Archives of Gynecology and Obstetrics

, Volume 274, Issue 4, pp 233–239 | Cite as

Labor analgesia for the parturient with herbal medicines use: what does an obstetrician need to know?

Original Article

Abstract

The use of herbal medicines in the developed world is widespread, and increasing. Herbal medicines, which include a wide spectrum of substances ranging from home-made teas to the national regulatory bodies-approved medicinal substances, are defined as plant-derived products that are used for medicinal and/or nutritional purposes. The use of herbal self-therapy is common in pregnancy, with many parturients consuming more than one agent at a time. Despite widespread use there has been surprisingly little research into the outcomes or the potential risks of using herbal therapies during pregnancy. As epidural analgesia is the most popular form of pain relief in labor, the potential for herbal remedies-related alterations in maternal hemodynamics (e.g., hypertension, tachycardia), and increased bleeding tendencies (e.g., spinal-epidural hematoma) remain a significant concern. Obstetricians and obstetric anesthesiologists must be familiar with the effects of herbal medicines and should specifically enquire about the use of herbal medicines during prenatal/preanesthetic assessment. This review article attempts to summarize current data on special considerations for labor analgesia in parturients with herbal medicines use.

Keywords

Pregnancy Dietary supplements Medicine Complementary Alternative Herbal Obstetric anesthesia Labor analgesia Complications 

