Neuraxial analgesia in labour and the foetus

IF 2.8 3区 医学 Q1 ANESTHESIOLOGY
R.J. Kearns Dr , D.N. Lucas Professor
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Abstract

Providing pain relief during labour is a fundamental human right and can benefit both mother and foetus. Epidural analgesia remains the ‘gold standard’, providing excellent pain relief, as well as the facility to convert to anaesthesia should operative intervention be required. While maternal well-being remains the primary focus, epidural analgesia may also have implications for the foetus. Data from meta-analyses finds that epidural compared with systemic opioids in labour is associated with reduced neonatal respiratory depression. Clinically relevant neonatal outcomes such as Apgar score <7 at 5 min, neonatal resuscitation and need for admission to a neonatal unit are reassuring, with the benefits of epidural analgesia for both mother and neonate outweighing any potential risks. Recent concerns regarding an association of epidural with the development of autism spectrum disorder in childhood appear to be unfounded, with several large observational studies refuting this association. This review discusses the evidence relating to maternal neuraxial analgesia in labour, implications for the foetus in utero, and childhood outcomes both in the immediate peripartum period and longer term.

分娩和胎儿的神经轴镇痛
在分娩期间提供疼痛缓解是一项基本人权,对母亲和胎儿都有好处。硬膜外镇痛仍然是“金标准”,可以提供极好的疼痛缓解,并且在需要手术干预时可以转换为麻醉。虽然产妇的健康仍然是首要关注点,但硬膜外镇痛也可能对胎儿产生影响。荟萃分析数据发现,分娩时硬膜外麻醉与全身阿片类药物相比,可减少新生儿呼吸抑制。临床相关的新生儿结果,例如Apgar评分<;7在5分钟时,新生儿复苏和需要进入新生儿病房是令人放心的,硬膜外镇痛对母亲和新生儿的益处大于任何潜在风险。最近关于硬膜外麻醉与儿童自闭症谱系障碍发展相关的担忧似乎是没有根据的,几项大型观察性研究驳斥了这种联系。这篇综述讨论了与分娩时母体神经轴镇痛有关的证据,对子宫内胎儿的影响,以及在近期和长期的儿童结局。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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36 days
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