Maternal and fetal effects of analgesia and anesthesia in spontaneous labor

Cover Page


Cite item

Full Text

Abstract

Labor analgesia is an important aspect of obstetrics, because it significantly influences the process, quality, result and costs of medical management of labor and delivery. From this perspective, one of the most urgent and not fully resolved issues, that requires further studies, is the efficacy and safety of anesthesiological management of spontaneous vaginal delivery. The review presents detailed information on the effects of labor pain on the fetus and on pathophysiological characteristics of the mother giving spontaneous vaginal birth. The authors discuss the influence of narcotic analgesics, neuroaxial analgesia and inhalation analgesia on perinatal and obstetric outcomes, duration of labor and delivery, rates of surgical delivery, with assessment of their side effects, patient's satisfaction with the quality of analgesia, as well as fetal status at birth, neurological status and umbilical blood gases. The use of narcotic analgesics is associated with the risks of inadequate analgesia and such adverse reactions as nausea, vomiting, dizziness in the mother and respiratory suppression in the newborn. Regional analgesia with highly concentrated analgesic solution is associated with pelvic muscle relaxation that may result in the fetus malposition and an increase in duration of delivery. Inhalation of nitrogen monoxide for labor analgesia is no longer used due to its low effectiveness and frequent side effects. The analysis of few publications on the use of inhalation anesthesia with flurane derivatives shows an absence of papers with detailed description of its safety, maternal and fetal effects of an inhalational anesthetic and its influence on perinatal and obstetric outcomes. Thus, the apparent well-doing of the methods used for labor analgesia and anesthesia is rather relative, and we believe that many issues of anesthesiological management have not been unequivocally resolved from the perspective of their effects on the mother, fetus and the newborn.

About the authors

E. Yu. Upriamova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Author for correspondence.
Email: vyalkova@gmail.com

Ekaterina Yu. Upriamova – MD, PhD, Head of Department of Anaesthesiology and Intensive Care.

22а Pokrovka ul., Moscow, 101000, tel.: +7 (906) 710 38 35

Russian Federation

E. M. Shifman

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Efim M. Shifman – MD, PhD, Professor, Chair of Anaesthesiology and Reanimatology, Postgraduate Training Faculty.

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

A. M. Ovezov

Moscow Regional Research and Clinical Institute (MONIKI)

Email: fake@neicon.ru

Aleksey M. Ovezov – MD, PhD, Head of the Chair of Anaesthesiology and Reanimatology, Postgraduate Training Faculty; Head of Department of Anaesthesiology.

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

S. V. Novikova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

Svetlana V. Novikova – MD, PhD, Head of Observational Obstetric Department.

22а Pokrovka ul., Moscow, 101000

Russian Federation

A. G. El'chaninova

Moscow Regional Scientific Research Institute for Obstetrics and Gynecology

Email: fake@neicon.ru

Anastasiya G. El'chaninova – MD, Postgraduate Student, Observational Obstetric Department.

22а Pokrovka ul., Moscow, 101000

Russian Federation

O. V. Chaplygina

Moscow Regional Perinatal Center

Email: fake@neicon.ru

Oksana V. Chaplygina – MD, Head of Anesthesiology and Critical Care Department.