References

  1. 1.
    Fontanarosa PB, Rennie D, DeAngelis CD (2003) The need for regulation of dietary supplements—lessons from ephedra. JAMA 289:1568–1570PubMedCrossRefGoogle Scholar
  2. 2.
    Hodges PJ, Kam PC (2002) The peri-operative implications of herbal medicines. Anaesthesia 57:889–899PubMedCrossRefGoogle Scholar
  3. 3.
    Bateman J, Chapman RD, Simpson D (1998) Possible toxicity of herbal remedies. Scott Med J 43:7–15PubMedGoogle Scholar
  4. 4.
    Drew AK, Myers SP (1997) Safety issues in herbal medicine: implications for the health professions. Med J Aust 166:538–541PubMedGoogle Scholar
  5. 5.
    Skinner CM, Rangasami J (2002) Preoperative use of herbal medicines: a patient survey. Br J Anaesth 89:792–795PubMedCrossRefGoogle Scholar
  6. 6.
    DeAngelis CD, Fontanarosa PB (2003) Drugs alias dietary supplements. JAMA 290:1519–1520PubMedCrossRefGoogle Scholar
  7. 7.
    Finkel RS, Zarlengo KM (2004) Blue cohosh and perinatal stroke. N Engl J Med 351:302–303PubMedCrossRefGoogle Scholar
  8. 8.
    Blumenthal M (2000) Interactions between herbs and conventional drugs: introductory considerations. Herbal Gram 49:52–63Google Scholar
  9. 9.
    Horlocker TT, Wedel DJ, Benzon H, et al (2003) Regional anesthesia in the anticoagulated patient: defining the risks (the second ASRA consensus conference on neuraxial anesthesia and anticoagulation). Reg Anesth Pain Med 28:172–197PubMedCrossRefGoogle Scholar
  10. 10.
    Gunning K (1999) Echinacea in the treatment and prevention of upper respiratory tract infections. West J Med 171:198–200PubMedGoogle Scholar
  11. 11.
    Stevinson C, Pittler MH, Ernst E (2000) Garlic for treating hypercholesterolemia: a meta-analysis of randomized clinical trials. Ann Intern Med 133:420–429Google Scholar
  12. 12.
    Apitz-Castro R, Escalante J, Vargas R, Jain MK (1986) Ajoene, the antiplatelet principle of garlic, synergistically potentiates the antiaggregatory action of prostacyclin, forskolin, indomethacin and dypiridamole on human platelets. Thromb Res 42:303–311PubMedCrossRefGoogle Scholar
  13. 13.
    Rose KD, Croissant PD, Parliament CF, Levin MB (1990) Spontaneous spinal epidural hematoma with associated platelet dysfunction from excessive garlic ingestion: a case report. Neurosurgery 26:880–882Google Scholar
  14. 14.
    Burnham BE (1995) Garlic as a possible risk for postoperative bleeding. Plast Reconstr Surg 95:213PubMedCrossRefGoogle Scholar
  15. 15.
    German K, Kumar U, Blackford HN (1995) Garlic and the risk of TURP bleeding: a case report. Br J Urol 76:518PubMedCrossRefGoogle Scholar
  16. 16.
    Miller LG (1998) Herbal medicinals. Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 158:2200–2211PubMedCrossRefGoogle Scholar
  17. 17.
    Attele AS, Wu JA, Yuan CS (1999) Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol 58:1685–1693PubMedCrossRefGoogle Scholar
  18. 18.
    Matthews MK Jr (1998) Association of Gingko bilboa with intracerebral hemorrhage. Neurology 50:1933–1934PubMedGoogle Scholar
  19. 19.
    Rowin J, Lewis SL (1996) Spontaneous bilateral subdural hematomas associated with chronic gingko bilboa ingestion. Neurology 46:1775–1776PubMedGoogle Scholar
  20. 20.
    Vale S (1998) Subarachnoid haemorrhage associated with Gingko bilboa. Lancet 352:36PubMedCrossRefGoogle Scholar
  21. 21.
    Gilbert GJ (1997) Gingko bilboa. Neurology 48:1137PubMedGoogle Scholar
  22. 22.
    Fessendsen JM, Wittenborn W, Clarke L (2001) Gingko bilboa: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy. Am Surg 67:33–35Google Scholar
  23. 23.
    Rey JM, Walter G (1998) Hypericum perforatum (St John’s Wort) in depression: pest or blessing? Med J Aust 169:583–586PubMedGoogle Scholar
  24. 24.
    Gurley BJ, Gardner SF, Hubbard MA (2000) Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 57:963–969PubMedGoogle Scholar
  25. 25.
    Gardner SF, Franks AM, Gurley BJ, et al (2003) Effect of multicomponent, ephedra-containing dietary supplement (Metabolite 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Cardiol 91:1510–1513PubMedCrossRefGoogle Scholar
  26. 26.
    Foxford RJ, Sahlas DJ, Wingfield KA (2003) Vasospasm-induced stroke in a varsity athlete secondary to ephedrine ingestion. Clin J Sport Med 13:183–185PubMedCrossRefGoogle Scholar
  27. 27.
    Pipe A, Ayotte C (2002) Nutritional supplements and doping. Clin J Sport Med 12:245–249PubMedCrossRefGoogle Scholar
  28. 28.
    Haller CA, Benowitz NL (2000) Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 21:1833–1838CrossRefGoogle Scholar
  29. 29.
    Chanwai LG (2000) Kava toxicity. Emerg Med 12:142–145CrossRefGoogle Scholar
  30. 30.
    Leathwood PD, Chauffard F, Heck E, Munoz-Box R (1982) Aqueous extract of valerian root (Valeriana officinalis L) improves sleep quality in man. Pharmacol Biochem Behav 17:65–71PubMedCrossRefGoogle Scholar
  31. 31.
    Langner EL, Greifenberg S, Gruenwald J (1998) Ginger: history and use. Adv Nat Ther 15:25–44Google Scholar
  32. 32.
    U.S. Food and Drug Administration. Dietary supplements: overview. Available at: http://www.cfsan.fda.gov/dms/supplmnt.html
  33. 33.
    Bebbington A, Kulkarini R, Roberts P (2005) Gingko bilboa: persistent bleeding after total hip arthroplasty caused by herbal self-medication. J Arthroplasty 20:125–126PubMedGoogle Scholar
  34. 34.
    Rousseaux CG, Schachter H (2003) Regulatory issues concerning the safety, efficacy and quality of herbal remedies. Birth Defects Res B Dev Reprod Toxicol 68:505–510PubMedCrossRefGoogle Scholar
  35. 35.
    Refuerzo JS, Blackwell SC, Sokol RJ, et al (2005) Use of over-the-counter medications and herbal remedies in pregnancy. Am J Perinatol 22:321–324PubMedCrossRefGoogle Scholar
  36. 36.
    Mabina MH, Moodley J, Pitsoe SB (1997) The use of traditional herbal medication during pregnancy. Trop Doct 27:84–86PubMedGoogle Scholar
  37. 37.
    Hepner DL, Harnett M, Segal S, et al (2002) Herbal medicine use in parturients. Anesth Analg 94:690–693PubMedCrossRefGoogle Scholar
  38. 38.
    Marcus DM, Snodgrass WR (2005) Do no harm: avoidance of herbal medicines during pregnancy. Obstet Gynecol 105:1119–1122PubMedGoogle Scholar
  39. 39.
    Pinn G (2001) Herbs used in obstetrics and gynaecology. Aust Fam Physician 30:351–354PubMedGoogle Scholar
  40. 40.
    Friedman JM (2000) Teratology society: presentation to the FDA public meeting on safety issues associated with the use of dietary supplements during pregnancy. Teratology 62:134–137PubMedCrossRefGoogle Scholar
  41. 41.
    Rumbold A, Crowther CA (2005) Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev 18:CD004072Google Scholar
  42. 42.
    Rumbold A, Crowther CA (2005) Vitamin E supplementation in pregnancy. Cochrane Database Syst Rev 18:CD004069Google Scholar
  43. 43.
    Wong RS, Cheng G, Chan TY (2003) Use of herbal medicines by patients receiving warfarin. Drug Saf 26:585–588PubMedCrossRefGoogle Scholar
  44. 44.
    Ong CO, Cahn LY, Yung PB, Leung TN (2005) Use of traditional Chinese herbal medicine during pregnancy: a prospective study. Acta Obstet Gynecol Scand 84:699–700PubMedCrossRefGoogle Scholar
  45. 45.
    Wolfe SM (2003) Ephdera—Scientific Evidence Versus Money/Politics. Science 300:437PubMedCrossRefGoogle Scholar
  46. 46.
    Kuczkowski KM (2003) Labor analgesia for the drug abusing parturient: is there cause for concern? Obstet Gynecol Surv 58:599–608PubMedCrossRefGoogle Scholar
  47. 47.
    Kuczkowski KM (2005) Cardiovascular complications of recreational cocaine use in pregnancy: myth or reality? Acta Obstet Gynecol Scand 84:100–101PubMedCrossRefGoogle Scholar
  48. 48.
    Kuczkowski KM (2005) Crack cocaine as a cause of acute postoperative pulmonary oedema in a pregnant drug addict. Ann Fr Anesth Reanim 24:437–438PubMedGoogle Scholar
  49. 49.
    Kuczkowski KM, Benumof J.L (2003) Amphetamine abuse in pregnancy: anesthetic implications. Acta Anaesthesiol Belg 54:161–163PubMedGoogle Scholar
  50. 50.
    Kuczkowski KM (2006) Ephedrine containing oral nutritional supplements in a pregnant athlete: is it worth the risk? Acta Obstet Gynecol Scand (in press)Google Scholar
  51. 51.
    Izzo AA, Ernst E (2001) Interactions between herbal medicines and prescribed drugs: a systemic review. Drugs 61:2163–2175PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of California San Diego Medical CenterSan DiegoUSA

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