Epidural analgesia: effects on labor progress and maternal and neonatal outcome.


:The intended and unintended effects of epidural labor analgesia are reviewed. Mothers randomized to epidural rather than parenteral opioid analgesia have better pain relief. Fetal oxygenation is not affected by analgesic method; however, neonates whose mothers received intravenous or intramuscular opioids rather than epidural analgesia require more naloxone and have lower Apgar scores. Epidural analgesia does not affect the rates of cesarean delivery, obstetrically indicated instrumented vaginal delivery, neonatal sepsis, or new-onset back pain. Epidural analgesia is associated with longer second labor stages, more frequent oxytocin augmentation, and maternal fever (particularly among women who shiver and women receiving epidural analgesia for > 5 hours) but not with longer first labor stages. Epidural analgesia has no affect but intrapartum opioids decrease lactation success. Epidural use and urinary incontinence are weakly, but probably not causally, associated. Epidural labor analgesia would improve if the mechanisms of these unintended effects could be determined.


Semin Perinatol


Seminars in perinatology


Leighton BL,Halpern SH





Has Abstract


2002-04-01 00:00:00














  • The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia.

    abstract::Many infants with CDH can be managed with conventional mechanical ventilation and pharmacotherapy. However, some infants will require levels of ventilator support that are not compatible with survival. In these circumstances, extracorporeal membrane oxygenation (ECMO) has been used with varying results. The indication...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Khan AM,Lally KP

    更新日期:2005-04-01 00:00:00

  • Reflections on future directions of perinatal medicine.

    abstract::Up to the immediate past, and perhaps even to the present, a major difference between care of the fetus and of the neonate was the ability to examine directly the physical and biochemical traits of the unborn patient. In a span of time as short as perhaps 10 years it has become progressively possible to institute almo...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章


    authors: Manning FA

    更新日期:1989-08-01 00:00:00

  • Abruptio placentae and disseminated intravascular coagulopathy.

    abstract::Abruptio placentae is an important cause of vaginal bleeding in the latter half of pregnancy. The key factor in the pathophysiology is hemorrhage at the decidual-placental interface. Small episodes may escape clinical detection, but severe grades impact significantly on fetal and maternal morbidity and mortality, with...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Hall DR

    更新日期:2009-06-01 00:00:00

  • Rhesus disease in Brazil: A multi-professional national survey.

    abstract::Universal prenatal Rhesus (Rh) screening and prophylaxis with Rh immunoglobulin have been highly effective practices for preventing neonatal morbidities and mortality. However, there has been an enormous failure to prevent Rh sensitization and its adverse consequences worldwide, especially in low- and middle-income co...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章


    authors: Variane GF,Sant'Anna GM

    更新日期:2021-02-01 00:00:00

  • Obstetrical venous thromboembolism: Epidemiology and strategies for prophylaxis.

    abstract::Venous thromboembolism (VTE) is a leading cause of severe maternal morbidity and mortality. While pregnancy alone is a risk factor for VTE, additional population-based risk factors such as obesity are becoming increasingly common, particularly in the developed world. Maternal death from VTE is amenable to prevention a...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Friedman AM,Ananth CV

    更新日期:2016-03-01 00:00:00

  • Cesarean section on demand.

    abstract::The safety of cesarean section has improved dramatically over the past 50 years. During the past 20 years a greater awareness of and discussion about the symptomatic morbidity that can result for women following vaginal delivery has occurred and women's expectations for the outcome of pregnancy for them and their babi...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Morrison J,MacKenzie IZ

    更新日期:2003-02-01 00:00:00

  • Aortopathy in pregnancy.

    abstract::Up to half of all aortic dissections and ruptures in women younger than 40 years are associated with pregnancy. In pregnancy, women with aortic disease such as arteritis and aortitis are at significant risk of aneurysmal formation and dissection with potential for catastrophic outcomes. Pregnancy places predisposed wo...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Smok DA

    更新日期:2014-08-01 00:00:00

  • Other factors/conditions associated with cerebral palsy.

    abstract::The cause for most cases of cerebral palsy is unknown. There are however, risk factors that have been associated with this chronic neuromuscular disease. The objective of this article is to review the maternal and fetal conditions (other than asphyxia and infection) strongly associated with increased rate of cerebral ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Ramin SM,Gilstrap LC 3rd

    更新日期:2000-06-01 00:00:00

  • Modulators of inflammation in Bronchopulmonary Dysplasia.

    abstract::Over 50 years after its first description, Bronchopulmonary Dysplasia (BPD) remains a devastating pulmonary complication in preterm infants with respiratory failure and develops in 30-50% of infants less than 1000-gram birth weight. It is thought to involve ventilator- and oxygen-induced damage to an immature lung tha...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Savani RC

