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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of a caesarean delivery with epidural analgesia of a term parturient with quadruplets is presented. Maternal considerations of hypotension, respiratory embarrassment and aspiration of gastric content and foetal considerations of prematurity and impaired placental function are discussed relative to the use of general anaesthesia or epidural analgesia.
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PMID:Anaesthetic considerations in caesarean section for quadruplets. 65 98

During the period January 1969 to November 1974, in a total of 39,800 deliveries, there were two sets of quadruplets. Both parturients had been taking ovulation-inducing drugs. Maternal problems were distended abdomen and heavy uterus, causing supine hypotension and lordosis; toxemia of pregnancy; increased possibility of hemorrhage before, during and/or after delivery; edema of the back; mental depression. The fetal problems were prematurity; intrauterine growth retardation; increased possibility of transfusion syndrome and prolapsed cord; increased obstetric manipulation. An adequate number of obstetricians, pediatricians, anesthesiologists, and nurses, necessary equipment, and blood and blood components should be available. Early hospitalization is necessary. Close observation of the patient before, during, and after delivery is essential. The patient should stay on her side throughout the labor. General anesthesia may add to fetal depression and increase the possibility of uterine atony. Spinal or lumbar epidural anesthesia may be difficult because of the associated lordosis and back edema. Caudal block allowed intrauterine manipulation; provided adequate analgesia, permitted high FIO2 administration, and did not interfere with voluntary bearing down when required.
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PMID:Caudal analgesia for quadruplet delivery. 94 32

Fetal reduction techniques, experiences at Northwestern University of Evanston, Illinois, USA, and ethical issues are discussed. The use of fetal reduction pertains to higher order multiple pregnancies due to successful fertility treatments. The risk associated with multifetal pregnancy is preterm delivery i.e., 29-31 weeks for quadruplets. In addition, survivors often have a high risk of congenital abnormalities and complications related to prematurity. 1978 marked the 1st time selective termination was possible. Other terms include "selective" birth, reduction, feticide, abortion, and multiple pregnancy reduction. The procedure takes place in the 1st or 2nd trimester, and procedures are similar to an elective abortion but with different techniques. Although there are many techniques, the preferred one is transabdominal cardiac puncture and injection of potassium chloride. A highly skilled ultrasonographer is essential for a successful technique. The complexity of the technique is one where the physician from a 2-dimensional screen must envision a 3-dimensional picture of the uterus and contents. Accurate needle placement is important. The reports from 7 clinical trials using the intracardiac potassium chloride technique are presented. The Northwestern experience includes 25 reductions between 1987-91 using fentanyl and midazolidocaine analgesia and general anesthesia with 1% lidocaine. Gestational age ranged from 9 to 13 weeks. There was total loss in 2 cases and deliveries in 8 cases including neonatal death of a very preterm set of twins. At or = 37 weeks, there were 11 pregnancies. 11 patients were or = 35 years, and 4 of the 20 30 years. In 33% of cases, only 1 pregnancy was left, which is dissimilar to other studies. Many difficulties may be faced with a complete pregnancy loss where there is a lack of support for the decision for fetal reduction. 2 concerns are mentioned in the ethical debate: the adequacy of counseling and the criteria for determining how many reductions per pregnancy. Difficulties arise in physician counseling when patients are unable to assimilate complex and detailed information, and physicians may not accurately convey information. Institutions may bias patient counseling. When an abnormality exists, the decision is easy; but with multiple normal development, the recommendation is twins. The Northwestern recommendation involves patient and family decisions and joint discussion of risk. The likelihood of severely premature delivery and maternal morbidity should also be considered, as well as the medical cost incurred with delivery and care of preterm multiple infants i.e., 1.2 million dollars for delivery of quads at 27 weeks. Science should be directed to reducing multiple pregnancies by refining technique and using fetal reduction as an interim technique. Fetal reduction is not appropriate for all multiple pregnancies.
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PMID:Fetal reduction: is this the appropriate answer to multiple gestation? 134 38

