Fetal bradycardia due to intrathecal opioids for labour analgesia: a systematic review (original) (raw)
Related papers
Regional Anesthesia and Pain Medicine, 2001
Background and Objectives: Intrathecal opioids used to relieve labor pain have been associated with uterine hyperactivity and nonreassuring fetal heart rate abnormalities. We retrospectively evaluated all charts of singleton, term, vertex-presenting parturients in active labor requesting neuraxial pain relief during a 1-year period for the occurrence of nonreassuring fetal heart rate tracings. Methods: Three different strategies to relieve labor pain were routinely used in our department: conventional epidural using 10 mL bupivacaine 0.125% and sufentanil 0.75 g/mL; combined spinal and epidural (CSE) using intrathecal sufentanil (7.5 g); and CSE using intrathecal bupivacaine (2.5 mg) and sufentanil (1.5 g). Charts (n ϭ 1,293) were evaluated for nonreassuring fetal heart tracings and uterine hyperactivity as well as for neonatal and labor outcome. Results: Intrathecal sufentanil (7.5 g) produced significantly more nonreassuring tracings and uterine hyperactivity. However, this did not result in more cesarean deliveries or detrimental neonatal outcome. Conclusion: Based on this retrospective analysis, we conclude that intrathecal sufentanil in a dose of 7.5 g has the potential to result in more nonreassuring fetal heart rate tracings compared with both intrathecal analgesia using a bupivacaine (2.5 mg)/sufentanil (1.5 g) mixture and epidural analgesia using bupivacaine, sufentanil, and epinephrine.
Effect of single low dose intrathecal labor analgesia on maternal and fetal outcome
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Background: Labour is one of the most painful experiences women encounter during their lifetime and the experience is different for each women. Aim of the study was to evaluate the effect of low dose intrathecal labour analgesia using fentanyl, bupivacaine and morphine on maternal and fetal outcome.Methods: 100 parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4-6cm were enrolled for the study. They were randomized into two groups of 50 each, using computer based block randomization. Group 1 (N=50) received intrathecal labor analgesia using. Fentanyl (25µg), bupivacaine (2.5mg) and morphine (250µg) and Group 2 (N=50) received programmed labor. The two groups were well matched in terms of age, weight, height, parity, baseline vitals and mean cervical dilatation at the time of administration of labor analgesia . Progress of labor, duration of analgesia, and neonatal APGAR score were recorded. Feto-maternal and neonatal outcomes were studie...
A study on the maternal and Perinatal outcome of Obstetric analgesia during labour
2014
INTRODUCTION: The birth of an neonate to the pain free parturient will be the most rewarding moment in Obstetric practice. The most painfull experience in a woman s life is labour. Quite unbearable is the pain of child birth and its related agony at times is beyond description. The mother of yesterday is no more the mother of today”. Complex, psycological, physiological interactions are involved in labour. Multiple system like gastrointestinal, cardiovascular, respiratory, genito urinary, neuro endocrine may be affected if pain not adequately controlled, blood flow to the placenta which may be reduced due to pain lead to altered fetal homeostasis. These consequences are avoidable by effective analgesia during labour. There are several methods that can be employed in labour pain control like intravenous anesthesia’ opiod analgesics local anesthetics inhalational anesthetics regional anesthetics, lumbar epidural analgesics The most effective and least depressant treatments for labor p...
Labor analgesia and its impact on the maternal and perinatal outcomes
Revista Da Associacao Medica Brasileira, 2023
OBJECTIVE: This study aimed to assess adverse maternal and perinatal outcomes in parturients undergoing labor analgesia. METHODS: This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)-analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)-analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)-analgesia performed with cervical dilatation ≥9.0 cm. RESULTS: Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50-9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62-6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%). CONCLUSION: Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.