    更新日期:2018-11-01 00:00:00

  • Current status of newborn screening worldwide: 2015.

    abstract::Newborn screening describes various tests that can occur during the first few hours or days of a newborn's life and have the potential for preventing severe health problems, including death. Newborn screening has evolved from a simple blood or urine screening test to a more comprehensive and complex screening system c...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Therrell BL,Padilla CD,Loeber JG,Kneisser I,Saadallah A,Borrajo GJ,Adams J

    更新日期:2015-04-01 00:00:00

  • Disorders of the central nervous system.

    abstract::In this article, we have reviewed the most common CNS abnormalities seen in perinatal medicine. The prognosis in ventriculomegaly is most closely related to the presence or absence of associated anomalies. The current treatment for DWM consists of shunting of either the posterior fossa cyst or lateral ventricles. Faci...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Paidas MJ,Cohen A

    更新日期:1994-08-01 00:00:00

  • Nitric oxide synthase gene therapy in vascular pathology.

    abstract::Nitric oxide (NO) is intimately involved in vascular homeostasis through its antiplatelet, antiproliferative, and vasodilating actions. Because of these beneficial properties, methods of harnessing NO for the prevention of vascular injury responses, such as intimal hyperplasia, are being explored. One such method invo...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Kibbe MR,Tzeng E

    更新日期:2000-02-01 00:00:00

  • Suppression of lactation.

    abstract::Medical and psychological indications for lactation suppression are discussed, and methods for lactation suppression are evaluated. Medical indications for lactation suppression include 1) maternal anatomical abnormalities, such as inadequate secretory tissue and inverted nipples; 2) maternal breast infections and tu...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Harrison RG

    更新日期:1979-07-01 00:00:00

  • What we have learned about the role of 17-alpha-hydroxyprogesterone caproate in the prevention of preterm birth.

    abstract::Despite major advances in neonatal care, the burden of preterm birth remains high. This is not unexpected since strategies to identify and treat risk factors in early pregnancy have not been very effective in reducing the preterm birth rate. Initial studies suggested a potential benefit for 17-alpha-hydroxyprogesteron...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Caritis SN,Feghali MN,Grobman WA,Rouse DJ,Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network.

    更新日期:2016-08-01 00:00:00

  • Placental transfer of selected substances of abuse.

    abstract::The placenta was classically considered a barrier, but in 1957 this notion was shattered. This organ is only a selective filter and metabolic site. In this review, the placental transfer of the top 17 substances of abuse are analyzed. In the National Library of Medicine only 41 papers that documented placental transfe...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Little BB,VanBeveren TT

    更新日期:1996-04-01 00:00:00

  • The pathophysiology of human premature cervical remodeling resulting in spontaneous preterm birth: Where are we now?

    abstract::Approximately one in ten (approximately 500,000) pregnancies results in preterm birth (PTB) annually in the United States. Although we have seen a slight decrease in the U.S. PTB rate between 2007 and 2014, data from 2014 to 2015 shows the preterm birth rate has slightly increased. It is even more intriguing to note t...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Vink J,Mourad M

    更新日期:2017-11-01 00:00:00

  • A systematic approach to the management of preterm labor.

    abstract::Preterm birth occurs in 7% to 12% of all deliveries, but accounts for over 85% of all perinatal morbidity and mortality. Although the ability of obstetric care providers to identify women at risk for preterm delivery has improved, the overall incidence of preterm birth has remained unchanged for the past 30 years. Pre...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Norwitz ER,Robinson JN

    更新日期:2001-08-01 00:00:00

  • Lung maturation in diabetes in pregnancy: if and when to test.

    abstract::Poorly controlled maternal diabetes in pregnancy may delay fetal pulmonary maturation. However, diabetic women with good glycemic control have fetal lung maturation at the same gestational age as nondiabetic women. With modern ultrasound technology, gestational dates can be accurately assessed in the first or early se...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Piper JM

    更新日期:2002-06-01 00:00:00

  • Immunosuppressant therapy in pregnant organ transplant recipients.

    abstract::Transplant recipients are becoming pregnant with increasing frequency, and successful pregnancy outcomes have now been reported for women with all types of solid organ transplants. To prevent rejection of the transplanted organ, these patients are maintained on a life-long immunosuppressive regimen that must also be c...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Fuchs KM,Coustan DR

    更新日期:2007-12-01 00:00:00

  • Conducting research during the COVID-19 pandemic.

    abstract::The highly contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected every aspect of medical practice and has all but ceased clinical, translational and basic science research. Pregnant women appear to be similarly affected by the virus as non-pregnant adults. As obstetricians, not only do w...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Mourad M,Bousleiman S,Wapner R,Gyamfi-Bannerman C

    更新日期:2020-11-01 00:00:00

  • Amniotic fluid antibacterial mechanisms: newer concepts.

