Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial

  • Juan Sebastián Parada Zuluaga Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana. Medellín, Colombia.
  • Diego Alejandro Bastidas Palacios School of Medicine, Universidad Pontificia Bolivariana. Medellín, Colombia.
  • Yerlin Andrés Colina Vargas School of Medicine, Universidad Pontificia Bolivariana. Medellín, Colombia.
  • Nury Isabel Socha García Maternal Child Unit, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana. Medellín, Colombia.
  • Juan Guillermo Barrientos Gómez School of Health Sciences, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana. Medellín, Colombia.
  • Ancízar Joaquín de la Peña Silva Maternal Child Unit, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana. Medellín, Colombia.
Keywords: Obstetrical analgesia, Length of stay, Patient discharge, Obstetric labor, Postpartum period

Abstract

Introduction: The duration of labor and the immediate puerperium are affected by obstetric and maternal-fetal factors. Interventions to provide obstetric analgesia may prolong the hospital stay.

Objective: To characterize the procedure for obstetric analgesia and describe the time elapsed between analgesia and delivery and postpartum surveillance in healthy mothers.

Methods: Observational, descriptive trial. The time elapsed between analgesia and delivery, and postpartum surveillance were measured in healthy pregnant women with vaginal delivery and a prescription of a neuraxial analgesia technique.

Results: 226 patients were included. The mean time elapsed between analgesia an delivery was 4 hours (IQR 3-7). 50.7 % (n = 114) received early analgesia (neuraxial technique with ≤ 4 centimeters of cervical dilatation), of which 48.2 % (n = 109) experienced a duration of analgesia until delivery longer than expected. The mean cervical dilatation at the time of the neuraxial approach was 4 centimeters (IQR 4-6) and the epidural technique was the most frequently used – 92.9 % (n = 210). The mean postpartum surveillance was 20 hours (IQR 15-27).

Conclusions: Half of the patients included received early analgesia and around fifty percent of them took longer than expected in completing delivery. The postpartum surveillance time was consistent with the provisions of the Ministry of Health and with the current trend of a short postpartum surveillance aimed at early hospital discharge and the benefits thereof.

References

Geltore TE, Kelbore AG, Angelo AT. Perceptions of obstetric analgesia: a qualitative study among midwives attending normal vaginal deliveries in Durame Hospital, Southern Ethiopia. JPR. 2019;12:2187-92. doi: https://doi.org/10.2147/JPR.S209913

PNUD. Objetivo 3: Salud y bienestar [Internet]. 2012 [citado: 2020 jul. 12]. Disponible en: https://www.undp.org/content/undp/es/home/sustainable-development-goals/goal-3-good-health-and-well-being.html

Hanna JS, Herrera-Almario GE, Pinilla-Roncancio M, Tulloch D, Valencia SA, Sabatino ME, et al. Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis. Lancet Glob Health. 2020;8(5):e699-710. doi: https://doi.org/10.1016/S2214-109X(20)30090-5

Navarro-Vargas JR, Eslava-Schmalbach JH. Does Colombia need more anaesthetists? Colombian Journal of Anesthesiology. 2014;42(4):245-6. doi: https://doi.org/10.1016/j.rcae.2014.07.005

Pascual-Ramírez J, Haya Palazuelo J, Valverde Mantecón JM. Analgesia combinada epidural-intradural para el trabajo de parto: una revisión bibliográfica sistemática cuantitativa (metaanálisis). Rev Esp Anestesiol Rean. 2013;60(9):489-97. doi: https://doi.org/10.1016/j.redar.2013.04.015

Setty T. Systemic analgesia: Parenteral and inhalational agents. En: Chestnut´s obstetric anesthesia: principles and practice Part VI Labor and Vaginal Delivery. 5th ed. Elsevier; 2014. p. 21.

