RCOG Scientific Impact Paper - Antenatal and Postnatal Analgesia
The RCOG has released a scientific impact paper on antenatal and postnatal analgesia to help clarify advice on pain relief. The paper covers paracetamol, Nonsteroidal anti‐inflammatory drugs (NSAIDs), Codeine, Dihydrocodeine (DHC), Tramadol and Morphine.
Considered safe for use throughout pregnancy and during breastfeeding.
Where possible avoid use throughout pregnancy. If clinically indicated lowest effective dose for shortest possible period advised if required before 30 weeks. Recommended to avoid after 30 weeks. Ibuprofen and diclofenac preferred choice for postnatal analgesia but should be avoided in certain circumstances.
Can be used during pregnancy and breastfeeding short term to treat moderate to severe pain when paracetamol not effective. Recommends the lowest possible dose for shortest possible period. Important to inform neonatal team if intrapartum women have received long term opioids as it can lead to neonatal respiratory issues. Postnatal use of opioid analgesics appropriate if woman in more severe pain.
Specifically, for postnatal analgesia codeine has been associate with some reported fetal complications. DHC, Tramadol and morphine can all be used but lowest effective dose for shortest possible period is recommended.
The paper summarises:
‘Analgesics should be used at the lowest effective dose for the shortest possible duration to minimise any potential risks to the mother, developing fetus or neonate. When stronger analgesia is required, DHC should be used in preference to codeine because of the concerns regarding toxicity, as detailed in the case reports published.’
The full paper can be access here.
PReCePT programme Eligible mothers receiving Magnesium sulphate – A mum’s perspective
The PReCePT programme is aiming to ensure at least 85% of all eligible mothers are receiving magnesium sulphate across all maternity hospitals in England by 2020. The project is designed to help reduce the number of babies with cerebral palsy by providing mothers with magnesium sulphate to mothers during preterm labour. The video below is with a mother who received magnesium sulphate explaining why she supports the programme.
US Maternal Mortality
The ACOG presidents blog has recently published 2 posts on the rising rates of maternal mortality and how it can be reversed.
One titled Critical Steps to Reverse Rising U.S. Maternal Mortality Rates highlights the progress towards the passing of the ‘Preventing Maternal Deaths Act’ in the US and how it will help with the creation or expansion of maternal mortality review committees in all states. It also discusses the Alliance for Innovation in Maternal Health (AIM) and the expansion of that programme.
The second post ACOG Battles Maternal Mortality in Texas Through Maternal Site Surveys outlines the launch of the Levels of Maternal Care programme in Texas. As part of the programme facilities that provide maternal care underwent surveys to received level of maternal care designations. Observations from the survey include:
The two posts highlight the work being done to combat maternal mortality but also recognise that there is still much more to do.