Current Practice in Obstetric Anesthesia and Analgesia in Public Hospitals of Greece: A 2016 National Survey

Effects of epidural analgesia at 1 cm cervical dilatation on multiparae: A retrospective cohort study using propensity score-matching

OBJECTIVE

The aim of the present study was to investigate the effects of epidural analgesia (EA) administered at cervical dilatation of 1 cm on multiparae who underwent vaginal delivery.

METHODS

This propensity score-matched retrospective cohort research was conducted between 2021 and 2022. All the singleton multiparae who had previous successful vaginal deliveries and epidural analgesia during this delivery were screened for eligibility. The primary outcome was the effect of EA on the duration of labor. The main secondary outcomes included the incidence of cesarean delivery and umbilical arterial pH.

RESULTS

This study incorporated 686 multiparae who were divided into two cohorts: EA 1 (cervical dilatation = 1 cm, n = 166) and EA 2 (cervical dilatation >1 cm, n = 520). In the propensity score-matched cohort (including 164 women in each group), there were no statistically significant differences in the incidence of cesarean delivery (4 [2.4%] vs 4 [2.4%], P = 1.000), umbilical arterial pH (7.28 ± 0.06 vs 7.28 ± 0.07, P = 0.550) and other secondary outcomes between the two groups. Based on a comparative assessment of the women who delivered vaginally to the Kaplan-Meier curves and propensity score-matching (including 160 women in each group), there was no statistical significance in the duration of the first, second and third stages of labor (log rank P, P = 0.811; P = 0.413; P = 0.773, respectively).

CONCLUSION

Initiation of epidural analgesia at cervical dilatation of 1 cm in multiparae did not cause adverse effects with regard to the duration of labor, increased cesarean deliveries, and bad neonatal outcomes.

Anesthetic Practices for Lower Segment Cesarean Section in the Sultanate of Oman: A National Survey

Background Over the years, obstetric anesthesia has evolved into a comprehensive sub-specialty. Several countries have their guidelines and recommendations for obstetric anesthesia. This survey aimed to describe the current obstetric anesthesia practices in the Sultanate of Oman by performing a questionnaire-based survey. Methods The Ministry of Health-Centre approved the survey for Studies and Research, Sultanate of Oman (MOH-CSR/25057). A Google Form with 25 questions (seven general questions and 18 specific questions) was initially shared in a WhatsApp group of members of the Oman Society of Anaesthesia and Critical Care (OSACC). Anesthesiologists who were not members were contacted directly and responses were recorded. Results Responses were accepted until midnight on December 31, 2023. The number of responses received was 66. Variations in practices like less compliance to Enhanced Recovery After Surgery (ERAS) pathways, use of oxytocin, and choice of intrathecal opioids were observed. Labor analgesia was not practiced by 30.3% of respondents. The majority of respondents did not follow international recommendations regarding the use of the uterotonic drug oxytocin. Conclusion A lot of heterogeneity in the practice of obstetric anesthesia in the Sultanate of Oman was observed. The limitations included the relatively low number of responses and many aspects that were missed in the survey. The findings of this survey will help in establishing a national task force for obstetric anesthesia, which will guide the members of the task force to develop practice guidelines based on international recommendations and the latest evidence.

Physical and Mental Effects of Foot Baths Among Women in Labor: Protocol for a Pre-Post Test Experimental Design

BACKGROUND

Foot baths are used in complementary and alternative therapy to improve the duration and quality of sleep and reduce tension, anxiety, fatigue, and confusion. They are also known to improve the frequency of labor contractions and to increase their duration in women; thus, they are commonly used by midwives in clinical settings in Japan. However, the physical and mental effects of foot baths during labor are unknown.

OBJECTIVE

This study aims to assess the physical and mental effects of foot baths based on biomarker levels and self-administered questionnaires.