Arnal D, Serrano ML, Corral E, García del Valle S. Remifentanilo intravenoso para analgesia del trabajo del parto. Rev Esp Anestesiol Reanim. 2009;56:222-31. doi: https://doi.org/10.1016/S0034-9356(09)70376-7

Eltzschig HK, Lieberman ES, Camann WR. Regional anesthesia and analgesia for labor and delivery. N Engl J Med. 2003;348(4):319-32. doi: https://doi.org/10.1056/NEJMra021276

Brown S, Small R, Argus B, Davis PG, Krastev A. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database of Systematic Reviews. 2002;(3). doi: https://doi.org/10.1002/14651858.CD002958

Benahmed N, San Miguel L, Devos C, Fairon N, Christiaens W. Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review. BMC Pregnancy and Childbirth. 2017;17(1):289. doi: https://doi.org/10.1186/s12884-017-1465-7

Normal Labor. En: Williams Obstetrics. McGraw-Hill Medical [Internet]. 2018 [citado: 2020 jul. 17]. Disponible en: https://accessmedicine.mhmedical.com/content.aspx?bookid=1918&sectionid=185050991

De Pietri L, Siniscalchi A, Reggiani A, Masetti M, Begliomini B, Gazzi M, et al. The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg. 2006;102(4):1157-63. doi: https://doi.org/10.1213/01.ane.0000198567.85040.ce

Zha Y, Gong X, Yang C, Deng D, Feng L, Luo A, et al. Epidural analgesia during labor and its optimal initiation time-points: A real-world study on 400 Chinese nulliparas. Medicine (Baltimore). 2021;100(9):e24923. doi: https://doi.org/10.1097/MD.0000000000024923

Hoefnagel A, Yu A, Kaminski A. Anesthetic complications in pregnancy. Critical Care Clinics. 2016;32(1):1-28. doi: https://doi.org/10.1016/j.ccc.2015.08.009

Ramírez VG, García MAB, Limas CAS. Norma técnica para la atención del parto [Internet]. s. f. [citado: 2020 jul. 18]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/3Atencion %20del %20Parto.pdf

Grueso Angulo ML, Matajira Gaitán CA, Barney Iglesias E. Informe Nacional de Calidad de la Atención en Salud, 2015. Ministerio de Salud y Protección Social, Gobierno de Colombia. 2015 [citado: 2020 jul. 12]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/informe-nal-calidad-atencion-salud-2015.pdf

Berryman GK, Rhodes MK. Early discharge of mothers and infants following vaginal childbirth. Mil Med. 1991;156(11):583-4. doi: https://doi.org/10.1093/milmed/156.11.583

OCDE. Average length of stay: childbirth 2014/1: Single spontaneous delivery [Internet]. [citado: 2020 oct. 13]. Disponible en: https://www.oecd-ilibrary.org/social-issues-migration-health/average-length-of-stay-childbirth-2014-1_l-o-s-childbirth-table-2014-1-en

Johansson K, Aarts C, Darj E. First-time parents’ experiences of home-based postnatal care in Sweden. Ups J Med Sci. 2010;115(2):131-7. doi: https://doi.org/10.3109/03009730903431809

Lin Y, Zhu X, Liu F, Zhao Y, Du J, Yao G, et al. [Analysis of risk factors of prolonged intensive care unit stay of critically ill obstetric patients: a 5-year retrospective review in 3 hospitals in Beijing]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011;23(8):449-53.

Danbjørg DB, Wagner L, Clemensen J. Do families after early postnatal discharge need new ways to communicate with the hospital? A feasibilility study. Midwifery. 2014;30(6):725-32. doi: https://doi.org/10.1016/j.midw.2013.06.006

Guiasalud. Ministerio de sanidad, servicios sociales e igualdad, España. Guía de Práctica Clínica de atención en el Embarazo y Puerperio. 6. Atención durante el puerperio [Internet]. GuíaSalud. 2014 [citado: 2020 jul. 18]. Disponible en: https://portal.guiasalud.es/egpc/embarazo-atencion-puerperio/

De Luca D, Carnielli VP, Paolillo P. Neonatal hyperbilirubinemia and early discharge from the maternity ward. Eur J Pediatr. 2009;168(9):1025-30. doi: https://doi.org/10.1007/s00431-009-0969-1

How to Cite
1.
Parada Zuluaga JS, Bastidas Palacios DA, Colina Vargas YA, Socha García NI, Barrientos Gómez JG, de la Peña Silva AJ. Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial . Colomb. J. Anesthesiol. [Internet]. 2021Sep.21 [cited 2021Oct.16];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1005

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Published
2021-09-21
How to Cite
1.
Parada Zuluaga JS, Bastidas Palacios DA, Colina Vargas YA, Socha García NI, Barrientos Gómez JG, de la Peña Silva AJ. Assessing the duration of obstetric analgesia and the time elapsed between analgesia and delivery. Observational trial . Colomb. J. Anesthesiol. [Internet]. 2021Sep.21 [cited 2021Oct.16];49. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/1005
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