الفهرس 
Physiology of labor pain
Complications of epidural analgesiaOnly 14 pages are availabe for public view
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Abstract
Labor pain includes components that differ completely from pain in general. It is the result of natural events and has a special meaning, leading in most cases to something extremely positive, the birth of a healthy child.
The aim of labor analgesia is to soothe anxiety and pain in the mother, while simultaneously guaranteeing the physiological progression of labor, reduced onset of obstetric complications, and maximum well-being of the maternal–fetal unit. The ideal analgesic should be safe for the mother and newborn, and provides flexibility in changing conditions. Additionally, the ideal technique should provide long-lasting, consistent analgesia titrated to individual parturient needs, with minimal or no risk, no undesirable maternal or fetal side effects, and with minimal physician input and cost.
An understanding of labor pain in a multidimensional framework provides the basis for a woman-centered approach to labor pain management that includes a broad range of pharmacologic and nonpharmacologic intervention strategies. The most common pharmacological methods currently in use are entonox and epidural analgesia. Nonpharmacologic methods include continuous labor support, baths, intradermal water blocks, acupuncture, massage, transcutaneous electrical nerve stimulation, and hypnosis.
Epidural analgesia is considered one of the best methods for pain relief during labor and indeed its use has increased greatly in the last decade. Rates of epidural use vary widely, and are as high as 98% in some European countries. Epidural analgesia involves administration of an analgesic agent in the space around the dura mater surrounding the spinal cord.
Intracutaneous sterile water injection is a simple and inexpensive way to provide a medication-free option to women who want to either avoid or delay use of epidural analgesia or for those for whom epidurals are not available. Sterile water injections have been used for treatment for pain other than labor pain with positive outcomes, including acute attack of urolithiasis, and neck and shoulder pain after whiplash injury.
The objective of this study is to compare the effectiveness, safety and women satisfaction of epidural analgesia and intracutaneous sterile water injection to decrease pain in the 1st stage of labor.
The study was carried on one hundred pregnant women at term (37-41weeks) in the first stage of labor requesting relief for labor pain fulfilled the selection criteria mentioned in this study protocol, and the selection was from the prelabor ward of Ain-Shams Maternity Hospital after their acceptance and signing the appropriate consent and were randomly assigned to two groups (fifty parturient each):
1- Epidural group.
2- Intracutaneous sterile water injection group.
Routine intrapartum management of all women included intravenous fluid administration and auscultation of the fetal heart with fetal stethoscope after each uterine contraction. The frequency and duration of uterine contractions were assessed with the palm of the hand on the uterus. Pelvic examination was performed every hour to evaluate the progress of labor. The aim was to produce a rate of cervical dilation of at least 1 cm/h.
The women’s baseline vital signs (blood pressure, heart rate, and respiratory rate) were documented between contractions, and each parturient was complete during contractions a baseline assessment with a 10-cm visual analog scale (VAS) score for pain.
In all women, the administration of the analgesic drug was carried out within the active phase of labor, at cervical dilatation between 3 and 5 cm, and in the presence of at least three uterine contractions in 10 minutes.
The following parameters were assessed:
1- Pain assessment: pain was assessed with a linear 10-cm visual analog scale with 0 representing no pain and 10 being the worst pain imaginable (Siddik-Sayyid et al., 2008) before initiation of analgesia, 10 min, 30 min after analgesia and every 30 min till the end of 1st stage of labor.
2- Maternal blood pressure, heart rate, O2 saturation, and fetal heart rate were recorded at half hourly intervals.
3- Side effects and complications of the epidural administration and intracutaneous sterile water injection.
4- Duration of the 1st stage of labor.
5- Delivery mode.
6- Apgar scores at one, five, and 10 min.
7- Parturient satisfaction:
The results of this study showed that, the visual analogue scale (VAS) significantly decreased after administration of the analgesic agents in the two studied groups as compared with the pre injection value of each group. The visual analogue scale (VAS) significantly decreased after administration of the analgesic agents in the epidural group as compared with sterile water injection group.
There were no statistically significant differences regarding the frequency of uterine contraction between both groups.
Both type of analgesia had no deleterious effect on the neonatal outcome. There were no statistical significant differences between both groups as regard the results of Apgar score assessment of the neonates at one, five and ten minutes.
The incidence of hypotension was significant high among epidural group as compared with sterile water injection group.
The percentage of CS and instrumental delivery were higher in epidural group as compared with sterile water injection group without significant difference between both groups.
There were no statistically significant differences regarding the satisfaction with labor analgesia between the two studied groups