12 Shosse Entuziastov, Balashikha, Moskovskaya oblast', 143900

Russian Federation

References

  1. Littleford J. Effects on the fetus and newborn of maternal analgesia and anesthesia: a review. Can J Anaesth. 2004;51(6): 586–609. doi: 10.1007/BF03018403.
  2. Caton D. The history of obstetric anesthesia. In: Chestnut DH, editor. Obstetric Anesthesia, Principles and Practice. 2nd ed. New York: Mosby; 1999. p. 1–13.
  3. Tomimatsu T, Kakigano A, Mimura K, Kanayama T, Koyama S, Fujita S, Taniguchi Y, Kanagawa T, Kimura T. Maternal carbon dioxide level during labor and its possible effect on fetal cerebral oxygenation: mini review. J Obstet Gynaecol Res. 2013;39(1): 1–6. doi: 10.1111/j.1447-0756.2012.01944.x.
  4. Dreiling M, Bischoff S, Schiffner R, Rupprecht S, Kiehntopf M, Schubert H, Witte OW, Nathanielsz PW, Schwab M, Rakers F. Stress-induced decrease of uterine blood flow in sheep is mediated by alpha 1-adrenergic receptors. Stress. 2016;19(5): 547–51. doi: 10.1080/10253890.2016.1203417.
  5. Rakers F, Bischoff S, Schiffner R, Haase M, Rupprecht S, Kiehntopf M, Kühn-Velten WN, Schubert H, Witte OW, Nijland MJ, Nathanielsz PW, Schwab M. Role of catecholamines in maternal-fetal stress transfer in sheep. Am J Obstet Gynecol. 2015;213(5): 684.e1–9. doi: 10.1016/j.ajog.2015.07.020.
  6. Reynolds F. Labour analgesia and the baby: good news is no news. Int J Obstet Anesth. 2011;20(1): 38–50. doi: 10.1016/j.ijoa.2010.08.004.
  7. Scarth E, Smith S. Drugs in anaesthesia and intensive care. 5th ed. Oxford University Press; 2016. 390 p. doi: 10.1093/med/9780198768814.001.0001.
  8. Wee MY, Tuckey JP, Thomas PW, Burnard S. A comparison of intramuscular diamorphine and intramuscular pethidine for labour analgesia: a two-centre randomised blinded controlled trial. BJOG. 2014;121(4): 447–56. doi: 10.1111/1471-0528.12532.
  9. Stocki D, Matot I, Einav S, Eventov-Friedman S, Ginosar Y, Weiniger CF. A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women. Anesth Analg. 2014;118(3): 589–97. doi: 10.1213/ANE.0b013e3182a7cd1b.
  10. Markley JC, Rollins MD. Non-neuraxial labor analgesia: options. Clin Obstet Gynecol. 2017;60(2): 350–64. doi: 10.1097/GRF.0000000000000277.
  11. Phillips SN, Fernando R, Girard T. Parenteral opioid analgesia: does it still have a role? Best Pract Res Clin Anaesthesiol. 2017;31(1): 3–14. doi: 10.1016/j.bpa.2017.02.002.
  12. Al-Hashimi M, Scott SW, Thompson JP, Lambert DG. Opioids and immune modulation: more questions than answers. Br J Anaesth. 2013;111(1): 80–8. doi: 10.1093/bja/aet153.
  13. Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2010;(9):CD007396. doi: 10.1002/14651858.
  14. CD007396.pub2.
  15. Tomson G, Garle RI, Thalme B, Nisell H, Nylund L, Rane A. Maternal kinetics and transplacental passage of pethidine during labour. Br J Clin Pharmacol. 1982;13(5): 653–9. doi: 10.1111/j.1365-2125.1982.tb01432.x.
  16. Caldwell J, Wakile LA, Notarianni LJ, Smith RL, Correy GJ, Lieberman BA, Beard RW, Finnie MD, Snedden W. Maternal and neonatal disposition of pethidine in childbirth – a study using quantitative gas chromatography-mass spectrometry. Life Sci. 1978;22(7): 589–96. doi: 10.1016/0024-3205(78)90338-7.
  17. Kuhnert BR, Kuhnert PM, Philipson EH, Syracuse CD. Disposition of meperidine and normeperidine following multiple doses during labor. II. Fetus and neonate. Am J Obstet Gynecol. 1985;151(3): 410–5. doi: 10.1016/0002-9378(85)90314-X.
  18. El-Refaie TA, El-Said MM, Shoukry AA, Khafagy SM, El-Din AS, Badawy MM. Meperidine for uterine dystocia and its effect on duration of labor and neonatal acid-base status: a randomized clinical trial. J Obstet Gynaecol Res. 2012;38(2): 383–9. doi: 10.1111/j.14470756.2011.01719.x.
