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[PMID]:27778527
[Au] Autor:Klomp T; Witteveen AB; de Jonge A; Hutton EK; Lagro-Janssen AL
[Ad] Endereço:a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands.
[Ti] Título:A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands.
[So] Source:J Psychosom Obstet Gynaecol;38(2):94-102, 2017 Jun.
[Is] ISSN:1743-8942
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain. METHODS: Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010. RESULTS: Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time. DISCUSSION: It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.
[Mh] Termos MeSH primário: Parto Domiciliar/normas
Dor do Parto/terapia
Tocologia/normas
Manejo da Dor/normas
Satisfação do Paciente
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Países Baixos
Período Pós-Parto
Gravidez
Pesquisa Qualitativa
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171212
[Lr] Data última revisão:
171212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1080/0167482X.2016.1244522


  2 / 807 MEDLINE  
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[PMID]:29019880
[Au] Autor:Zhao Y; Xiao M; Tang F; Tang W; Yin H; Sun GQ; Lin Y; Zhou Y; Luo Y; Li LM; Tan ZH
[Ad] Endereço:aDepartment of Obstetrics bDepartment of Pelvic Floor Rehabilitation, Maternal and Child Health Hospital of Hubei Province, Wuhan, China.
[Ti] Título:The effect of water immersion delivery on the strength of pelvic floor muscle and pelvic floor disorders during postpartum period: An experimental study.
[So] Source:Medicine (Baltimore);96(41):e8124, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Water immersion delivery is a non-pharmacological approach to ease labor pain. This paper aims to investigate the effect of water immersion delivery on increasing strength of pelvic floor muscle (PFM) and relieving pelvic floor disorders (PFDs) during postpartum period. METHODS: A total of 2749 vaginal-delivery primiparas in postpartum 6-8 weeks were selected as research objects. Based on the modes of delivery, 600 patients were assigned into water immersion delivery group, 2149 were assigned into conventional delivery group. The scales of PFM strength and pelvic organ prolapsed (POP) were determined by specially trained personnel using digital palpation, and the symptoms of stress urinary incontinence (SUI) were investigated by questionnaire survey. The weak PFM strength was improved by doing Kegel exercise at home for 6-8 weeks. RESULTS: We found that ①The rate of episiotomy in water immersion delivery group was 77.50% (465/600), which was lower than that in conventional delivery group (84.69%, 1820/2149) (P < .01); The primiparas without having an episiotomy have higher PFM strength than those having an episiotomy for both groups (P < .01). ②There was a negative correlation between the scale of PFM strength and SUI or POP, wherein the r-values were -0.135 and -0.435, respectively (P < .01). ③The rate of SUI was 6.50% (39/600) in water immersion delivery group and 6.89% (148/2149) in the conventional delivery group, wherein the intergroup difference was not significant (P > .05); ④The rates of vaginal wall prolapsed and uterus prolapsed were 29.83% (179/600) and 2.83% (17/600) in water immersion delivery group and 30.95% (665/2149) and 4.37% (94/2149) in the conventional delivery group, wherein the intergroup difference was not significant (P > .05). ⑤After Kegel exercise, the strength of PFM was promoted (P < .01). CONCLUSION: Water immersion delivery has been proved to a beneficial alternative method for conventional delivery method. This delivery mode is associated with fewer episiotomy rate, and avoiding episiotomy is beneficial for maintaining PFM strength of women in postpartum 6-8 weeks. The strength of PFM during postpartum period can be improved by doing Kegel exercise at home.
