International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1996
Maternal expectations and experiences of labour pain and analgesia: a multicentre study of nulliparous women.
Six hospitals with large maternity units in five different European countries were involved in this multicentre study. At least 100 primiparae for each country were examined. All mothers received two standardized interviews, one during the last month of pregnancy, and one 24 h after delivery. ⋯ Maternal expectations of labor pain and the answers to the pre-delivery interview varied significantly between the centers, as did maternal knowledge, expectation and ultimate choice of analgesic technique. Generally speaking the level of maternal satisfaction with analgesia and childbirth experience was high; however, epidural analgesia was more effective than other methods of pain relief (P<0.0001). The most satisfied mothers were those who expected more pain, were satisfied with the analgesia received and had good pain relief after analgesia (P<0.001).
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Complications of pregnancy may necessitate admission to an Intensive Therapy Unit (ITU). All obstetric patients admitted to ITU were reviewed in order to assess whether these admissions could have been predicted and to determine the place of intensive care compared with high dependency nursing. Case notes of 122 women from a total group of 144 women admitted to an ITU of an inner-city hospital from 1989-1993 were reviewed retrospectively. ⋯ The perinatal mortality rate was 6% and there were three maternal deaths. The need for admission to ITU was unpredictable in two-thirds of the cases. Many of the women evaluated in this review were ineligible for high dependency care and required full ITU facilities, both of which will always be needed to deal with serious complications of pregnancy.
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Int J Obstet Anesth · Oct 1996
Comparison of 15 mg and 25 mg of bupivacaine both with 50 microg fentanyl as initial dose for epidural analgesia.
Bupivacaine 15 mg is commonly used as a test dose prior to the initial dose for epidural analgesia in labour. When 15 mg or 25 mg of bupivacaine (15 ml of 0.1% or 0.167%) with 50 microg fentanyl was administered blindly to two groups of labouring women, as an initial dose, 83% and 90% of women respectively, achieved analgesia within 20 min. All the remaining women achieved analgesia with a further dose of 10 mg bupivacaine (10 m10.1%) with fentanyl 2 microg per ml given at 20 min.
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Int J Obstet Anesth · Oct 1996
The anaesthetic management of a labouring woman with pulmonary arterio-venous malformations.
Epidural analgesia is recommended for many medical conditions in labouring women. We describe a case where it was used successfully in a parturient with multiple pulmonary arterio-venous (a-v) malformations. It has been noted that pregnancy can cause marked deterioration in the condition of such patients. We support the suggestion that pulmonary a-v malformations can be added to the list of conditions for which epidural analgesia should be considered.