The dynamics of epidural and opioid analgesia during labour
Archives of Gynecology and Obstetrics, 2016
Purpose To investigate the association of analgesia, opioids or epidural, or the combination of both with labour duration and spontaneous birth in nulliparous women. Methods A secondary data analysis of an existing cohort study was performed and included nulliparous women (n = 2074). Durations of total labour and first and second labour stage were calculated with Kaplan-Meier estimation for the four different study groups: no analgesia (n = 620), opioid analgesia (n = 743), epidural analgesia (n = 482), and combined application (n = 229). Labour duration was compared by Cox regression while adjusting for confounders and censoring for operative births. Logistic regression was used to investigate the association between the administration of different types of analgesia and mode of birth. Results Most women in the combined application group were first to receive opioid analgesia. Women with no analgesia had the shortest duration of labour (log rank p \ 0.001) and highest chance of a spontaneous birth (p \ 0.001). If analgesia was administered, women with opioids had a shorter first stage (p = 0.018), compared to women with epidural (p \ 0.001) or women with combined application (p \ 0.001). Women with opioids had an increased chance to reach full cervical dilatation (p = 0.006). Women with epidural analgesia (p \ 0.001) and women with combined application (p \ 0.001) had a prolonged second stage and decreased chance of spontaneous birth compared to women without analgesia. Conclusions Women with opioids had a prolonged first stage, but increased chance to reach full cervical dilatation. Women with epidural analgesia and women with both opioid and epidural analgesia had a prolonged first and second stage and a decreased chance of a spontaneous birth. Keywords Combined analgesia Á Labour duration Á Spontaneous birth Á Cox regression Á Longitudinal studies Á Timing of interventions Abbreviations ACOG American Congress of Obstetrics and Gynecologists EDD Expected delivery date HR Hazard ratio CI Confidence interval PROM Prelabour rupture of membranes VBAC Vaginal birth after caesarean This study based on the M.Sc. thesis of the first author. The data set was funded by the German Research Council (DFG).
Geburtshilfe und Frauenheilkunde, 2019
Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolo...
MedPulse International Journal of Anesthesology, 2019
Background: Ideally pain relief with epidural techniques should be produced with minimum disturbance to the progress of labour or to sympathetic functions, sensory functions (proprioception) and motor functions of the CNS. Materials and Methods: This study was undertaken after obtaining approval from the Research and Ethics committee of the hospital. Written informed consent was obtained from all parturients. This study did not interfere with the normal obstetric management technique employed in this hospital. This is a prospective case control study. The study population included 120 pregnant women 60 of who were given labour analgesia-'GROUP T' and 60 of who underwent a delivery without labour analgesia-'GROUP C'. Studied patients were ASA physical status I and II parturients with term singleton gestations and cephalic presentation who requested analgesia. When the patient was in active labor, achieving a cervical dilation of 3-4cm and requested analgesia, a combined spinal-epidural technique was used. Parturients were excluded who were unwilling, any contraindication to regional technique, history of local anesthetic allergy, psychological or neurological diseases. Results: There were no differences between the groups with respect to demographic and labor characteristics. Gestational age. Height and weight, Parity, cervical dilatation at which analgesia was instituted, were compared and no significant difference was obtained (p>0.05). Though a higher mean systolic and diastolic BP, pulse rate were seen in stage 2 in both groups, the vitals were significantly lower in Group T in both stage 1 and 2 when compared to Group C. Conclusion: Low dose' labour analgesia is a safe technique for painless labour with no harmful effects on the mother or baby and it does not significantly affect the obstetric outcome.
Outcome of labor with epidural analgesia in primigravida at term
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics. Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-(n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of deliverynormal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and neonatal breast-feeding behavior between the two groups. Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of higher neonatal Apgar scores in the epidural group than in the tramadol group. Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in tertiary setups and equipped centres when the patients are apprehensive about labor pains.
The Effects of Opioids During Pregnancy: A Literature Review
Georgetown Medical Review
The alarming increase in opioid use in the United States, particularly during pregnancy, over the past few decades underlines the need to thoroughly investigate the consequences of opioid use within the context of reproduction and development. Opioid exposure has been linked to a number of effects on the various physiologic processes involved in embryonic development. Opioids have been shown to hinder the preimplantation embryo from progressing into the blastocyst stage and implanting into the uterus. Maternal opioid use has also been shown to be neurotoxic to the embryo. Exogenous opioids negatively affect the somatosensory cortex, hippocampus, and cholinergic system in the developing embryo, leading to consequences ranging from poor memory function to learning disabilities. Additionally, opioids have the potential to negatively affect the embryonic heart. Opioid use has been shown to slow down the growth of cardiac tissue, decrease fetal heart rate, and increase the incidence of congenital heart defects. Through review of existing studies, we conclude that opioid use during pregnancy has a significant risk of being detrimental to the embryo. Based on the available scientific literature, we recommend reevaluating current guidelines on opioid use during pregnancy to ensure that opioid exposure to the embryo is limited as much as possible.