ANALYSIS OF CLINICAL CASES AND FUNDAMENTAL BASES FOR SOLVING THE SAFETY PROBLEMS OF EPIDURAL ANALGESIA IN CHILDBIRTH

Abstract

In modern obstetrical practice, the maternal request is considered as a sufficient medical indication to alleviate pain during childbirth. At the same time, the increased use of epidural analgesia to control pain in childbirth occasionally provokes controversy about its effect on childbirth and their duration, the frequency of instrumental obstetric care and the cesarean section and may also be associated with an increased frequency of complications. The complications associated with the anesthesia of childbirth are quite rare. A significant place in their structure probably take mistakes related to the human factor, which may be caused by the insufficient competence of the obstetrician and/or anesthesiologist in matters of obstetric analgesia and anesthesia, and the lack or inadequacy of information support. Proper risk management is likely to reduce the percentage of human errors by 60– 87%. This article presents an analysis of 2 cases of vaginal parturitions in conditions of epidural analgesia and outlines the fundamental bases for solving the safety problems of epidural analgesia in childbirth from the perspective of evidence-based medicine, namely: the need to develop and implement a standardized approach to the epidural analgesia and monitoring the status of the mother and fetus; the introduction of new more safer technologies for epidural analgesia for the anesthesia of childbirth, including the use of PCA — patient controlled analgesia; use of modern technical and medical equipment; training and information support of specialists.