School of Nursing, University of Nevada, Las Vegas, NV, USA.
School of Nursing, University of Nevada, Las Vegas, NV, USA; School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Midwifery. 2021 Apr;95:102943. doi: 10.1016/j.midw.2021.102943. Epub 2021 Feb 9.
The effects of epidural and combined spinal-epidural analgesia on uterine contraction parameters are unclear, although as many as 80% of laboring women use neuraxial analgesia. We explored the effects of epidural and combined spinal-epidural analgesia on all uterine contraction parameters using a retrospective analysis of selected parturients, who required Intrauterine Pressure Catheter (IUPC) instrumentation for clinical management. Additionally, we analyzed the effects of parity, Pitocin dose, and mode of neuraxial anesthesia, i.e. epidural verses combined spinal-epidural on uterine contractility.
Using a retrospective within and between repeated measure design we compared uterine contraction parameters at 4 time points (epochs): (1) baseline, (2) pre-epidural fluid bolus, (3) immediate and (4) secondary post-epidural/combined spinal-epidural analgesia to detect differences in contractility over time comparing two types of epidural interventions.
Eighteen healthy parturients at term gestation were admitted to the labor unit for induction, augmentation, or spontaneous labor. Contraction parameters including frequency, duration, peak intensity, resting intensity and duration, and Montevideo Units (MVUs) were collected using fetal monitor strip data with intrauterine pressure catheter (IUPC) instrumentation.
Parametric and non-parametric tests showed no significant differences within or between the two Epidural intervention groups for frequency, duration, peak intensity, resting intensity and duration, and MVUs at all epochs at the .05 alpha level. Compared with Nulliparous women, multiparous women had significantly lower contraction intensity and longer contraction duration. Based on multilevel modeling (MLM), neither Pitocin dose nor type of epidural intervention revealed significant differences on any contraction parameters.
When parity, other demographic variables and Pitocin dose were statistically controlled, no uterine contraction parameter changed from baseline through 90 min following either epidural or combined spinal-epidural analgesia. Obstetrical care providers should consider the preciseness their contraction monitoring instrumentation and their clinical management preferences as well parity as before prescribing Pitocin after neuraxial analgesia intervention.
尽管多达 80%的分娩妇女使用椎管内镇痛，但硬膜外和联合脊髓-硬膜外镇痛对子宫收缩参数的影响尚不清楚。我们通过对需要宫内压力导管（IUPC）仪器进行临床管理的选定产妇进行回顾性分析，探讨了硬膜外和联合脊髓-硬膜外镇痛对所有子宫收缩参数的影响。此外，我们还分析了产次、缩宫素剂量以及椎管内麻醉方式（即硬膜外与联合脊髓-硬膜外）对子宫收缩力的影响。
使用回顾性的within 和 between 重复测量设计，我们比较了四个时间点（时期）的子宫收缩参数：（1）基线，（2）硬膜外前输液期，（3）立即和（4）硬膜外/联合脊髓-硬膜外镇痛后的次要时期，以检测两种硬膜外干预方式随时间的收缩力差异。
18 名足月妊娠的健康产妇被收入产房进行引产、催产或自然分娩。使用胎儿监护带数据和宫内压力导管（IUPC）仪器收集收缩参数，包括频率、持续时间、峰值强度、静息强度和持续时间以及蒙得维的亚单位（MVUs）。
参数和非参数检验显示，在 0.05 置信水平下，两种硬膜外干预组在所有时期的频率、持续时间、峰值强度、静息强度和持续时间以及 MVUs 方面均无显著差异。与初产妇相比，多产妇的收缩强度较低，收缩持续时间较长。基于多层次模型（MLM），缩宫素剂量和硬膜外干预类型均未显示对任何收缩参数有显著差异。
当控制产次、其他人口统计学变量和缩宫素剂量时，无论是硬膜外还是联合脊髓-硬膜外镇痛后，从基线到 90 分钟，没有子宫收缩参数发生变化。在开具椎管内镇痛干预后的缩宫素之前，产科护理提供者应考虑其收缩监测仪器的精确性及其临床管理偏好以及产次。
