American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · May 2002
ReviewNitrous oxide for relief of labor pain: a systematic review.
A systematic review was conducted to determine the efficacy and safety of nitrous oxide for labor analgesia. Eleven randomized controlled trials with adequate control groups and outcome assessment by parturients during or shortly after the intervention were used to determine efficacy. ⋯ Nitrous oxide is not a potent labor analgesic, but it is safe for parturient women, their newborns, and health care workers in attendance during its administration. It appears to provide adequately effective analgesia for many women.
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Am. J. Obstet. Gynecol. · May 2002
ReviewPsychological factors in the etiology and treatment of severe nausea and vomiting in pregnancy.
The assumption is frequently made that women with severe nausea and vomiting during pregnancy are transforming psychological distress into physical symptoms. Psychoanalytic theory supporting this assumption is reviewed, along with the few methodologically flawed empirical studies that have been conducted. ⋯ This implies that psychological responses can interact with the physiology of nausea and vomiting during pregnancy to exacerbate the condition. As such, psychological treatments for the symptoms of this disorder need to be further explored.
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Am. J. Obstet. Gynecol. · May 2002
ReviewParacervical block for labor analgesia: a brief historic review.
This historic review was written to clarify the known efficacy and side effects of paracervical blockade for labor analgesia. Although the popularity of the technique has diminished considerably, it continues to be used by some clinicians with ostensibly good results. The Cochrane Controlled Trials Register (CCTR;SR-PREG) and the electronic database MEDLINE were searched for studies reported in English to determine efficacy and side effects of paracervical block. ⋯ Postparacervical block fetal bradycardia is the most significant side effect with a reported incidence ranging from 0% to approximately 40%. Overall, it appears that the incidence of postparacervical block fetal bradycardia is approximately 15%. However, the etiology of the observed fetal bradycardia remains unclear, and the incidence of adverse impact on fetal or neonatal outcome remains uncertain because there are too few trials with too few patients.
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Am. J. Obstet. Gynecol. · May 2002
ReviewParenteral opioids for labor pain relief: a systematic review.
Parenteral opioids are commonly used for labor pain relief and have been the subject of research for many years. The objectives of this review were to determine the safety and effectiveness of parenteral opioids in this context. Of 85 trials systematically reviewed, 48 comprising more than 9800 were included, but the number of trials contributing data to individual outcome measures is very limited. ⋯ Pethidine is the most commonly used opioid worldwide, and although there are considerable doubts about its analgesic effectiveness and concerns about its potential maternal, fetal, and neonatal side effects, it has the virtue of familiarity and low cost. There is as yet no convincing research evidence to show that alternative opioids are better. In view of the large number of women who receive opioids in labor and the paucity of research evidence about the relative effectiveness and side effects of different opioids and opioids compared with other methods (apart from epidural), well-designed and suitably sized trials of pethidine versus the main alternatives that address substantive outcomes for mothers and babies are strongly recommended.
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Am. J. Obstet. Gynecol. · May 2002
ReviewEvidence-based view of safety and effectiveness of pharmacologic therapy for nausea and vomiting of pregnancy (NVP).
Our goal was to review the safety and effectiveness of available antiemetics for treatment of nausea and vomiting of pregnancy. ⋯ Many medications, particularly H(1)-antagonists and phenothiazines, are safe and effective for treatment of varying degrees of NVP.