A study of perinatal mortality in multiple pregnancy over a period of 12 years, 1972 to 1984, showed prematurity and low birthweight as the major causes of fetal loss. The highest risk was found at 28 to 30 weeks gestation (306/1,000). There was a significantly greater risk to babies delivered by the breech (136/1,000), and likewise in the second twin when compared with the first, ratio 1:14. A significant drop in the perinatal mortality rate, from 98/1,000 to 39/1,000, was observed between 1972-1978 and 1979-1984. Ultrasound has facilitated the earlier diagnosis of twins and provides more accurate serial fetal assessment. Bedrest, more vigilant antenatal care, intrapartum surveillance and improved neonatal care, are required to maintain and further reduce the perinatal mortality rate. When regional analgesia was employed in labour, the number of babies lost was 41/1,000, vs 93/1,000 in patients not receiving regional analgesia. External cephalic version and vertex delivery of the second twin is preferable to internal version and breech extraction. It should also be contemplated, as an alternative to elective cesarean section for a transverse lie or breech presentation of the second fetus.
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PMID:Perinatal mortality in multiple pregnancy patients. 325 23

An analysis of all perinatal deaths occurring in twin pregnancies in Dundee women from 1956 to 1983 was performed. The uncorrected perinatal mortality rate fell from 116/1000 births in 1956-60 to 16/1000 births in 1981-83, this fall almost entirely taking place after 1975. Causes of death were identified using the Aberdeen Classification and a reduction in deaths in all cause groupings occurred. About half of the deaths were in the Premature, Cause Unknown group and a marked decrease in deaths in this group made the largest contribution to the improved perinatal mortality rate. This fall was partly due to a reduction in the incidence of extreme prematurity and low birth weight. Changes in obstetric management which may have influenced outcome included the introduction of routine early pregnancy ultrasound scanning, the use of tocolytic drugs, intrapartum fetal monitoring, epidural analgesia and an increase in Caesarean section rate from 2% in 1956-60 to 39% in 1981-83.
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PMID:An assessment of perinatal mortality in twin pregnancies in Dundee. 383 32

Labor, delivery, and newborn course were studied in 621 pregnancies in which labor was electively induced at or after 39 weeks, and in 3,851 control pregnancies in which the onset of labor was spontaneous. Induced labors were not prolonged, nor was the duration of ruptured membranes. Fetal distress and birth asphyxia were not more frequent after induction, and release of meconium occurred much less frequently (9.3% for induced labor versus 16.7% for spontaneous). There was greater use of epidural analgesia and of forceps delivery in induced labor. Among primiparous patients, cesarean delivery for "failure to progress" was performed in 14% of electively induced labors and 7% of spontaneous control labors, a difference not noted among multiparous patients who had a primary cesarean birth rate of less than 2%. Iatrogenic prematurity was not a problem; none of the 621 infants who was born after elective induction developed respiratory distress syndrome, and only one weighed less than 2,500 gm.
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PMID:Hazards and benefits of elective induction of labor. 653 86

Subpartal and neonatal blood gas analyses have attracted increasing interest during the past 20 years. Different studies have been carried out to investigate the causes and immediate consequences of perinatal acidosis. It was the aim of this study to examine the long term outcome of acidotic-born babies. During 16 consecutive months all deliveries in the Obstetric Department of the Centre Hospitalier Universitaire Vaudois (CHUV) were investigated with regard to incidence and causes of a perinatal acidosis (pHa.umb. less than 7.15). The psycho-motor development of all acidotic newborns was followed up for an average of 15 months. Out of 1922 deliveries a blood sample was available in all but 11 cases (0.57%). Seven newborns were excluded from the study on the assumption that their acidosis and outcome might be related to the underlying condition (congenital malformation and infection, extreme prematurity) rather than perinatal events. From the remaining 1904 deliveries 6.4% (N = 121) had a pHa.umb. less than 7.15 (Tab. I). The incidence of certain perinatal factors was compared in the acidotic and the non acidotic groups (Tab. II). The percentage of acidotic newborns is significantly higher in primipareae, in deliveries done on peridural analgesia in cord complications and premature rupture of the membranes, and in forceps deliveries. No difference could be found with regard to multiple pregnancies, meconiumstained amniotic fluid, cesarean sections, prematurity of 28-37 weeks, and sex. The relationship between CTG score and pHa.umb. is summarized in Tab. III.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Systematic pH-measurements in the umbilical artery: causes and predictive value of neonatal acidosis. 666 30