[Mh] Termos MeSH primário: Parto Obstétrico
Imersão
Dor do Parto
Distúrbios do Assoalho Pélvico/prevenção & controle
Diafragma da Pelve/fisiopatologia
Incontinência Urinária por Estresse
[Mh] Termos MeSH secundário: Adulto
Estudos de Casos e Controles
China
Parto Obstétrico/efeitos adversos
Parto Obstétrico/métodos
Feminino
Seres Humanos
Dor do Parto/diagnóstico
Dor do Parto/terapia
Primeira Fase do Trabalho de Parto
Monitorização Fisiológica/métodos
Força Muscular/fisiologia
Medição da Dor/métodos
Distúrbios do Assoalho Pélvico/etiologia
Gravidez
Resultado do Tratamento
Incontinência Urinária por Estresse/diagnóstico
Incontinência Urinária por Estresse/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008124


  3 / 807 MEDLINE  
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[PMID]:29016499
[Au] Autor:Shen X; Li Y; Xu S; Wang N; Fan S; Qin X; Zhou C; Hess PE
[Ad] Endereço:Departments of Anesthesiology and Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing, Jiangsu, China; and the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial.
[So] Source:Obstet Gynecol;130(5):1097-1103, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate whether maintaining a motor-sparing epidural analgesia infusion affects the duration of the second stage of labor in nulliparous parturients compared with a placebo control. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested epidural analgesia. All women received epidural analgesia for the first stage of labor using 0.08% ropivacaine with 0.4 micrograms/mL sufentanil with patient-controlled epidural analgesia. At the onset of the second stage of labor, women were randomized to receive a blinded infusion of the same solution or placebo saline infusion. The primary outcome was the duration of the second stage of labor. A sample size of 200 per group (400 total) was planned to identify at least a 15% difference in duration. RESULTS: Between March 2015 and September 2015, 560 patients were screened and 400 patients (200 in each group) completed the study. Using an intention-to-treat analysis, the duration of the second stage was similar between groups (epidural 52±27 minutes compared with saline 51±25 minutes, P=.52). The spontaneous vaginal delivery rate was also similar (epidural 193 [96.5%] compared with saline 198 [99%], P=.17). Pain scores were similar between groups at each measurement during the second stage. More women who received placebo reported satisfaction scores of 8 or less (epidural 32 [16%] compared with saline 61 [30.5%], P=.001). CONCLUSION: Maintaining the infusion of epidural medication had no effect on the duration of the second stage of labor compared with a placebo infusion. Maternal and neonatal outcomes were similar. A low concentration of epidural local anesthetic does not affect the duration of the second stage of labor. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Register, http://www.chictr.org.cn/enindex.aspx, ChiCTR-IOR-15005875.
[Mh] Termos MeSH primário: Analgesia Epidural/métodos
Analgesia Obstétrica/métodos
Analgésicos/administração & dosagem
Dor do Parto/tratamento farmacológico
Segunda Fase do Trabalho de Parto/efeitos dos fármacos
[Mh] Termos MeSH secundário: Amidas/administração & dosagem
Método Duplo-Cego
Feminino
Seres Humanos
Gravidez
Sufentanil/administração & dosagem
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Amides); 0 (Analgesics); 7IO5LYA57N (ropivacaine); AFE2YW0IIZ (Sufentanil)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002306


  4 / 807 MEDLINE  
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[PMID]:28683112
[Au] Autor:Fathi Najafi T; Latifnejad Roudsari R; Ebrahimipour H
[Ad] Endereço:PhD Student, Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran.
[Ti] Título:The best encouraging persons in labor: A content analysis of Iranian mothers' experiences of labor support.
[So] Source:PLoS One;12(7):e0179702, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND AIMS: The process of giving birth is very stressing for the mother. Meanwhile, maternity ward staff's lack of awareness of mothers' fears make mothers feel lonely and helpless. This study aimed to explore women's perceptions of labor support during vaginal delivery. MATERIALS AND METHODS: This exploratory qualitative study used qualitative content analysis to explore Iranian mothers' experiences of labor support. Data were collected using observations and semi-structured interviews with 25 individuals. The participants were recruited through a purposive sampling method. RESULTS: Three categories, including "involvement of the spouse in the labor process", "asking for a companion during labor", and "mother's self-care to cope with labor pain", emerged during data analysis. These categories were merged to form the main theme of "trying to comply with the labor process". CONCLUSION: Women believed that the presence of a companion, e.g. their husband, a family member, or a doula, during labor helped them better deal with the labor process, particularly when they felt lonely. Health care providers are expected to consider the needs of mothers and try to provide holistic support for mothers during labor pain. IMPLICATIONS FOR PRACTICE: It seems that some mothers adopted particular coping strategies without receiving any relevant training. It is noteworthy that although mothers may make every effort to minimize their pain, health professionals should also practice medical approaches to help them through the process of labor.
