دورية أكاديمية
Fentanyl in the labor epidural impacts the results of intrapartum and postpartum maternal and neonatal toxicology tests.
| العنوان: | Fentanyl in the labor epidural impacts the results of intrapartum and postpartum maternal and neonatal toxicology tests. |
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| المؤلفون: | Siegel MR; Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA. Electronic address: mrsiegel@partners.org., Mahowald GK; Pathology, Massachusetts General Hospital, Boston, MA., Uljon SN; Pathology, Massachusetts General Hospital, Boston, MA., James K; Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA., Leffert L; Department of Anesthesiology, Yale School of Medicine, New Haven, CT., Sullivan MW; Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA., Hernandez SJ; Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA., Gray JR; Department of Medicine, Massachusetts General Hospital, Boston, MA., Schiff DM; Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA., Bernstein SN; Departments of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA. |
| المصدر: | American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2023 Jun; Vol. 228 (6), pp. 741.e1-741.e7. Date of Electronic Publication: 2022 Nov 23. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 0370476 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6868 (Electronic) Linking ISSN: 00029378 NLM ISO Abbreviation: Am J Obstet Gynecol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: <2005->: New York : Elsevier Original Publication: St. Louis. |
| مواضيع طبية MeSH: | Analgesia, Epidural* , Labor, Obstetric*, Pregnancy ; Female ; Infant, Newborn ; Humans ; Fentanyl ; Prospective Studies ; Postpartum Period |
| مستخلص: | Background: A positive urine fentanyl toxicology test may have considerable consequences for peripartum individuals, yet the extent to which fentanyl administration in a labor epidural may lead to such a positive test is poorly characterized. Objective: This study aimed to quantify the extent to which neuraxial fentanyl in labor neuraxial analgesia can lead to a positive peripartum maternal or neonatal urine toxicology test. Study Design: We performed a prospective cohort study of pregnant participants planning a vaginal delivery with neuraxial analgesia. Participants with a history of substance use disorder, hypertension, or renal or liver disease were excluded. A urine sample was collected before initiation of neuraxial analgesia, each time the bladder was emptied during labor, and up to 4 times postpartum. Neonatal urine was collected once. Urine fentanyl testing was performed using 2 common toxicology testing methods, namely immunoassay and liquid chromatography with tandem mass spectrometric detection. Results: A total of 33 maternal-infant dyads yielded a total of 178 urine specimens. All maternal specimens were negative for fentanyl using liquid chromatography with tandem mass spectrometric analysis and immunoassay before initiation of neuraxial analgesia. Intrapartum, 26 of 30 (76.7%) participants had positive liquid chromatography with tandem mass spectrometry results for fentanyl or its metabolites, and 12 of 30 (40%) participants had positive immunoassay results. Postpartum, 19 of 21 (90.5%) participants had positive liquid chromatograph with tandem mass spectrometric results, and 13 of 21 (61.9%) had a positive immunoassay result. Of the 13 neonatal specimens collected, 10 (76.9%) were positive on liquid chromatography with tandem mass spectrometry analysis, the last of which remained positive 29 hours and 50 minutes after delivery. Conclusion: Neuraxial fentanyl for labor analgesia may lead to positive maternal and neonatal toxicology tests at various times after epidural initiation and cessation and at different rates depending on the testing method used. Caution should be used in interpreting toxicology test results of individuals who received neuraxial analgesia to avoid false assumptions about nonprescribed use. (Copyright © 2022 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: epidural; fentanyl; immunoassay; mass spectrometry; neuraxial analgesia; peripartum toxicology testing; substance use disorder; toxicology testing methods |
| المشرفين على المادة: | UF599785JZ (Fentanyl) |
| تواريخ الأحداث: | Date Created: 20221125 Date Completed: 20230605 Latest Revision: 20230607 |
| رمز التحديث: | 20230608 |
| DOI: | 10.1016/j.ajog.2022.11.1293 |
| PMID: | 36427599 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1097-6868 |
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| DOI: | 10.1016/j.ajog.2022.11.1293 |