Pharmacological pain relief and fear of childbirth in low risk women; secondary analysis of the RAVEL study

Acknowledgements We would like to thank all of the participants in our study and the midwives and gynaecologists of the participating practices and hospitals respectively. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on request.Peer reviewedPublisher PD

A retrospective study on persistent pain after childbirth in the Netherlands

Reported prevalence rates of persistent postpartum pain (PPP) range from less than 1% to almost 20%. The aim of this study was to examine the prevalence of PPP in a Dutch cohort and to evaluate a possible causal role for specific risk factors on the development of chronic pain after childbirth. A questionnaire was sent to 960 postpartum women approximately 2 years after delivery. Primary outcome was pain that arose from childbirth at follow-up, and secondary outcomes included quality of life (QoL) and Hospital Anxiety and Depression Scale scores. Tested risk factors included mode of labor analgesia, history of negative effect, history of chronic pain, delivery route, parity, and ethnicity. A total of 495 (51.6%) women participated. At a mean time of 2.3 postpartum years, 7.3% of women reported any pain and 6.1% reported significant pain related to the delivery. Compared to spontaneous delivery, cesarean delivery provided protection against persistent pain (odds ratio, 0.12; 95% CI, 0.01–0.63, P<0.05). None of the other risk factors, including remifentanil use for labor pain, were of influence on the prevalence of persistent pain. Women with PPP experienced greater negative effects and had lower QoL scores compared to women without pain. In this cohort of Dutch patients, PPP is a serious problem with a great impact on the physical and mental health of women

Кредитний механізм реалізації фінансової стратегії розвитку великого промислового регіону

Мета даної статті полягає в розробці на основі системного підходу концепції вдосконалення кредитного механізму реалізації фінансової стратегії розвитку великого промислового регіону, яка призведе до підвищення його прибутковості

Remifentanil patient controlled analgesia versus epidural analgesia in labour. A multicentre randomized controlled trial

Contains fulltext : 109349.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Pain relief during labour is a topic of major interest in the Netherlands. Epidural analgesia is considered to be the most effective method of pain relief and recommended as first choice. However its uptake by pregnant women is limited compared to other western countries, partly as a result of non-availability due to logistic problems. Remifentanil, a synthetic opioid, is very suitable for patient controlled analgesia. Recent studies show that epidural analgesia is superior to remifentanil patient controlled analgesia in terms of pain intensity score; however there was no difference in satisfaction with pain relief between both treatments. METHODS/DESIGN: The proposed study is a multicentre randomized controlled study that assesses the cost-effectiveness of remifentanil patient controlled analgesia compared to epidural analgesia. We hypothesize that remifentanil patient controlled analgesia is as effective in improving pain appreciation scores as epidural analgesia, with lower costs and easier achievement of 24 hours availability of pain relief for women in labour and efficient pain relief for those with a contraindication for epidural analgesia.Eligible women will be informed about the study and randomized before active labour has started. Women will be randomly allocated to a strategy based on epidural analgesia or on remifentanil patient controlled analgesia when they request pain relief during labour. Primary outcome is the pain appreciation score, i.e. satisfaction with pain relief.Secondary outcome parameters are costs, patient satisfaction, pain scores (pain-intensity), mode of delivery and maternal and neonatal side effects.The economic analysis will be performed from a short-term healthcare perspective. For both strategies the cost of perinatal care for mother and child, starting at the onset of labour and ending ten days after delivery, will be registered and compared. DISCUSSION: This study, considering cost effectiveness of remifentanil as first choice analgesia versus epidural analgesia, could strongly improve the care for 180.000 women, giving birth in the Netherlands yearly by giving them access to pain relief during labour, 24 hours a day. TRIAL REGISTRATION NUMBER: Dutch Trial Register NTR2551, http://www.trialregister.nl

Praktijkvariatie in het gebruik van remifentanil tijdens de partus: Een beeld van de toepassing in de Nederlandse ziekenhuizen = [Practice variation in the application of remifentanil during labour: an overview of its application in Dutch hospitals]

Objective: To survey (a) the frequency of the use of patient-controlled analgesic remifentanil-PCA during labour in the Netherlands; (b) considerations by obstetricians whether or not to offer remifentanil-PCA; (c) target population for remifentanil-PCA and (d) the application of maternal monitoring.Design: Descriptive survey.Method: A questionnaire was sent to all 81 Dutch hospitals with a labour ward. The following subjects were covered: (a) available methods for pharmacological pain relief; (b) considerations by obstetricians whether or not to offer remifentanil-PCA; (c) target population for remifentanil-PCA; (d) maternal monitoring and (e) the hospital's birth data for the year 2016. The hospital pharmacist was asked for the number of remifentanil dispensed in 2016-2017.Results: The questionnaire was completed by 81 obstetricians (100% response rate). Remifentanil-PCA was available in 59 out of 81 (73%) of the hospitals with a mean use of 23% of the births (range 16-56%) in those units. In 34 (58%) of these hospitals, remifentanil-PCA is available for all women, and in 25 (42%) it was for a selected group of women. Most frequently mentioned considerations for offering remifentanil-PCA were 'a need for an alternative for epidural analgesia' and 'at the request of pregnant women' reported a respective 55 (93%) and 46 (78%) times. In hospitals where remifentanil-PCA was not offered, the following motives were given for this policy: 'epidural analgesia is the most effective method of pain relief during labour'; 'risk of serious maternal complications'; and 'sufficient monitoring during labour not feasible in delivery rooms'.Conclusion: A large variation between Dutch hospitals exists in the application of remifentanil-PCA during labour. In the majority of the hospitals, remifentanil-PCA is available for all women. The most common motives mentioned by obstetricians for its use are 'a need for an alternative for epidural analgesia' and 'at the request of pregnant women'

