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Pain and analgesia during labor and delivery between 16 and 22 and 6/7 weeks gestational age: A retrospective chart review
Abstract Number: T-65
Abstract Type: Original Research
Background: Little is known about the severity of pain and its management during induction of labor at pre-viable estimated gestational ages (EGA), which can make counseling patients about analgesia options difficult. No data currently exist comparing neuraxial analgesia to systemic opioid analgesia in this clinical setting. Our objective in this study was to describe severity of pain during labor at pre-viable EGA and to determine the effectiveness of various methods of analgesia in this population.
Methods: In this IRB-approved study, we performed a retrospective chart review of all patients who underwent induction or augmentation of labor between 16w0d and 22w6d at the University of Chicago from 2011-2013. We noted demographic data, EGA, fetal weight, induction and delivery characteristics, and pain scores. Analgesia method (none, systemic or neuraxial) was recorded. We compared relevant patient characteristics to analgesia method and compared pain scores between methods using the Mann Whitney U test.
Results: Of eighty patients who met inclusion criteria, 4 requested no analgesia and 56 used systemic analgesia only (Group NONE-SYS, n=60); 11 patients used systemic analgesia initially and then requested neuraxial analgesia, and 9 used neuraxial only (Group NEUR, n=20). Median (IQR) age was 29 (23-35) and was not different between groups. Patients who chose neuraxial analgesia had higher EGA, fetal weight, and admission to delivery time intervals than those who chose no or systemic analgesia (Table and Figure). The median peak pain score for all patients was 7 (5–10) and not different between groups; nor did it vary by EGA or fetal weight. Immediate pre-analgesia peak pain scores were not different between groups, but patients who received neuraxial analgesia had lower immediate post-analgesia nadir scores than those who chose systemic pain relief.
Conclusion: Induction of labor at pre-viable gestational age is associated with significant pain that often requires systemic opioids or neuraxial analgesia. Neuraxial analgesia may provide more optimal pain relief for patients with higher EGA and fetal weight, and longer labors, particularly after 22 weeks EGA.