The Effect Of The Degree Of Primiparous Anxiety On The Epidural Labor Analgesia And Labor Pain

Objective: To observe the influences of the degree of primiparous anxiety on the epidural labor analgesia, the mode of delivery and the labor course. It would provide theoretical basis for individuating labor analgesia.Methods: 1. The study population: 180 primiparae were randomly selected from the obstetrics of the second Affiliated Hospital of HeBei Medical University from December 2002 and December 2003. Inclusion criteria were as follows: the age of 20 to 32 years old, the gestational age of 38 to 40 weeks, singleton pregnancy, vertex presentation, no relative cephalopelvic disproportion, no pathological obstetrical conditions during prenatal examination, no serious medical or surgical diseases and no the symptom of depress. The study group was composed of 90 primiparae requiring epidural labor analgesia without the contraindication of epidural block. The control group was composed of 90 primiparae whose delivery courses were processed routinely without interference. The two groups did not differ significantly in maternal age, gestational age and weight. 2. During the labor, two fixed members of the task group evaluated every parturients psychosis according to Hamiton Anxiety Scale (HAS) and Hamilton depression scale (HDS) by the mode of talking and observation, to select the mean as every primiparous score. The two groups were divided into three subgroups according to the HAS scores: the HAS score <7 score was defined as no-anxiety (Ⅰ); the HAS scores of 7 to 20 score was defined as mild anxiety (Ⅱ); the HAS score of 21 to 28 score was defined as moderate anxiety, the HAS scores >29 score was defined as severe anxiety, the moderate and severe anxiety were combined as moderate-severe anxiety (Ⅲ). Moreover, there was not any primiparae with depression (the HDS scores<8). In the study group, the number of cases of Ⅰand Ⅱ,Ⅲ was respectively 55,23 and 12. In the control group, the number of cases ofⅠand Ⅱ,Ⅲ subgroups was respectively 54,22 and 14. 3. The methods of analgesia: when the primiparae in the study group were in the first stage of labor, an intravenous line was established and 5% glucose-normal saline 500-1000ml was being infused. When the external cervical was dilated to 4-5cm, epidural catheter was placed at L2-3 by the anesthetist. After success, a test dose of 3ml (0.075% ropivacaine of 1.33ml + fentanyl of 2μg +normal saline up to10 ml) was given. 5minutes later when no sign of complications, a dose of 7ml was given again. 30minutes later, the analgesic pump with the type of WZ-6520-05 (the pump liquids consisted of 0.075% ropivacaine of 8.67ml + fentanyl of 65μg +normal saline up to 65ml) was jointed to the epidural catheter, the background infusion was started at a rate of 5 ml/h until the second stage of labor began. 4. To evaluate the labor pain of every primiparae at the end of first stage of labor and at the beginning of active phase according to visual analgesia scale (VAS) (0~20 score: no-pain; 20~40 score: mild-pain; 40~60 score: moderate-pain; 60~80 score: severe-pain; 80~100 score: fierce-pain). 5. At the end of the first stage of labor, to evaluate again the degree of primiparous anxiety according to HAS scores. 6. To record the latent phase time, the active phase time, the second stage of labor time, the mode of labor and the conditions of oxytotin's usage in the two groups. 7. Using the America HUIPU Fetal Heart Monitor, to monitor persistently fetal heart rate and to judge the fetal conditions in the uterus and the uterine contraction of primiparae. The fetal Apgar's scores of 1minute and 5minutes were evaluated after birth. 8. The material anconeal median venous blood sample of 5ml was taken at the end of the first stage of labor (the number of primiparous of every subgroup was as follows:Ⅰ-1:15, Ⅱ-2:15, Ⅲ-1:15；Ⅰ-2:15, Ⅱ-1:4, Ⅲ-2:2), to measure the plasma concentrations of E (epinephrine) and NE (norepinephrine) with the modified spectrophotometer fluorometry.Results: 1. Anxiety rate of primiparae was 39%. 2. At the end of the first stage of...