ACOG has issued
clinical guidance for obstetricians and other healthcare professional for
management of pain during labor and giving anesthesia for any surgical
procedure required during labor.
The reviewed guidelines were published in Journal of Obstetrics & Gynecology, April issue.
The reviewed guidelines were published in Journal of Obstetrics & Gynecology, April issue.
Non-pharmacological
options were not covered in this bulletin. Many such options are used in
healthcare and home settings like massage, acupuncture, relaxation techniques
and water immersion in first stage. Recently physicians are also using virtual reality during labor to distract patients and limit the use of analgesic.
The
recommendation includes:
- Analgesia and anesthesia services should be available to provide labor analgesia and surgical anesthesia in all hospitals that offer maternal care (levels I–IV).
- American Society of Anesthesiologists (ASA) and ACOG believe that trained labor nurses, under supervision from a physician should not be restricted from participating in the management of pain relief during labor.t
- Neuraxial analgesia does not increase the rates of cesarean delivery and according to ACOG and (ASA) maternal request in absence of any contraindication is a sufficient medical indication for pain relief during labor.
- Thrombocytopenia is a relative contraindication for neuraxial analgesia, in absence of current guidance on safe lower limit for platelet count.
- A platelet count ≥80,000/microliter, with no history of any congenital or acquired coagulopathy, or current antiplatelet or anticoagulant therapy, with normal platelet function is currently accepted okay for receiving Epidural and Spinal.
- Narcotics or opioids like fentanyl, morphine, and nalbuphine are associated with adverse effects for newborn and mother, specifically respiratory depression. So, a close watch of respiratory status is warranted.
- Epidural, combined spinal–epidural (CSE) or general anesthesia are suitable for emergency C-section if no Epidural is in place.
Thanks for recent guidelines, it's really a great achievement in pain relief in labor. Epidural analgesia is a boon for labor pain relief
ReplyDeleteThanks, Dr Bansi Shinde. Indeed its a boon for labor pain relief. I appreciate your reading the article.
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