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Author: search.filters.author.Farber, Michaela K.Language: search.filters.language.English

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    Mindful meditation for epidural catheter placement during labor: a single-center randomized controlled trial
    (Oxford University Press (OUP), 2025-06-16)
    Lumbreras-Márquez, Mario Isaac  
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    Lazaridou, Asimina
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    Villela-Franyutti, Diego
    ;
    Fields, Kara G.
    ;
    Farber, Michaela K.
    Importance: Labor epidural placement can cause significant procedural anxiety for patients. Behavioral interventions, such as mindful meditation, can effectively reduce anxiety, including during pregnancy. Objective: This study aimed to assess the impact of a 10-minute mindful meditation session on anxiety and pain during labor epidural placement. Design, Setting, Participants, Intervention, and Outcome Measures: Pregnant women were recruited and randomized into 2 groups: A 10-minute guided mindful meditation, or a neutral content recording, both delivered via headphones before the epidural procedure as a recording. After the procedure, participants reported their levels of anxiety, pain, and satisfaction. Linear regression analyses were used to evaluate the main effects of the intervention on anxiety, pain, and satisfaction. Additionally, an exploratory post hoc moderation analysis assessed the role of baseline pain catastrophizing and its interaction with the intervention. Results: A total of 100 participants were included (50 per group). There were no overall main effect of mindful meditation on primary outcomes of anxiety and pain, or secondary outcome of procedural satisfaction, compared to the neutral content recording (P’s > .05). Exploratory post hoc analysis indicated a moderation of treatment effect, such that participants with higher baseline pain catastrophizing experienced greater benefits from mindful meditation compared to neutral content on anxiety (b = −0.18, P = .01) and pain (b = −0.14, P = .03). Conclusions and Relevance: While no overall group-level effects of mindful meditation were found, exploratory analysis suggested that the intervention may be more beneficial for participants with high baseline pain catastrophizing. Future studies enrolling a larger sample, or enriching for patients with these characteristics are needed to confirm these results. ©The authors ©Oxford University Press.
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    Second-Line Uterotonics for Uterine Atony
    (Lippincott, Williams & Wilkins, 2024)
    Cole, Naida M.
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    Kim, Jimin J.
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    Lumbreras-Márquez, Mario Isaac  
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    Fields, Kara G.
    ;
    Mendez-Pino, Laura
    Objective: To evaluate the comparative efficacy of two of the most commonly used second-line uterotonics—methylergonovine maleate and carboprost tromethamine. Methods: We conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0–10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations. © 2024 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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