Praktijkvariatie in het gebruik van remifentanil tijdens de partus: Een beeld van de toepassing in de Nederlandse ziekenhuizen = [Practice application of remifentanil during labor: An overview of its application in Dutch hospitals]

DoelOnderzoeken (a) frequentie van het gebruik van patiëntgecontroleerde toediening van remifentanil (remifentanil-PCA) durante partu in Nederland; (b) wat motieven zijn om remifentanil-PCA al dan niet aan te bieden; (c) voor welke vrouwen remifentanil-PCA beschikbaar is; en (d) welke maternale monitoring wordt toegepast.OpzetBeschrijvend vragenlijstonderzoek.MethodeAlle 81 Nederlandse ziekenhuizen met een verlosafdeling ontvingen een vragenlijst over de volgende onderwerpen: (a) beschikbare methoden voor farmacologische pijnbehandeling; (b) motieven van gynaecologen om remifentanil-PCA wel of niet aan te bieden; (c) de doelgroep voor remifentanil-PCA; (d) maternale monitoring; en (e) Perined-gegevens uit 2016. Wij vroegen de ziekenhuisapothekers naar aantallen ampullen remifentanil die zij in de periode 2016-2017 geleverd hadden.ResultatenDe vragenlijst werd door 81 gynaecologen (100%) ingevuld. In 59 (73%) van de 81 ziekenhuizen was remifentanil-PCA beschikbaar. In deze ziekenhuizen werd remifentanil-PCA bij gemiddeld 23% van de partussen toegepast (uitersten: 16-56%). In 34 (58%) van deze 59 ziekenhuizen was remifentanil-PCA voor alle vrouwen beschikbaar en in 25 (42%) voor een selecte groep. De meest genoemde motieven om remifentanil-PCA beschikbaar te stellen waren ‘de wenselijkheid van een alternatief voor epidurale analgesie’ en ‘op verzoek van zwangeren’, respectievelijk 55 keer (93%) en 46 keer (78%). In ziekenhuizen waar remifentanil-PCA niet beschikbaar was, waren ‘betere pijnbehandeling door epidurale analgesie’, ‘het risico op ernstige maternale bijwerkingen’ en ‘onvoldoende mogelijkheden voor observatie op verloskamers’ de belangrijkste motieven voor dit beleid.ConclusieEr is aanzienlijke variatie in de toepassing van remifentanil-PCA durante partu in Nederland. Remifentanil-PCA is in het merendeel van de ziekenhuizen beschikbaar voor alle vrouwen. De belangrijkste motieven van gynaecologen zijn ‘de wenselijkheid van een alternatief voor epidurale analgesie’ en ‘op verzoek van zwangeren’

Good reliability and validity for a new utility instrument measuring the birth experience, the Labor and Delivery Index

Objectives To validate the Labor and Delivery Index (LADY-X), a new delivery-specific utility measure. Study Design and Setting In a test-retest design, women were surveyed online, 6 to 8 weeks postpartum and again 1 to 2 weeks later. For reliability testing, we assessed the standard error of measurement (S.E.M.) and the intraclass correlation coefficient (ICC). For construct validity, we tested hypotheses on the association with comparison instruments (Mackey Childbirth Satisfaction Rating Scale and Wijma Delivery Experience Questionnaire), both on domain and total score levels. We assessed known-group differences using eight obstetrical indicators: method and place of birth, induction, transfer, control over pain medication, complications concerning mother and child, and experienced control. Results The questionnaire was completed by 308 women, 257 (83%) completed the retest. The distribution of LADY-X scores was skewed. The reliability was good, as the ICC exceeded 0.80 and the S.E.M. was 0.76. Requirements for good construct validity were fulfilled: all hypotheses for convergent and divergent validity were confirmed, and six of eight hypotheses for known-group differences were confirmed as all differences were statistically significant (P-values

Neonatal Safety of Elective Family-Centered Caesarean Sections: A Cohort Study

BackgroundAlthough little data are available concerning safety for newborns, family-centered caesarean sections (FCS) are increasingly implemented. With FCS mothers can see the delivery of their baby, followed by direct skin-to-skin contact. We evaluated the safety for newborns born with FCS in the Leiden University Medical Center (LUMC), where FCS was implemented in June 2014 for singleton pregnancies with a gestational age (GA) ≥38 weeks and without increased risks for respiratory morbidity.MethodsThe incidence of respiratory pathology, unplanned admission, and hypothermia in infants born after FCS in LUMC were retrospectively reviewed and compared with a historical cohort of standard elective cesarean sections (CS).ResultsFrom June 2014 to November 2015, 92 FCS were performed and compared to 71 standard CS in 2013. Incidence of respiratory morbidity, hypothermia, temperatures at arrival at the department, GA, and birth weight were comparable (ns). Unplanned admission occurred more often after FCS when compared to standard CS (21 vs 7%; p = 0.03), probably due to peripheral oxygen saturation (SpO2) monitoring. There was no increase in respiratory pathology (8 vs 6%, ns). One-third of the babies were separated from their mother during or after FCS.ConclusionUnplanned neonatal admissions after elective CS increased after implementing FCS, without an increase in respiratory morbidity or hypothermia. SpO2 monitoring might have a contribution. Separation from the mother occurred often