Dataset Information

Analgesia in Obstetrics.

ABSTRACT: Background: An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. Methods: We performed a selective literature search in Medline via PubMed using the search-terms "Analgesia" and "Obstetrics". We also included the current guidelines of the German Society for Anesthesiology and Intensive Care Medicine. Results: PDA and CSE are safe techniques for the relief of labour pain if contraindications are excluded. The risk for instrumental delivery but not for caesarean section is increased under neuraxial analgesia. PDA and CSE should be performed in an early stage of labour using low doses of local anaesthetics if possible. It is not necessary to wait for a defined cervical dilatation before starting neuraxial analgesia. Anesthesiologists and obstetricians should inform patients as soon as possible before the situation of stress during labour. Systemic opioid analgesia is a possible alternative for neuraxial techniques. Because of possible side effects systemic remifentanil analgesia should only be performed under continuous monitoring. Several nonpharmacologic methods can also relieve labour pain, but results of studies about their effectiveness are inconsistent.

SUBMITTER: Heesen M

PROVIDER: S-EPMC4168364 | biostudies-literature | 2012 Jul

REPOSITORIES: biostudies-literature

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Analgesia in Obstetrics.

Heesen M M Veeser M M

Geburtshilfe und Frauenheilkunde 20120701 7

<b>Background:</b> An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. <b>Methods:</b> We performed a selective literature search in Medline via PubMed using th ...[more]

PMID: 25264376

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Project description:BackgroundDespite reported positive results of telemonitoring effectiveness in various health care domains, this new technology is rarely used in prenatal care. A few isolated investigations were performed in the past years but with conflicting results.ObjectiveThe aim of this review was to (1) assess whether telemonitoring adds any substantial benefit to this patient population and (2) identify research gaps in this area to suggest goals for future research.MethodsThis review includes studies exploring the effectiveness of telemonitoring interventions for pregnant women reported in the English language. Due to the paucity of research in this area, all reports including uncontrolled nonrandomized and randomized controlled studies were selected.ResultsFourteen studies, which performed their data collection from 1988 to 2010, met the inclusion criteria and were published from 1995 to present; four of the 14 published papers were multicenter randomized controlled trials (RCTs), five papers were single-center RCTs, three papers were retrospective studies, one paper was an observational study, and one paper was a qualitative study. Of the 14 papers, nine were available for a risk of bias assessment: three papers were classified as low risk, one as medium risk, and five as high risk. Furthermore, of those 14 papers, 13 focused on telemonitoring for maternal outcomes, and nine of the 14 papers focused on telemonitoring for fetal or neonatal outcomes. The studies reviewed report that telemonitoring can contribute to significant reductions in health care costs, (unscheduled) face-to-face visits, low neonatal birth weight, and admissions to the neonatal intensive care unit (NICU), as well as prolonged gestational age and improved feelings of maternal satisfaction when compared with a control group. When only studies with low risk of bias were taken into account, the added value of telemonitoring became less pronounced: the only added value of telemonitoring is for pregnant women who transmitted their uterine activity by telecommunication. They had significant prolonged pregnancy survivals, and the newborns were less likely to be of low birth weight or to be admitted to the NICU. Following these results, telemonitoring can only be recommended by pregnant women at risk for preterm delivery. It is however important to consider that these studies were published in the mid-90s, which limits their direct applicability given the current technologies and practice.ConclusionsThis review shows that telemonitoring can be tentatively recommended for pregnant women at risk for preterm delivery. More recent RCTs with a blinded protocol are needed to strengthen the level of evidence around this topic and to have an insight in the added value of the technologies that are available nowadays. In addition, studies investigating patient satisfaction and economic effects in relation to telemonitoring are suggested for future research.

Project description:ObjectivesThis review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs.DesignA rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively.InterventionsWe included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015.Primary and secondary outcome measuresRCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included.ResultsThe search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500?000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs.ConclusionsOur results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

Project description:BackgroundIn the United States (US), many obstetrics & gynecology (OB-GYN) trainees feel unprepared to care for lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) individuals, but interest in this topic is rising. Residency program websites are one way that directors can advertise whether this training is offered within their program. We aimed to describe the extent to which LGBTQI content is currently featured on OB-GYN residency websites across the country.MethodsWe identified all OB-GYN residency programs in the United States using a publicly available database. We systematically searched for select LGBTQI keywords on program websites. We collected data on mentions of LGBTQI didactics and rotations. We also searched whether LGTBQI keywords were included in diversity, equity, and inclusion (DEI) statements. We used multivariable logistic regression to compare the characteristics of programs that do and do not include this content. We used STATA SE Version 16.0 for all analyses and set the level of significance at 5%.ResultsWe included 287/295 US OB-GYN residency programs in our analysis (97.3%) and excluded 8 that did not have websites. We identified any LGBTQI content on 50 program websites (17.4%), and specific mention of didactics or rotations on 8 websites (2.8%). On multivariable analysis, programs in the West were more likely to include any LGBTQI content compared to programs in the South (OR 2.81, 95%CI 1.04-7.63), as were programs with 1 or 2 fellowships (OR 3.41, 95%CI 1.43-8.14) or 3 or more fellowships (OR 4.85, 95%CI 2.03-11.57) compared to those without fellowships. Programs in departments led by female chairs were also more likely to include LBTQI content (OR 3.18, 95%CI 1.55-6.51).ConclusionsAcademic programs, West Coast programs, and those with departments led by female chairs are more likely to mention LGBTQI keywords on their websites. Given the increasing interest in LGBTQI education for OB-GYN trainees, program directors should consider providing training opportunities and including this content on their websites.

Dataset Information

Analgesia in Obstetrics.

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Analgesia in Obstetrics.

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