[Mh] Termos MeSH primário: Adaptação Psicológica
Cuidadores/psicologia
Parto Obstétrico/psicologia
Dor do Parto/psicologia
Trabalho de Parto/psicologia
Mães/psicologia
[Mh] Termos MeSH secundário: Adulto
Atitude do Pessoal de Saúde
Medo/psicologia
Feminino
Seres Humanos
Irã (Geográfico)
Dor do Parto/fisiopatologia
Solidão/psicologia
Gravidez
Pesquisa Qualitativa
Autocuidado/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0179702


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[PMID]:28625302
[Au] Autor:Landau R; Smiley R
[Ad] Endereço:Columbia University Medical Center, Center for Precision Medicine, Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 630 West 168th St PH-5 (5th Floor Office PH-546, 11th Floor Office CHN-1118), New York, NY 10032, USA. Electronic address: rl262@cumc.columbia.edu.
[Ti] Título:Pharmacogenetics in obstetric anesthesia.
[So] Source:Best Pract Res Clin Anaesthesiol;31(1):23-34, 2017 Mar.
[Is] ISSN:1878-1608
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The 21st century has been billed as the era of "precision/personalized medicine." Genetic investigation of clinical syndromes may guide therapy as well as reveal previously unknown biological or pharmacological pathways that may result in novel drug therapies. Several clinical issues in obstetrics and obstetric anesthesiology have been targets for genetic investigations. These include evaluation of the genetic effects on preterm labor and the progression of labor, spinal anesthesia-induced hypotension and the response to medications used to treat hypotension, and the effect of gene variants on pain and analgesic responses. Most studies have examined specific single nucleotide polymorphisms. Findings have revealed modest effects of genetic variation without tangible impact on current clinical practice. Over the next decade, increased availability of whole exome and genome sequencing, epigenetics, large genetic databases, computational biology and other information technology, and more rapid methods of real-time genotyping may increase the impact of genetics in the clinical arena of obstetrics and obstetric anesthesia.
[Mh] Termos MeSH primário: Anestesia Obstétrica
Dor do Parto/genética
Trabalho de Parto/genética
[Mh] Termos MeSH secundário: Anestesia Obstétrica/métodos
Anestesia Obstétrica/tendências
Feminino
Variação Genética
Seres Humanos
Hipotensão/induzido quimicamente
Hipotensão/tratamento farmacológico
Dor do Parto/tratamento farmacológico
Trabalho de Parto Prematuro/genética
Polimorfismo de Nucleotídeo Único
Medicina de Precisão
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE


  6 / 807 MEDLINE  
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[PMID]:28625301
[Au] Autor:Sng BL; Sia ATH
[Ad] Endereço:Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore. Electronic address: sng.ban.leong@singhealth.com.sg.
[Ti] Título:Maintenance of epidural labour analgesia: The old, the new and the future.
[So] Source:Best Pract Res Clin Anaesthesiol;31(1):15-22, 2017 Mar.
[Is] ISSN:1878-1608
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Neuraxial analgesia is considered the gold standard in labour analgesia, providing the most effective pain relief during childbirth. Improvements have enhanced the efficacy and safety of epidural analgesia through better drugs, techniques and delivery systems. This review describes the history of epidural labour analgesia and recent improvements in labour epidural analgesia. We discuss the role of the combined spinal epidural technique, low-concentration local anaesthetic-opioid epidural solutions, patient-controlled epidural analgesia, and programmed intermittent or automated mandatory boluses in the maintenance of epidural labour analgesia. We also review the newer interactive techniques for drug delivery, such as computer-integrated patient-controlled epidural analgesia and variable frequency automated mandatory bolus. Finally, we discuss future clinical research developments, including the use of data analytics and long-term outcomes associated with childbirth pain management.
