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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2023.tde-26022024-092029
Document
Author
Full name
Raul Yao Utiyama
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2023
Supervisor
Committee
Garcia, Luis Vicente (President)
Freitas, Cláudia Regina da Costa
Lauretti, Gabriela Rocha
Title in Portuguese
Análise da evolução e do desfecho obstétrico em pacientes com gestações de alto risco após analgesia de parto com duplo bloqueio
Keywords in Portuguese
Analgesia
Anestesia epidural
Anestesia obstétrica
Gravidez de alto risco
Raquianestesia
Abstract in Portuguese
A realização de duplo bloqueio é uma forma de inibir a dor do trabalho de parto. O duplo bloqueio consiste na raquianestesia associada à peridural. O objetivo do estudo foi avaliar, em mulheres com gestação de alto risco, se a analgesia de parto com duplo bloqueio aumenta a taxa de cesáreas. Um total de 177 pacientes divididas em dois grupos foram incluídas neste estudo prospectivo do tipo quase-experimental. Um grupo foi constituído com pacientes que não solicitaram analgesia e o outro constituído com pacientes que solicitaram analgesia. O duplo bloqueio foi realizado com 2,5 mg de bupivacaina com glicose e 5 mcg de sufentanil no espaço subaracnóideo e passagem de cateter peridural para injeção de 10 mL de ropivacaina a 0,2% nos momentos de necessidade. A analgesia de parto com duplo bloqueio em gestantes de alto risco não mostrou aumento na taxa de cesáreas. Das 90 pacientes que não solicitaram analgesia, 66,7% seguiram com a via normal de parto e 33,3% tiveram que passar por parto cirúrgico. Das 87 pacientes que solicitaram analgesia, 70,1% conseguiram ter o parto normal e 29,9% tiveram parto cesárea. A paridade demonstrou ter relevância significativa para a solicitação de analgesia. Das 177 pacientes, 68 eram primigestas e 109 multigestas. Das 68 primigestas, 35,3% solicitaram analgesia e 64,7% não solicitaram. Das 109 multigestas, 60,5% solicitaram analgesia de parto e 39,5% não solicitaram. Entre as gestantes que solicitaram analgesia de parto, aquelas com diabetes apresentaram maior chance de parto cesárea. Em comparação, das 56 pacientes com outras comorbidades que receberam analgesia, 78,6% tiveram parto normal e 21,4% tiveram parto cesariana. Conclusão: A analgesia de parto com duplo bloqueio não aumentou o risco de cesariana. Gestantes primigestas solicitam mais analgesia de parto.
Title in English
Analysis of the evolution and obstetric stage in patients with high-risk pregnancies after labor analgesia with double block
Keywords in English
Analgesia
Epidural anesthesia
High risk pregnancy
Obstetric anesthesia
Spinal anesthesia
Abstract in English
Performing a double block is a way to inhibit labor. The double block consists of spinal anesthesia associated with the epidural. The objective of the study was to evaluate, in women with high-risk pregnancies, whether labor analgesia with double block increases the rate of cesarean sections. A total of 177 patients divided into two groups were included in this prospective quasi-experimental study. One group consisted of patients who did not request analgesia and the other consisted of patients who requested analgesia. The double block was performed with 2.5 mg of bupivacaine with glucose and 5 mcg of sufentanil in the subarachnoid space and passage of an epidural catheter for injection of 10 mL of 0.2% ropivacaine in times of need. Labor analgesia with double block in high-risk pregnant women did not show an increase in the rate of cesarean sections. Of the 90 patients who did not request analgesia, 66.7% followed the normal route of delivery and 33.3% had to undergo surgical delivery. Of the 87 patients who requested analgesia, 70.1% had a natural birth and 29.9% had a cesarean section. The demonstrated parity has significant relevance for the request for analgesia. Of the 177 patients, 68 were primigravidae and 109 multigravidae. Of the 68 primigravidae, 35.3% requested analgesia and 64.7% did not request it. Of the 109 multigravidae, 60.5% requested labor analgesia and 39.5% did not request it. Among pregnant women who requested labor analgesia, those with diabetes were more likely to have a cesarean section. In comparison, of the 56 patients with other comorbidities who received analgesia, 78.6% had a natural birth and 21.4% had a cesarean section. Conclusion: Labor analgesia with double block did not increase the risk of cesarean section. First-time pregnant women request more labor analgesia.
 
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RAULYAOUTIYAMA.pdf (2.79 Mbytes)
Publishing Date
2024-03-25
 
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