International journal of obstetric anesthesia
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Int J Obstet Anesth · Feb 2021
Prediction of breakthrough pain during labour neuraxial analgesia: comparison of machine learning and multivariable regression approaches.
Risk-prediction models for breakthrough pain facilitate interventions to forestall inadequate labour analgesia, but limited work has used machine learning to identify predictive factors. We compared the performance of machine learning and regression techniques in identifying parturients at increased risk of breakthrough pain during labour epidural analgesia. ⋯ Machine learning did not improve the prediction of breakthrough pain compared with multivariable regression. Larger population-wide studies are needed to improve predictive ability.
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Int J Obstet Anesth · Feb 2021
Selection of baseline blood pressure to guide management of hypotension during spinal anaesthesia for caesarean section.
Recommendations on vasopressor management during caesarean section under spinal anaesthesia suggest maintaining systolic arterial pressure ≥90% of an accurately measured baseline value. The baseline is often taken as the first reading in the operating room. We hypothesise that this reading may not reflect an accurate baseline value. ⋯ Using the initial blood pressure reading in the operating room as the baseline value may lead to unnecessary vasopressor use and hypertension. Prospective research is required to clarify which reading represents the most accurate baseline to maintain homeostasis and reduce the hypotensive sequelae of neuraxial anaesthesia for both the mother and fetus.
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Int J Obstet Anesth · Feb 2021
Observational StudyThe influence of labor epidural analgesia on maternal, uteroplacental and fetoplacental hemodynamics in normotensive parturients: a prospective observational study.
Epidural analgesia provides sufficient analgesia during labor but can cause hypotension despite various prophylactic measures. We studied its effects on pre-placental, fetoplacental, and fetal hemodynamics using Doppler ultrasound. The primary endpoint was the pulsatility index of the umbilical artery at 30 min after establishing epidural analgesia. Secondary endpoints included maternal blood pressures and neonatal outcome data. ⋯ Pre-placental, fetoplacental and fetal hemodynamics remained stable despite a statistically significant decrease in maternal blood pressure in laboring parturients receiving epidural analgesia.
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Int J Obstet Anesth · Feb 2021
Temporal trends in the incidence of post-dural puncture headache following labor neuraxial analgesia in the United States, 2006 to 2015.
Labor neuraxial analgesia utilization has increased in the United States (U.S.) but its impact on maternal safety is unknown. This study analyzed the temporal trends in the incidence of post-dural puncture headache (PDPH) in obstetrics. ⋯ During the study period, the reported incidence of PDPH in the U.S. has decreased modestly. Intervention programs are needed to address this persistent and preventable cause of maternal morbidity.