[Mh] Termos MeSH primário: Analgesia Epidural/tendências
Analgesia Obstétrica/tendências
Dor do Parto/tratamento farmacológico
Trabalho de Parto
[Mh] Termos MeSH secundário: Analgesia Obstétrica/métodos
Analgesia Controlada pelo Paciente/métodos
Analgesia Controlada pelo Paciente/tendências
Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE


  7 / 807 MEDLINE  
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[PMID]:28438273
[Au] Autor:Jahdi F; Sheikhan F; Haghani H; Sharifi B; Ghaseminejad A; Khodarahmian M; Rouhana N
[Ad] Endereço:Faculty School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Nursing Research Institute, Iran University of Medical Science, Iran.
[Ti] Título:Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial).
[So] Source:Complement Ther Clin Pract;27:1-4, 2017 May.
[Is] ISSN:1873-6947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To investigate the effects of an antenatal yoga program on perceived maternal labor pain and delivery outcomes. MATERIAL & METHODS: This randomized control trial was conducted with sixty primiparous women, aged 18-35 years old, who were randomly assigned to either an antenatal yoga program or control groups. Labor pain and discomfort level of the participants were measured using a Visual Analogue Scale at cervical dilatation of 3-4 c and at 2 and 4 h after the initial measurement. Demographic and obstetrical information were collected. The antenatal yoga program consisted of a 1-h supervised yoga class, three times a weekly, starting at 26 weeks gestation. . RESULTS: Participants in control group reported higher pain intensity compared to experimental group at 3-4 cm of dilatation (p = 0.01) and at 2 h after the first and the second measurements (p = 0.000). Mothers in the antenatal intervention group that completed the yoga class required a decreased frequency of labor induction in comparison with control group (p = 0.008). In addition, mode of delivery of the intervention group resulted in a lower percentage of cesarean section than control group (p = 0.002). Lastly, the intervention group experienced a shorter duration of the second and third stages of labor. Interval level data was analyzed by using an independent t-test and chi-square. CONCLUSION: Yoga during pregnancy may contribute to a reduction pain of labor and improved adequacy of childbirth.
[Mh] Termos MeSH primário: Parto Obstétrico
Dor do Parto/terapia
Resultado da Gravidez
Ioga
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170626
[Lr] Data última revisão:
170626
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170426
[St] Status:MEDLINE


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[PMID]:28414707
[Au] Autor:Whitburn LY; Jones LE; Davey MA; Small R
[Ad] Endereço:aDepartment of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Victoria, Australia bJudith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Victoria, Australia cDepartment of Obstetrics and Gynaecology, Monash University, Victoria, Australia.
[Ti] Título:Supporting the updated definition of pain. But what about labour pain?
[So] Source:Pain;158(5):990-991, 2017 05.
[Is] ISSN:1872-6623
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Dor do Parto
Trabalho de Parto
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Gravidez
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170607
[Lr] Data última revisão:
170607
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170418
[St] Status:MEDLINE
[do] DOI:10.1097/j.pain.0000000000000841


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[PMID]:28407220
[Au] Autor:Weibel S; Jelting Y; Afshari A; Pace NL; Eberhart LH; Jokinen J; Artmann T; Kranke P
[Ad] Endereço:Department of Anaesthesia and Critical Care, University of Würzburg, Oberduerrbacher Str. 6, Würzburg, Germany.
[Ti] Título:Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour.