  19. Elbohoty AE, Abd-Elrazek H, Abd-El-Gawad M, Salama F, El-Shorbagy M, Abd-El-Maeboud KH. Intravenous infusion of paracetamol versus intravenous pethidine as an intrapartum analgesic in the first stage of labor. Int J Gynaecol Obstet. 2012;118(1): 7–10. doi: 10.1016/j.ijgo.2012.01.025.
  20. Singer J, Jank A, Amara S, Stepan PD, Kaisers U, Hoehne C. Efficacy and effects of parenteral pethidine or meptazinol and regional analgesia for pain relief during delivery. A comparative observational study. Geburtshilfe Frauenheilkd. 2016;76(9): 964–71. doi: 10.1055/s-0042-111009.
  21. Leong WL, Sng BL, Sia AT. A comparison between remifentanil and meperidine for labor analgesia: a systematic review. Anesth Analg. 2011;113(4): 818–25. doi: 10.1213/ANE.0b013e3182289fe9.
  22. Fleet J, Belan I, Jones MJ, Ullah S, Cyna AM. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG. 2015;122(7): 983–92. doi: 10.1111/1471-0528.13249.
  23. Miyakoshi K, Tanaka M, Morisaki H, Kim SH, Hosokawa Y, Matsumoto T, Minegishi K, Yoshimura Y. Perinatal outcomes: intravenous patient-controlled fentanyl versus no analgesia in labor. J Obstet Gynaecol Res. 2013;39(4): 783–9. doi: 10.1111/j.1447-0756.2012.02044.x.
  24. Moore A, el-Bahrawy A, Hatzakorzian R, Li-PiShan W. Maternal epidural fentanyl administered for labor analgesia is found in neonatal urine 24 hours after birth. Breastfeed Med. 2016;11(1): 40–1. doi: 10.1089/bfm.2015.0173.
  25. Kokki M, Westeren-Punnonen S, Hautajärvi H, Heinonen S, Mazzei M, Määttä S, Paalanen E, Kokki H. Neonatal safety of maternal fentanyl during labour. Br J Anaesth. 2015;115(4): 636– 8. doi: 10.1093/bja/aev314.
  26. Caton D, Frölich MA, Euliano TY. Anesthesia for childbirth: controversy and change. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S25–30.
  27. Kelly A, Tran Q. The optimal pain management approach for a laboring patient: a review of current literature. Cureus. 2017;9(5):e1240. doi: 10.7759/cureus.1240.
  28. Patel NP, El-Wahab N, Fernando R, Wilson S, Robson SC, Columb MO, Lyons GR. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia. 2014;69(5): 458–67. doi: 10.1111/anae.12602.
  29. Segal S, Csavoy AN, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Anesth Analg. 1998;87(4): 864–9. doi: 10.1213/00000539-199810000-00022.
  30. Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Can J Anaesth. 2013;60(9): 840–54. doi: 10.1007/s12630-013-9981-z.
  31. Gimovsky AC, Guarente J, Berghella V. Prolonged second stage in nulliparous with epidurals: a systematic review. J Matern Fetal Neonatal Med. 2017;30(4): 461–5. doi: 10.1080/14767058.2016.1174999.
  32. Anwar S, Anwar MW, Ahmad S. Effect of epidural analgesia on labor and its outcomes. J Ayub Med Coll Abbottabad. 2015;27(1): 146–50.
  33. Hasegawa J, Farina A, Turchi G, Hasegawa Y, Zanello M, Baroncini S. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome. J Anesth. 2013;27(1): 43–7. doi: 10.1007/s00540-0121480-9.
  34. Heesen M, Böhmer J, Klöhr S, Hofmann T, Rossaint R, Straube S. The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor, maternal, and neonatal outcomes: a systematic review and meta-analysis. Anesth Analg. 2015;121(1): 149–58. doi: 10.1213/ANE.0000000000000743.
  35. Schneider H. Mütterliche und kindliche Risiken der protrahierten Geburt. Gynäkologe. 1998;31:734–7. doi: 10.1007/PL00003157. 35. Sharpe EE, Arendt KW. Epidural labor analgesia and maternal fever. Clin Obstet Gynecol. 2017;60(2): 365–74. doi: 10.1097/GRF.0000000000000270.
  36. Kranke P, Frambach T, Schelling P, Wirbelauer J, Schaefer C, Stamer U. Anaesthesia and breast-feeding: should breast-feeding be discouraged? Anasthesiol Intensivmed Notfallmed Schmerzther. 2011;46(5): 304–11. doi: 10.1055/s-0031-1277971.
