss and lower Apgar scores. Early or late initiation of LEA should be defined as with cervical dilatation of less or more than 3 cm and the different effect should be understand. Trial registration ChiCTR2100042746. Registered 27 January 2021-Prospectively registered, http://www.chictr.org.cn.

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Relationship between delivery with anesthesia and postpartum depression: The Japan Environment and Children’s Study (JECS)

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03996-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nobuhiro Suzumori ◽

Takeshi Ebara ◽

Hazuki Tamada ◽

Taro Matsuki ◽

Hirotaka Sato ◽

...

Keyword(s):

Postpartum Depression ◽

Epidural Analgesia ◽

Vaginal Delivery ◽

Mode Of Delivery ◽

First Trimester ◽

Regression Analyses ◽

Postpartum Depressive Symptoms ◽

One Year ◽

Spinal Epidural ◽

Paracervical Block

Abstract Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with delivery with anesthesia, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without anesthesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, vaginal delivery with anesthesia was associated with a higher risk of postpartum depression (aOR: 1.233, 95% confidence interval: 1.079–1.409), compared with vaginal delivery without analgesia. Nevertheless, the risk dropped off one year after delivery. Among the pregnant women who requested delivery with anesthesia, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%). Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after vaginal delivery with anesthesia, compared with vaginal delivery without analgesia. Requests for delivery with anesthesia continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying maternal environmental statuses.

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