[So] Source:Cochrane Database Syst Rev;4:CD011989, 2017 Apr 13.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Multiple analgesic strategies for pain relief during labour are available. Recently remifentanil, a short-acting opioid, has recently been used as an alternative analgesic due to its unique pharmacological properties. OBJECTIVES: To systematically assess the effectiveness of remifentanil intravenous patient-controlled analgesia (PCA) for labour pain, along with any potential harms to the mother and the newborn. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 December 2015), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), handsearched congress abstracts (November 2015), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-randomised trials comparing remifentanil (PCA) with another opioid (intravenous (IV)/intramuscular (IM)), or with another opioid (PCA), or with epidural analgesia, or with remifentanil (continuous IV), or with remifentanil (PCA, different regimen), or with inhalational analgesia, or with placebo/no treatment in all women in labour including high-risk groups with planned vaginal delivery. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, extracted data, and appraised study quality.We contacted study authors for additional information other than incomplete outcome data. We performed random-effects meta-analysis.To reduce the risk of random error in meta-analysis we performed trial sequential analysis. We included total zero event trials and used a constant continuity correction of 0.01 (ccc 0.01) for meta-analysis. We applied the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to assess the quality of evidence. MAIN RESULTS: Twenty RCTs with 3569 women were included. Of those, 10 trials (2983 participants) compared remifentanil (PCA) to an epidural, four trials (216 participants) to another opioid (IV/IM), three trials (215 participants) to another opioid (PCA), two trials (135 participants) to remifentanil (continuous IV), and one trial (20 participants) to remifentanil (PCA, different regimen). No trials were identified for the remaining comparisons.Methodological quality of studies was moderate to poor. We assessed risk of bias as high for blinding issues and incomplete outcome data in 65% and 45% of the included studies, respectively.There is evidence of effect that women in the remifentanil (PCA) group were more satisfied with pain relief than women in the other opioids (IV/IM) group (standardised mean difference (SMD) 2.11, 95% confidence interval (CI) 0.72 to 3.49, four trials, very low-quality evidence), and that women were less satisfied compared to women in the epidural group (SMD -0.22, 95% CI -0.40 to -0.04, seven trials, very low-quality evidence).There is evidence of effect that remifentanil (PCA) provided stronger pain relief at one hour than other opioids administered IV/IM (SMD -1.58, 95% CI -2.69 to -0.48, three trials, very low-quality evidence) or via PCA (SMD -0.51, 95% CI -1.01 to -0.00, three trials, very low-quality evidence). Pain intensity was higher in the remifentanil (PCA) group compared to the epidural group (SMD 0.57, 95% CI 0.31 to 0.84, six trials, low-quality evidence).Data were limited on safety aspects for both the women and the newborns. Only one study analysed maternal apnoea in a comparison of remifentanil (PCA) versus epidural and reported that half of the women in the remifentanil and none in the epidural group had an apnoea (very low-quality evidence). There is no evidence of effect that remifentanil (PCA) was associated with an increased risk for maternal respiratory depression when compared to epidural analgesia (RR 0.91, 95% CI 0.51 to 1.62, ccc 0.01, three trials, low-quality evidence) and no reliable conclusion might be reached compared to remifentanil (continuous IV) (all study arms included zero events, two trials, low-quality evidence). In one trial of remifentanil (PCA) versus another opioid (IM) three out of 18 women in the remifentanil and none out of 18 in the control group had a respiratory depression (very low-quality evidence).There is no evidence of effect that remifentanil (PCA) was associated with an increased risk for newborns with Apgar scores less than seven at five minutes compared to epidural analgesia (RR 1.26, 95% CI 0.62 to 2.57, ccc 0.01, five trials, low-quality evidence) and no reliable conclusion might be reached compared to another opioid (IV) and compared to remifentanil (PCA, different regimen) both with zero events in all study arms (one trial, very-low quality evidence). In one trial of remifentanil (PCA) versus another opioid (PCA) none out of nine newborns in the remifentanil and three out of eight in the opioid (PCA) group had Apgar scores less than seven (very-low quality evidence).There is evidence that remifentanil (PCA) was associated with a lower risk for the requirement of additional analgesia when compared to other opioids (IV/IM) (RR 0.57, 95% CI 0.40 to 0.81, three trials, moderate-quality evidence) and that it was associated with a higher risk compared to epidural analgesia (RR 9.27, 95% CI 3.73 to 23.03, ccc 0.01, six trials, moderate-quality evidence). There is no evidence of effect that remifentanil (PCA) reduced the requirement for additional analgesia compared to other opioids (PCA) (RR 0.76, 95% CI 0.45 to 1.28, three trials, low-quality evidence).There is evidence that there was no difference in the risk for caesarean delivery between remifentanil (PCA) and other opioids (IV/IM) (RR 0.63, 95% CI 0.30 to 1.32, ccc 0.01, four trials, low-quality evidence) and epidural analgesia (RR 1.0, 95% CI 0.82 to 1.22, ccc 0.01, nine trials, moderate-quality evidence), respectively. Pooled meta-analysis revealed an increased risk for caesarean section under remifentanil (PCA) compared to other opioids (PCA) (RR 2.78, 95% CI 0.99 to 7.82, two trials, very low-quality evidence). However, a wide range of clinically relevant and non-relevant treatment effects is compatible with this result. AUTHORS' CONCLUSIONS: Based on the current systematic review, there is mostly low-quality evidence to inform practice and future research may significantly alter the current situation. The quality of evidence is mainly limited by poor quality of the studies, inconsistency, and imprecision. More research is needed on maternal and neonatal safety outcomes (maternal apnoea and respiratory depression, Apgar score) and on the optimal mode and regimen of remifentanil administration to provide highest efficacy with reasonable adverse effects for mothers and their newborns.
