European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 1995
ReviewInfluence of epidural analgesia on fetal and neonatal well-being.
Epidural analgesia is a frequently used method to reduce the pain of child-bearing. Concerns regarding the safety and potential hazards still persist in the medical community. This review intends to examine how epidural analgesia determines the various factors of fetal and neonatal well-being. ⋯ Neonatal depression can occur however with epidural use of morphine, fentanyl and alfentanil. Sufentanil, again in doses up to 30 micrograms in association with bupivacaine seems to be devoid of depressive effects on the neonate. In summary, the anaesthetist has good arguments to reassure his obstetrical colleagues that providing epidural analgesia for pregnant women in labour is a justifiable intervention to support the natural process of child-bearing.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 1995
ReviewThe nature and consequences of childbirth pain.
For most women, childbirth is associated with very severe pain often exceeding all expectations. Some childbirth education groups and popular texts on the subject, however, seem disposed to encourage unrealistic expectations: claiming that labour is other than painful and that pharmacological analgesia is both unnecessary and harmful. All too often, those who promote such views witness women in labour only occasionally and are rarely responsible for patient care. ⋯ As described in this review, it is now well established that uterine contraction pain evokes a generalised neuroendocrinal stress response producing widespread physiological effects during the first stage of labour. They include increased oxygen consumption, hyperventilation and respiratory alkalosis; increased cardiac output, systemic peripheral resistance and blood pressure; delayed gastric emptying; impaired uterine contractility and diminished uterine perfusion; and metabolic acidaemia. While other factors (such as anxiety, starvation and physical exertion) are also partly responsible for inducing some of these effects, pain appears to be the most potent source because they are all obtunded by effective epidural analgesia.