All the presently used local anesthetic agents in the increasingly popular modalities of obstetric regional anesthesia cross the placenta readily, governed only by two factors that the anesthesiologist has any control over (1) dosage and timing of doses and (2) uterine blood flow as it relates to the development of fetal acidosis. Uptake of a given dose of local agent from the epidural or caudal spaces may be limited with the addition of epinephrine to some extent with some drugs, but this is of little real value in the two safest drugs--bupivacaine and 2-chloroprocaine. At the doses and in the manner presently recommended, fetal intoxication with local anesthetic agent during maternal epidural analgesia should not occur in the absence of either direct intravascular injection, severe maternal hepatic disorder, marked fetal prematurity or postmaturity. The usual precautions in the exercise of regional anesthesia when applied to obstetrics render it very safe, if not the safest form of anesthesia-analgesia available.
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PMID:Placental transfer of local anesthetics. 703 31

From January 1975 to June 1980, 13,951 births took place at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil. Of these births, 105 (0.7%) were 1st births to adolescents between the ages of 9 and 15. 92.3% of the adolescents were unmarried, indicating that they failed to use adequate methods of birth control. 89.5% of the adolescents did not receive adequate prenatal care, contributing to the high incidence of complications during the pregnancy-puerperal cycle. Among complications occurring during pregnancy, the most common were toxemia (29.5%), urinary infection (16.1%), and anemia (8.5%). Premature birth took place in 30.5% of the adolescent pregnancies, a rate a prematurity greater than in the general population. Analgesia at birth was necessary in 20.9% of the cases. This tendency was more a consequence of nulliparity and emotional factors than of age of patient. Contrary to expectations, cesarean sections were required with no greater frequency than in the general population. Complications in birth and puerperium did not differ from patients in general. No cases of fetal death occurred; neonatal deaths occurred in 5.5% of the cases, the consequence of prematurity. Jaundice occurred as the most frequent complication in newborns (70.0%); no cases of serious malformations were observed.
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PMID:[Pregnancy in the adolescent. I. Primigravidas of 9 to 15 years old]. 1226 71

This paper presents a study of adolescent pregnancy in which different age groups were compared to establish which age group had the greatest incidence of risk factors. Primiparous adolescents who delivered at the Obstetric Clinic of the Medical School of the University of Sao Paulo, Brazil, between January 1975 and June 1980 were studied. During this period, 13,961 births occurred, of which 105 were to 9-15 year olds (0.7%), 137 were to 16 year olds (0.9%) and 106 were to 17 year olds (0.7%). A large majority of the adolescents in each age group were unmarried; similarly, a lack of adequate prenatal care was observed in all 3 groups. A gestational age of less than 38 weeks was encountered in 30.5% (30 cases), and 16.9% (18 cases), respectively, in the 9-15, 16, and 17 year age groups. Among pregnancy complications, there was an elevated incidence of arterial hypertension in all 3 groups, as well as an increased occurrence of eclampsia among the 9-15 year olds. Urinary infections and anemia were also evident during pregnancy. Analgesia was required in 22 cases (20.9%) of the 9-15 year old age group, in 3 cases (2.2%) of the 16 year age group, and in 2 cases (1.9%) of the 17 year age group. Fetal presentation, duration of labor, type of birth (normal, forceps, or cesarean), puerperal morbidity, birth weight, and perinatal mortality for each of the 3 groups are presented in tables. Neonatal deaths were determined to be the consequence of prematurity and its complications except in 1 case of congenital heart disease which occurred in the 17 year old group. Neonatal jaundice was the most frequent cause of morbidity in the newborns. The results of this study agree with those of similar studies appearing in the literature. The authors attribute the greater frequency of premature births among 9-16 year olds to immaturtity of uterine muscle fiber, deficient prenatal care, and the emotional tensions to which the adolescents were subjected, as well as to medical complications of pregnancy and general maternal physical immaturity. The 17 year olds presented behavior closer to that of the adult population.
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PMID:[Pregnancy in the adolescent. II. Comparative study between primigravida from 9 to 15, 16 and 17 years old]. 1226 72


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