低危产妇的药物性分娩镇痛与分娩恐惧：RAVEL 研究的二次分析。
Pharmacological pain relief and fear of childbirth in low risk women; secondary analysis of the RAVEL study.
机构信息
Department of Obstetrics and Gynaecology, Amsterdam UMC, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 ZA, Amsterdam, The Netherlands.
Department of Midwifery Science, AVAG, Amsterdam Public Health research institute, Amsterdam, the Netherlands.
出版信息
BMC Pregnancy Childbirth. 2018 Aug 25;18(1):347. doi: 10.1186/s12884-018-1986-8.
BACKGROUND
Fear of childbirth may reduce the womens' pain tolerance during labour and may have impact on the mother-infant interaction. We aimed to assess (1) the association between fear of childbirth antepartum and subsequent request for pharmacological pain relief, and (2) the association between the used method of pain relief and experienced fear of childbirth as reported postpartum in low risk labouring women.
METHODS
Secondary analysis of the RAVEL study, a randomised controlled trial comparing remifentanil patient controlled analgesia (PCA) and epidural analgesia to relieve labour pain. The RAVEL study included 409 pregnant women at low risk for obstetric complications at 18 midwifery practices and six hospitals in The Netherlands (NTR 3687). We measured fear of childbirth antepartum and experienced fear of childbirth reported postpartum, using the Wijma Delivery Expectancy/Experience Questionnaire.
RESULTS
Women with fear of childbirth antepartum more frequently requested pain relief compared to women without fear of childbirth antepartum, but this association did not reach statistical significance (adjusted odds ratio (aOR2.0; 95% confidence interval (CI) 0.8-4.6). Women who received epidural analgesia more frequently reported fear of childbirth postpartum compared to women who did not receive epidural analgesia (aOR3.5; CI 1.5-8.2), while the association between remifentanil-PCA and fear of childbirth postpartum was not statistically significant (aOR1.7; CI 0.7-4.3).
CONCLUSIONS
Women with fear of childbirth antepartum more frequently requested pain relief compared to women without fear of childbirth antepartum, but this association was not statistically significant. Women who received pharmacological pain relief more frequently reported that they had experienced fear of childbirth during labour compared to women who did not receive pain relief. Based on our data epidural analgesia with continuous infusion does not seem to be preferable over remifentanil-PCA as method of pain relief when considering fear of childbirth postpartum.
TRIAL REGISTRATION
Netherlands Trial Register 3687 ; Register date: 5 Nov 2012.
背景
分娩恐惧可能降低产妇分娩时的疼痛耐受力，并可能对母婴互动产生影响。我们旨在评估：（1）产前分娩恐惧与随后要求使用药物缓解疼痛之间的关联；（2）在低风险分娩的女性中，用于缓解疼痛的方法与产后报告的分娩恐惧之间的关联。
方法
这是一项比较瑞芬太尼患者自控镇痛（PCA）和硬膜外镇痛缓解分娩疼痛的随机对照试验（RAVEL 研究）的二次分析。该研究纳入了来自荷兰 18 家助产实践和 6 家医院的 409 名低产科并发症风险的孕妇（NTR3687）。我们使用 Wijma 分娩期望/体验问卷评估了产前和产后报告的分娩恐惧。
结果
与没有产前分娩恐惧的女性相比，有产前分娩恐惧的女性更频繁地要求缓解疼痛，但这种关联没有达到统计学意义（调整后的优势比（aOR）2.0；95%置信区间（CI）0.8-4.6）。接受硬膜外镇痛的女性产后报告的分娩恐惧比未接受硬膜外镇痛的女性更频繁（aOR3.5；CI1.5-8.2），而瑞芬太尼 PCA 与产后分娩恐惧之间的关联没有统计学意义（aOR1.7；CI0.7-4.3）。
结论
与没有产前分娩恐惧的女性相比，有产前分娩恐惧的女性更频繁地要求缓解疼痛，但这种关联没有达到统计学意义。接受药物缓解疼痛的女性比未接受疼痛缓解的女性更频繁地报告在分娩过程中感到恐惧。根据我们的数据，当考虑产后分娩恐惧时，连续输注硬膜外镇痛似乎并不优于瑞芬太尼 PCA 作为缓解疼痛的方法。
试验注册
荷兰临床试验注册 3687；注册日期：2012 年 11 月 5 日。
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