[Mh] Termos MeSH primário: Analgesia Obstétrica/métodos
Analgesia Controlada pelo Paciente/métodos
Analgésicos Opioides
Dor do Parto/tratamento farmacológico
Piperidinas
[Mh] Termos MeSH secundário: Analgesia Epidural/efeitos adversos
Analgésicos Opioides/administração & dosagem
Analgésicos Opioides/efeitos adversos
Apneia/induzido quimicamente
Cesárea/utilização
Feminino
Seres Humanos
Recém-Nascido
Medição da Dor
Satisfação do Paciente
Piperidinas/administração & dosagem
Piperidinas/efeitos adversos
Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Piperidines); P10582JYYK (remifentanil)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170802
[Lr] Data última revisão:
170802
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011989.pub2


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[PMID]:28406870
[Au] Autor:Hamlaci Y; Yazici S
[Ad] Endereço:Faculty of Health Science, Eskisehir Osmangazi University, Eskisehir, Turkey (Ms Hamlaci); and Faculty of Health Science, Istanbul University (Dr Yazici), Istanbul, Turkey.
[Ti] Título:The Effect of Acupressure Applied to Point LI4 on Perceived Labor Pains.
[So] Source:Holist Nurs Pract;31(3):167-176, 2017 May/Jun.
[Is] ISSN:1550-5138
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Controlling labor pain is one of the basic goals for caregivers during the birthing process. There are many pharmacological and nonpharmacological methods that are used for controlling pain and helping the mother to cope with pain and have a favorable labor. The study was planned as a randomized, controlled experimental study to detect the effect of acupressure applied to Point LI4 on perceived labor pains. The study sample comprised 88 pregnant women (44 acupressure group, 44 control group), who complied with the study guidelines, agreed with the conditions of the study, and signed the informed consent. Acupressure was applied to the study group when cervical dilatation reached 4 to 5 cm and again when cervical dilation was 7 to 8 cm. Acupressure was applied to Point LI4 on both the hands at the same time from the beginning to the end of the contraction (16 times). Evaluation with the visual analog scale was made 6 times: when the pregnant woman was first admitted to the hospital, before and after acupressure, and within 2 hours after delivery. The control group received routine care. There were statistically significant differences between the groups in subjective labor pain scores (P < .0001). There was a significant difference between the groups in terms of total duration of labor. As shown from our study, applying acupressure to Point LI4 was found to be effective in decreasing the perception of labor pains and shortening the labor (P < .05). Mothers were pleased with this treatment, but they found it insufficient to control their pain.
[Mh] Termos MeSH primário: Acupressão/normas
Dor do Parto/terapia
Manejo da Dor/métodos
Parto/psicologia
Complicações na Gravidez/terapia
[Mh] Termos MeSH secundário: Acupressão/métodos
Pontos de Acupuntura
Adolescente
Adulto
Terapias Complementares/normas
Feminino
Seres Humanos
Dor do Parto/enfermagem
Manejo da Dor/normas
Percepção
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE
[do] DOI:10.1097/HNP.0000000000000205



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