    abstract::In this review the factors present in human amniotic fluid that may function to inhibit bacterial growth have been examined. It appears that several potential antibacterial systems are present. Lysozyme and B-lysin may significantly contribute to the killing of gram-positive bacteria. Whether or not the remaining anti...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Schlievert P,Johnson W,Galask RP

    更新日期:1977-01-01 00:00:00

  • Current approaches to the evaluation and management of the fetus and neonate with immune thrombocytopenia.

    abstract::Fetal and neonatal alloimmune thrombocytopenia is not a well-known disease, except among specialists in maternal-fetal medicine, neonatologists, and certain pediatricians (ie, hematologists). However, this is by far the most common cause of early severe thrombocytopenia in neonates and of intracranial hemorrhage in te...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Bussel JB,Sola-Visner M

    更新日期:2009-02-01 00:00:00

  • Early-onset intraventricular hemorrhage in preterm neonates: incidence of neurodevelopmental handicap.

    abstract::The neurodevelopmental outcome of very low birth weight infants experiencing early-onset intraventricular hemorrhage (IVH) occurring within the first 6 postnatal hours was compared with that of their peers without early-onset IVH at 3 years corrected age. The 440 surviving preterm infants (birth weight 600 to 1,250 g)...

    journal_title:Seminars in perinatology

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Vohr B,Allan WC,Scott DT,Katz KH,Schneider KC,Makuch RW,Ment LR

    更新日期:1999-06-01 00:00:00

  • Oligohydramnios: problems and treatment.

    abstract::Oligohydramnios is a severe and common complication of pregnancy. The finding of oligohydramnios can be associated with fetal anomalies, PROM, uteroplacental insufficiency (eg, growth retardation, postdatism, abruptio placenta, significant maternal illness), abnormalities of twinning, and idiopathic oligohydramnios. U...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: McCurdy CM Jr,Seeds JW

    更新日期:1993-06-01 00:00:00

  • Ontogeny of autonomic regulation in late preterm infants born at 34-37 weeks postmenstrual age.

    abstract::Late preterm infants (34-37 weeks postmenstrual age at birth) are intermediate between less mature preterm infants and infants born at 38 weeks or more in regard to autonomic brain stem maturation. Ventilatory responses to CO(2) in preterm infants born at 33 to 36 week are significantly higher than in infants born at ...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Hunt CE

    更新日期:2006-04-01 00:00:00

  • Prediction of preeclampsia.

    abstract::The onset of preeclampsia at or near to term is associated with low maternal and neonatal morbidity and mortality. In contrast, those patients (1%) who suffer early onset preeclampsia engender significant maternal and perinatal morbidity and mortality. Therefore, because of the lack of proven prophylaxis for preeclamp...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Myatt L,Miodovnik M

    更新日期:1999-02-01 00:00:00

  • Sexually transmitted diseases in pregnancy.

    abstract::STDs can be one of the most common antepartum complications in high-risk gravidas. Screening for gonorrhea, syphilis, HPV, and possibly hepatitis B and chlamydial infection, should be considered in most, if not all, pregnant women. Familiarity with the common clinical presentations and treatment of bacterial STDs will...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Wendel GD Jr

    更新日期:1990-04-01 00:00:00

  • Amniotic fluid volume and its relationship to fetal fluid balance: review of experimental data.

    abstract::The studies described above collectively suggest that, whenever there is a decrease in fluid balance in the fetus, both fetal urine flow and tracheal secretion into the amniotic space are decreased. Conversely, when fetal hydration is increased, both urine and tracheal flows into the amniotic fluid may be increased. T...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Brace RA

    更新日期:1986-04-01 00:00:00

  • Prediction and prevention of ischemic placental disease.

    abstract::Preeclampsia, intrauterine growth restriction (IUGR), and placental abruption are obstetrical conditions that constitute the syndrome of ischemic placental disease or IPD, the leading cause of indicated preterm birth and an important cause of neonatal morbidity and mortality. While the phenotypic manifestations vary s...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章,评审


    authors: Friedman AM,Cleary KL

    更新日期:2014-04-01 00:00:00

  • Pathogenesis of bronchopulmonary dysplasia: the role of interleukin 1beta in the regulation of inflammation-mediated pulmonary retinoic acid pathways in transgenic mice.

    abstract:BACKGROUND:Pulmonary inflammation, increased production of the inflammatory cytokine interleukin-1beta (IL-1beta), and vitamin A deficiency are risk factors for the development of bronchopulmonary dysplasia (BPD) in premature infants. To determine the mechanisms by which IL-1beta influences lung development, we have ge...

    journal_title:Seminars in perinatology

    pub_type: 杂志文章


    authors: Bry K,Lappalainen U

    更新日期:2006-06-01 00:00:00