  37. Klomp T, van Poppel M, Jones L, Lazet J, Di Nisio M, Lagro-Janssen AL. Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev. 2012;(9):CD009351. doi: 10.1002/14651858.CD009351.pub2.
  38. Anwari JS, Khalil L, Terkawi AS. Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient. Saudi J Anaesth. 2015;9(4): 370–5. doi: 10.4103/1658-354X.159457.
  39. Parsa P, Saeedzadeh N, Roshanaei G, Shobeiri F, Hakemzadeh F. The effect of Entonox on labour pain relief among nulliparous women: a randomized controlled trial. J Clin Diagn Res. 2017;11(3):QC08–11. doi: 10.7860/JCDR/2017/21611.9362.
  40. Agah J, Baghani R, Safiabadi Tali SH, Tabarraei Y. Effects of continuous use of Entonox in comparison with intermittent method on obstetric outcomes: a randomized clinical trial. J Pregnancy. 2014;2014:245907. doi: 10.1155/2014/245907.
  41. Yeo ST, Holdcroft A, Yentis SM, Stewart A, Bassett P. Analgesia with sevoflurane during labour: ii. Sevoflurane compared with Entonox for labour analgesia. Br J Anaesth. 2007;98(1): 110–5. doi: 10.1093/bja/ael327.
  42. Attar AS, Feizabadi AS, Jarahi L, Feizabadi LS, Sheybani S. Effect of Entonox on reducing the need for Pethidine and the Relevant Fetal and Maternal Complications for Painless Labor. Electron Physician. 2016;8(12): 3325–32. doi: 10.19082/3325.
  43. Agah J, Baghani R, Tabaraei Y, Rad A. Maternal side-effects of continuous vs. intermittent method of Entonox during labor: a randomized clinical trial. Iran J Pharm Res. 2016;15(2): 641–6.
  44. Mobaraki N, Yousefian M, Seifi S, Sakaki M. A randomized controlled trial comparing use of Enthonox with Pethidine for pain relief in primigravid women during the active phase of labor. Anesth Pain Med. 2016;6(4):e37420. doi: 10.5812/aapm.37420.
  45. Abboud TK, Swart F, Zhu J, Donovan MM, Peres Da Silva E, Yakal K. Desflurane analgesia for vaginal delivery. Acta Anaesthesiol Scand. 1995;39(2): 259–61. doi: https://doi. org/10.1111/j.1399-6576.1995.tb04053.x.
  46. Yılmaz Doğru H, Benli İ, Doğru S. The oxidative/ anti-oxidative effects of sevoflurane on reproductive system of females: an experimental study. Turk J Obstet Gynecol. 2017;14(4): 228– 32. doi: 10.4274/tjod.78871.
  47. Morimoto Y, editor. Anesthesia and Neurotoxicity. Springer Japan; 2017. 167 p.
  48. Istaphanous GK, Howard J, Nan X, Hughes EA, McCann JC, McAuliffe JJ, Danzer SC, Loepke AW. Comparison of the neuroapoptotic properties of equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in neonatal mice. Anesthesiology. 2011;114(3): 578–87. doi: 10.1097/ALN.0b013e3182084a70.
  49. Briner A, De Roo M, Dayer A, Muller D, Habre W, Vutskits L. Volatile anesthetics rapidly increase dendritic spine density in the rat medial prefrontal cortex during synaptogenesis. Anesthesiology. 2010;112(3): 546–56. doi: 10.1097/ALN.0b013e3181cd7942.
  50. Head BP, Patel HH, Niesman IR, Drummond JC, Roth DM, Patel PM. Inhibition of p75 neurotrophin receptor attenuates isoflurane-mediated neuronal apoptosis in the neonatal central nervous system. Anesthesiology. 2009;110(4): 813–25. doi: 10.1097/ALN.0b013e31819b602b.
  51. Yang T, Zhuang L, Rei Fidalgo AM, Petrides E, Terrando N, Wu X, Sanders RD, Robertson NJ, Johnson MR, Maze M, Ma D. Xenon and sevoflurane provide analgesia during labor and fetal brain protection in a perinatal rat model of hypoxia-ischemia. PLoS One. 2012;7(5):e37020. doi: 10.1371/journal.pone.0037020.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2018 Upriamova E.Y., Shifman E.M., Ovezov A.M., Novikova S.V., El'chaninova A.G., Chaplygina O.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies