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

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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.

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References

  1. Fontanarosa PB, Rennie D, DeAngelis CD (2003) The need for regulation of dietary supplements—lessons from ephedra. JAMA 289:1568–1570

    Article  PubMed  Google Scholar 

  2. Hodges PJ, Kam PC (2002) The peri-operative implications of herbal medicines. Anaesthesia 57:889–899

    Article  PubMed  CAS  Google Scholar 

  3. Bateman J, Chapman RD, Simpson D (1998) Possible toxicity of herbal remedies. Scott Med J 43:7–15

    PubMed  CAS  Google Scholar 

  4. Drew AK, Myers SP (1997) Safety issues in herbal medicine: implications for the health professions. Med J Aust 166:538–541

    PubMed  CAS  Google Scholar 

  5. Skinner CM, Rangasami J (2002) Preoperative use of herbal medicines: a patient survey. Br J Anaesth 89:792–795

    Article  PubMed  CAS  Google Scholar 

  6. DeAngelis CD, Fontanarosa PB (2003) Drugs alias dietary supplements. JAMA 290:1519–1520

    Article  PubMed  CAS  Google Scholar 

  7. Finkel RS, Zarlengo KM (2004) Blue cohosh and perinatal stroke. N Engl J Med 351:302–303

    Article  PubMed  CAS  Google Scholar 

  8. Blumenthal M (2000) Interactions between herbs and conventional drugs: introductory considerations. Herbal Gram 49:52–63

    Google Scholar 

  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 28:172–197

    Article  PubMed  Google Scholar 

  10. Gunning K (1999) Echinacea in the treatment and prevention of upper respiratory tract infections. West J Med 171:198–200

    PubMed  CAS  Google Scholar 

  11. Stevinson C, Pittler MH, Ernst E (2000) Garlic for treating hypercholesterolemia: a meta-analysis of randomized clinical trials. Ann Intern Med 133:420–429

    Google Scholar 

  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 42:303–311

    Article  PubMed  CAS  Google Scholar 

  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 26:880–882

    Google Scholar 

  14. Burnham BE (1995) Garlic as a possible risk for postoperative bleeding. Plast Reconstr Surg 95:213

    Article  PubMed  CAS  Google Scholar 

  15. German K, Kumar U, Blackford HN (1995) Garlic and the risk of TURP bleeding: a case report. Br J Urol 76:518

    Article  PubMed  CAS  Google Scholar 

  16. Miller LG (1998) Herbal medicinals. Selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 158:2200–2211

    Article  PubMed  CAS  Google Scholar 

  17. Attele AS, Wu JA, Yuan CS (1999) Ginseng pharmacology: multiple constituents and multiple actions. Biochem Pharmacol 58:1685–1693

    Article  PubMed  CAS  Google Scholar 

  18. Matthews MK Jr (1998) Association of Gingko bilboa with intracerebral hemorrhage. Neurology 50:1933–1934

    PubMed  Google Scholar 

  19. Rowin J, Lewis SL (1996) Spontaneous bilateral subdural hematomas associated with chronic gingko bilboa ingestion. Neurology 46:1775–1776

    PubMed  CAS  Google Scholar 

  20. Vale S (1998) Subarachnoid haemorrhage associated with Gingko bilboa. Lancet 352:36

    Article  PubMed  CAS  Google Scholar 

  21. Gilbert GJ (1997) Gingko bilboa. Neurology 48:1137

    PubMed  CAS  Google Scholar 

  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 67:33–35

    Google Scholar 

  23. Rey JM, Walter G (1998) Hypericum perforatum (St John’s Wort) in depression: pest or blessing? Med J Aust 169:583–586

    PubMed  CAS  Google Scholar 

  24. Gurley BJ, Gardner SF, Hubbard MA (2000) Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 57:963–969

    PubMed  CAS  Google Scholar 

  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 91:1510–1513

    Article  PubMed  Google Scholar 

  26. Foxford RJ, Sahlas DJ, Wingfield KA (2003) Vasospasm-induced stroke in a varsity athlete secondary to ephedrine ingestion. Clin J Sport Med 13:183–185

