Knowledge and expectations of labour among primigravid women in the public health sector.

Objectives: We analysed knowledge and expectations of the process and pain of labour in primigravidas attending a local midwifery obstetric unit (MOU). It was anticipated that the results of this study could inform the development of interventions aimed at improving the analgesic care of women delivering at primary health care obstetric units.

Design: Qualitative analysis of data obtained from in-depth semi-structured interviews.

[Anaesthesia, a cause of fetal distress?].

Objective: To describe the effects of anaesthetic techniques and agents on the risk of fetal distress during labour pain relief and anaesthesia for caesarean section.

Study Design: Data on obstetric anaesthesia- and analgesia-induced fetal distress were searched in Medline database using MESH terms: fetal distress, anaesthesia, analgesia, labour, caesarean section, and umbilical artery pH. Trials published in English or French language were selected.

Case report: Successful labour epidural analgesia in a patient with spinocerebellar ataxia.

Purpose: To report the favourable outcome associated with epidural analgesia in a parturient with spinocerebellar ataxia (SCA).

Clinical Features: A 34-yr-old patient, G2 P0, presented at term with a history of SCA since the age of 22 characterized by slurred speech, balance and gait disturbances, diplopia and nystagmus. A magnetic resonance imaging of the brain at the age of 27 showed cerebellar degeneration.

[Walking epidurals: mobilisation during neuraxial labour analgesia].

Neuraxial anaesthesia offers the most effective form of obstetric pain relief and is superior to other methods of analgesia, and it does not increase the risk of caesarean section. In daily practice, various techniques are used including the options of patient-controlled epidural analgesia (PCEA) and combined spinal epidural analgesia (CSEA). Risk information is one of the prerequisites for 'informed consent'.

[Combined spinal-epidural anaesthesia for pain relief in obstetric patients].

Besides epidural analgesia combined spinal-epidural anaesthesia (CSE) is one of the favourite techniques of regional anaesthesia for pain relief in obstetric patients. CSE combines the advantage of spinal anaesthesia, e.g.

Efficacy of patient-controlled epidural analgesia after initiation with epidural or combined spinal-epidural analgesia.

Background: The aim of the present study was to compare the efficacy of patient-controlled epidural analgesia after initiation with either epidural or combined spinal-epidural analgesia.

Methods: Forty ASA I parturients at 37-42 weeks' gestation and cervical dilatation <6 cm were randomly allocated to receive either epidural analgesia (group EA) or combined spinal-epidural analgesia (group CSEA). Analgesia was initiated with a 7-mL epidural bolus 0.

Magnitude of episiotomy in a teaching hospital in Addis Ababa, Ethiopia.

Objective: To assess the rate of Episiotomy in vaginal birth in Tikur Anbessa teaching Hospital and the associated factors that influences the use of episiotomy in the unit.

Methods: A cross-sectional study was conducted in the delivery unit of the Tikur Anbessa Hospital from May to September 2000. Data on mothers who delivered in the study period was collected using structured questionnaire.

Labor analgesia and cesarean section in women affected by tuberous sclerosis: report of two cases.

Tuberous sclerosis is a multi-system disease characterized by the presence of benign growths in many tissues, mostly localized in skin, brain, kidney and lungs. Epileptic seizures and renal hemorrhage are frequent in such patients. Apart from life-threatening hemorrhage after rupture of angiomyolipomatoma, few data are available about anesthetic considerations during pregnancy.

Case report: cerebral vein thrombosis after subarachnoid analgesia for labour.

Purpose: We report a case of sagittal sinus thrombosis occurring after spinal analgesia for labour to highlight the difficulty of such diagnosis in the presence of postpartum atypical headache following regional anesthesia/analgesia.

Clinical Features: A previously healthy 21-yr-old, primiparous, preeclamptic parturient was admitted to the hospital at 37 weeks gestation for uterine contractions. Before pregnancy she was taking no medication other than oral contraceptives and was a non-smoker.

A survey of labor patient-controlled epidural anesthesia practice in California hospitals.

Background: Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States.

Cesarean section in a patient with familial cardiomyopathy and a cardioverter-defibrillator.

Purpose: To describe the impact of maternal automatic implantable cardioverter-defibrillator (AICD) therapy on pregnancy outcome, and discuss the clinical rationale for regional anesthesia in parturients with AICDs.

Clinical Features: A 20-yr-old primigravida with a history of familial cardiomyopathy and AICD placement presented at 39 weeks gestational age for elective labour induction. Ultimately, the patient underwent a Cesarean section for a failed induction.

Obstetric regional blocks for women with multiple sclerosis: a survey of UK experience.

Background: There has been a reluctance to use regional blocks for women with multiple sclerosis as effects on the course of the disease are unclear. We assessed the views of UK consultant obstetric anaesthetists regarding management of women with multiple sclerosis.

Methods: Following Obstetric Anaesthetists' Association approval a questionnaire was sent to UK consultant members.

