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BACKGROUND Epidural analgesia initiated early in labor (when the cervix is less than 4.0 cm dilated) has been associated with an increased risk of cesarean delivery. It is unclear, however, whether this increase in risk is due to the analgesia or is attributable to other factors. METHODS We conducted a randomized trial of 750 nulliparous women at term who(More)
OBJECTIVE Neurological injury associated with present day labor and delivery is thought to be unusual. The purpose of this study was to estimate the incidence, severity, and duration of postpartum lumbosacral spine and lower extremity nerve injury and identify factors related to nerve injury. METHODS All women who delivered a live-born infant from July(More)
Neuraxial analgesic techniques are the gold standards for pain relief during labour and delivery. Despite the increased use and known benefits of neuraxial labour analgesia, there has been significant controversy regarding the impact of neuraxial analgesia on labour outcomes. Review of the evidence suggests that effective neuraxial labour analgesia does not(More)
OBJECTIVE To determine whether early initiation of neuraxial analgesia (anesthetic[s] placed around the nerves of the central nervous system) compared with systemic opioid analgesia, followed later in labor by epidural analgesia, increases the rate of cesarean delivery in nulliparas undergoing induction of labor. METHODS Nulliparas undergoing induction of(More)
Serious and permanent neurologic complications in the obstetric population are rare. Most neurologic complications following childbirth are intrinsic obstetric palsies. The most common intrinsic obstetric palsy is lateral femoral neuropathy. Palsies of the femoral, obturator, sciatic, common peroneal nerves and lumbosacral plexus have also been reported.(More)
OBJECTIVE To evaluate the association between the introduction of neuraxial (epidural) labor analgesia and mode of delivery in a large urban maternity hospital in China. METHODS A single-intervention impact study was conducted at Shijiazhuang Obstetrics and Gynecology Hospital in Shijiazhuang. Baseline data collection occurred between August 1 and(More)
Bolus injection through an epidural catheter may result in better distribution of anesthetic solution in the epidural space compared with continuous infusion of the same anesthetic solution. In this randomized, double-blind study we compared total bupivacaine consumption, need for supplemental epidural analgesia, quality of analgesia, and patient(More)
BACKGROUND Visual blood loss estimation often underestimates blood loss. In this study we sought to determine the effect of calibrated drape markings on blood loss estimation in a simulated vaginal delivery. METHODS Subjects were randomized to estimate simulated blood loss (300, 500, 1000, and 2000 mL) in calibrated or noncalibrated vaginal delivery(More)
BACKGROUND Ketamine at subanesthetic doses has analgesic properties that have been shown to reduce postoperative pain and morphine consumption. We hypothesized that intravenous ketamine 10mg administered during spinal anesthesia for cesarean delivery, in addition to intrathecal morphine and intravenous ketorolac, would decrease the incidence of breakthrough(More)
BACKGROUND The decrease in the percentage of patients having cesarean delivery during general anesthesia has led some educators to advocate the increased use of simulation-based training for this anesthetic. The authors developed a scoring system to measure resident performance of this anesthetic on the human patient simulator and subjected the system to(More)