METHODS

A single-arm pre-post test trial design is being used in this study, and the study is being conducted at a general hospital in Tochigi Prefecture, Japan. The target study population is women in the first stage of labor, the phase when the uterus starts to contract and when the cervix dilates to 10 cm, or those undergoing labor induction. Participants who meet the eligibility criteria are recruited, and written informed consent is obtained from them. They are asked to answer the questionnaire and to collect 1.5 mL of saliva in 2 microtubes each, before and after the intervention. The intervention is foot baths for 15-20 minutes using a foot bath device. Data on delivery, such as gestational age, gravidity, parity, diagnosis following the last vaginal examination, and presence or absence of membrane rupture, are retrieved from the medical records. The primary outcomes are salivary cortisol levels before and after the foot baths. The secondary outcomes are levels of relaxation and comfort, labor pain, body warmth, vital signs, and interval of labor pain before and after the foot baths, which are assessed using a numerical rating scale. A paired t test or Wilcoxon signed-rank test will be performed to compare the data for salivary cortisol levels and numerical rating scale scores.

RESULTS

Data collection started on April 1, 2022. As of October 2022, we had enrolled 10 participants. Because of the COVID-19 pandemic in Japan, it is difficult for medical personnel to freely interact with women in labor until the results of the COVID-19 polymerase chain reaction test are available in the research facility, complicating the recruitment process.

CONCLUSIONS

This is the first prospective study to assess the effects of foot baths using a biomarker during the first stage of labor. The findings on the effects of foot baths on women in labor will provide novel insights that may improve the outcomes of delivery. A randomized controlled trial to investigate the effects of foot baths to obtain robust evidence should be conducted in the future.

TRIAL REGISTRATION

University Hospital Medical Information Network-Clinical Trial Registry UMIN000046539; https://tinyurl.com/2wwj7dns.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39985.

Effects of intrathecal opioids on cesarean section: a systematic review and Bayesian network meta-analysis of randomized controlled trials

PURPOSE

We aimed to compare the beneficial and harmful effects of opioids used as adjuncts to local anesthetics in patients undergoing cesarean section under spinal anesthesia.

METHODS

We searched electronic databases and ClinicalTrials.gov from their inception until March, 2021 without language restrictions. The primary outcome was the complete analgesia duration (Time to VAS > 0). Data were synthesized using the Bayesian random-effects model. Evidence confidence was evaluated using the Confidence In Network Meta-Analysis.

RESULTS

We identified 66 placebo-controlled randomized controlled trials (RCTs) comprising 4400 patients undergoing elective cesarean section. Compared with the placebo, intrathecal opioids (fentanyl, sufentanil, and morphine) significantly prolonged the analgesia duration by 96, 96, and 190 min, respectively (mean difference). Despite morphine ranking first, opioid efficacy was similar; the results were inconsistent with respect to other analgesic outcomes. Except for diamorphine, all opioids were associated with significant increases in the pruritus incidence. Sufentanil and morphine were associated with increases in the respiratory depression incidence.

CONCLUSIONS

We confirmed that intrathecal opioids benefit postoperative analgesia. Although morphine seems to be the most appropriate agent, some results were inconsistent, and the evidence confidence was often moderate or low, especially for adverse outcomes. Well-designed RCTs with an evidence-based approach are imperative for determining the most appropriate opioid for cesarean sections.

National survey of obstetric anaesthesia clinical practices in the republic of Austria

BACKGROUND

The aim of this study was to describe the current obstetric anaesthetic practices in Austria by performing a comprehensive questionnaire survey.

METHODS

A questionnaire was sent via email to key anaesthesiologists from obstetric anaesthesia departments of 81 hospitals registered at the Austrian Ministry of Health.

RESULTS

Of 81 departments contacted, 65 (80%), covering 84% of annual births in Austria, responded to the 82-question survey. Epidural analgesia was offered universally, at a rate under 30% in 56 (86%) of respondent hospitals. The caesarean section rate was under 30% in 44 (68%) respondent obstetric units. All respondents provided spinal anaesthesia as the primary anaesthetic technique for elective caesarean section. Three (5%) respondents administered long-acting intrathecal morphine and 18 (28%) respondents did not routinely administer any intrathecal opioid. Wound infiltration for acute postoperative pain control was practiced in two (3%) respondent units. A transversus abdominis plane block was offered as rescue analgesia in 14 (22%) departments. Spinal hypotension was treated using a prophylactic phenylephrine infusion in two (3%) respondent hospitals. Prophylactic antibiotics were administered prior to skin incision by 31 (48%) respondents.

CONCLUSION

This survey reveals that obstetric anaesthetic practices in Austria differ in part from current European and American guidelines. Findings will direct the national workforce on obstetric anaesthesia that aims to introduce into Austria practice guidelines, based on international collaborations and guideline recommendations.