    Article  PubMed  Google Scholar 

  27. Pipe A, Ayotte C (2002) Nutritional supplements and doping. Clin J Sport Med 12:245–249

    Article  PubMed  Google Scholar 

  28. Haller CA, Benowitz NL (2000) Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 21:1833–1838

    Article  Google Scholar 

  29. Chanwai LG (2000) Kava toxicity. Emerg Med 12:142–145

    Article  Google Scholar 

  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 17:65–71

    Article  PubMed  CAS  Google Scholar 

  31. Langner EL, Greifenberg S, Gruenwald J (1998) Ginger: history and use. Adv Nat Ther 15:25–44

    CAS  Google Scholar 

  32. U.S. Food and Drug Administration. Dietary supplements: overview. Available at: http://www.cfsan.fda.gov/dms/supplmnt.html

  33. Bebbington A, Kulkarini R, Roberts P (2005) Gingko bilboa: persistent bleeding after total hip arthroplasty caused by herbal self-medication. J Arthroplasty 20:125–126

    PubMed  Google Scholar 

  34. Rousseaux CG, Schachter H (2003) Regulatory issues concerning the safety, efficacy and quality of herbal remedies. Birth Defects Res B Dev Reprod Toxicol 68:505–510

    Article  PubMed  CAS  Google Scholar 

  35. Refuerzo JS, Blackwell SC, Sokol RJ, et al (2005) Use of over-the-counter medications and herbal remedies in pregnancy. Am J Perinatol 22:321–324

    Article  PubMed  Google Scholar 

  36. Mabina MH, Moodley J, Pitsoe SB (1997) The use of traditional herbal medication during pregnancy. Trop Doct 27:84–86

    PubMed  CAS  Google Scholar 

  37. Hepner DL, Harnett M, Segal S, et al (2002) Herbal medicine use in parturients. Anesth Analg 94:690–693

    Article  PubMed  Google Scholar 

  38. Marcus DM, Snodgrass WR (2005) Do no harm: avoidance of herbal medicines during pregnancy. Obstet Gynecol 105:1119–1122

    PubMed  Google Scholar 

  39. Pinn G (2001) Herbs used in obstetrics and gynaecology. Aust Fam Physician 30:351–354

    PubMed  CAS  Google Scholar 

  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 62:134–137

    Article  PubMed  CAS  Google Scholar 

  41. Rumbold A, Crowther CA (2005) Vitamin C supplementation in pregnancy. Cochrane Database Syst Rev 18:CD004072

    Google Scholar 

  42. Rumbold A, Crowther CA (2005) Vitamin E supplementation in pregnancy. Cochrane Database Syst Rev 18:CD004069

    Google Scholar 

  43. Wong RS, Cheng G, Chan TY (2003) Use of herbal medicines by patients receiving warfarin. Drug Saf 26:585–588

    Article  PubMed  Google Scholar 

  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 84:699–700

    Article  PubMed  Google Scholar 

  45. Wolfe SM (2003) Ephdera—Scientific Evidence Versus Money/Politics. Science 300:437

    Article  PubMed  CAS  Google Scholar 

  46. Kuczkowski KM (2003) Labor analgesia for the drug abusing parturient: is there cause for concern? Obstet Gynecol Surv 58:599–608

    Article  PubMed  Google Scholar 

  47. Kuczkowski KM (2005) Cardiovascular complications of recreational cocaine use in pregnancy: myth or reality? Acta Obstet Gynecol Scand 84:100–101

    Article  PubMed  Google Scholar 

  48. Kuczkowski KM (2005) Crack cocaine as a cause of acute postoperative pulmonary oedema in a pregnant drug addict. Ann Fr Anesth Reanim 24:437–438

    PubMed  CAS  Google Scholar 

  49. Kuczkowski KM, Benumof J.L (2003) Amphetamine abuse in pregnancy: anesthetic implications. Acta Anaesthesiol Belg 54:161–163

    PubMed  CAS  Google Scholar 

  50. Kuczkowski KM (2006) Ephedrine containing oral nutritional supplements in a pregnant athlete: is it worth the risk? Acta Obstet Gynecol Scand (in press)

  51. Izzo AA, Ernst E (2001) Interactions between herbal medicines and prescribed drugs: a systemic review. Drugs 61:2163–2175

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Krzysztof M. Kuczkowski.

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Kuczkowski, K.M. Labor analgesia for the parturient with herbal medicines use: what does an obstetrician need to know?. Arch Gynecol Obstet 274, 233–239 (2006). https://doi.org/10.1007/s00404-006-0136-0

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  • DOI: https://doi.org/10.1007/s00404-006-0136-0

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