Similar onset time of 2-chloroprocaine and lidocaine + epinephrine for epidural anesthesia for elective Cesarean section.

Background: The use of regional anesthesia for elective Cesarean section has been demonstrated to be safe for both the mother and new-born. In parturients with an epidural catheter placed previously for labor analgesia, extension of the epidural block may be the preferred option, provided that adequate speed of onset and adequate surgical anesthesia are obtained. We therefore performed a prospective, randomized, double-blind trial to examine the speed of onset and anesthetic quality of 2-chloroprocaine vs.

The effects of continuous epidural analgesia on Doppler velocimetry of uterine arteries during different periods of labour analgesia.

Background: The transient effects of epidural bupivacaine 0.25-0.5% on the Doppler velocimetry of umbilical and uterine arteries had been reported, but the effects of continuous lower dose epidural bupivacaine (0.

Use of an information leaflet to improve general practitioners' knowledge of post dural puncture headache.

Background: The number of women receiving neuraxial anaesthesia for labour and delivery is increasing. Women are also being discharged into the community sooner after delivery. Thus, complications arising from neuraxial anaesthesia may present to general practitioners, so it is of vital importance that they are familiar with and can manage potential problems associated with these anaesthetic techniques.

Epidural versus non-epidural or no analgesia in labour.

Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain and is widely used as a form of pain relief in labour. However, there are concerns regarding unintended adverse effects on the mother and infant.

Objectives: To assess the effects of all modalities of epidural analgesia (including combined -spinal-epidural) on the mother and the baby, when compared with non-epidural or no pain relief during labour.

Trends in pain relief in labour: implications for obstetric analgesia service in Nigeria.

Labour and delivery result in severe pain for most women. Attention to comfort and analgesia for women in labour is important for physiological reasons and out of compassion. A review of common methods of pain relief of labour was done.

Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice.

Objective: To investigate use of pharmacological and non-pharmacological methods of perineal analgesia used by midwives during the second stage of labour and perineal repair in the UK.

Design: Postal survey.

Methods: Self-complete questionnaires were sent to Heads of Midwifery in all 219 maternity units in the UK.

Epidural analgesia for childbirth: effects of newer techniques on neonatal outcome.

New low-dose, local anesthetic-opioid combinations, combined spinal epidural analgesia, and new anesthetic drugs, such as ropivacaine and levobupivacaine, have modified the anesthetic practice in obstetric labor analgesia. These new analgesic techniques have less or no neonatal effects when compared with traditional epidural labor analgesia. They also have less effect on mode of delivery, which may in turn affect neonatal outcome.

A multicenter randomized controlled trial comparing patient-controlled epidural with intravenous analgesia for pain relief in labor.

In this multicenter, randomized, controlled trial, we sought to determine whether patient-controlled epidural analgesia (PCEA) for labor affected the incidence of cesarean delivery when compared with patient-controlled IV opioid analgesia (PCIA). Healthy, term nulliparous patients in 4 Canadian institutions were randomly assigned to receive PCIA with fentanyl (n = 118) or PCEA with 0.08% bupivacaine and fentanyl 1.

A primigravida allegedly allergic to local anaesthetics.

Pregnant patients may give a history of allergy to local anaesthetics, but many of these supposed allergies have not been investigated. There is cross-reactivity between the amide local anaesthetics, which are the only group available in the UK for regional analgesia. We report the management of a primigravida who gave a history of allergy to two local anaesthetics, lidocaine and prilocaine.

Intrapartum pain management at the Royal Hospital for Women.

Aims: To explore use of, and women's satisfaction with, intrapartum pain management at Royal Hospital for Women (RHW), Sydney, Australia.

Methods: From October 2002 to January 2003 women aged over 16 who had been in labour at RHW were given a questionnaire to complete in the first week post-partum regarding their intrapartum pain management. Supplementary information was obtained from patient records.

[Myasthenia gravis, pregnancy and delivery: a series of ten cases].

Objective: To study the reciprocal interferences between pregnancy and myasthenia gravis (MG) and to describe obstetric and anaesthetic management during labour and the post-partum period.

Study Design: Retrospective, single centre study.

Methods: The files of 10 patients with MG, who delivered between October 1994 and May 2002, were examined.

Status of obstetric epidural analgesia services in Hong Kong public hospitals: postal questionnaire survey.

Objective: To examine the status of obstetric epidural analgesia services in Hong Kong public hospitals in 2001, and to compare findings with those from a similar survey conducted in 1995.

Design: Postal questionnaire survey.

Setting: Hospital Authority hospitals in Hong Kong offering an obstetric and delivery service.

[Anesthesia and analgesia in obstetrics].

Anesthesia in obstetrics includes the medical attendance of women in the delivery room as well as giving anesthesia for cesarean sections in the operating room. Over the last years the treatment of labor pain with epidural anesthesia has been modified. Whereas a couple of years ago local anesthetics were used almost exclusively, the recent trend goes toward a combination of local anesthetics with opioids.