Low-dose midazolam for anxiolysis for pregnant women undergoing cesarean delivery: a randomized trial

Anxiety and fear are common among pregnant women undergoing cesarean delivery. In addition to psychologically unpleasant, they can elicit endocrine and metabolic changes. Administration of benzodiazepines in this patient group is uncommon and investigation focusing on the topic is rare. This study aimed to determine anxiolysis efficacy of low-dose midazolam administered preoperatively, right before cesarean delivery, and to evaluate whether its administration impacts neonatal vitality, maternal consciousness, and recall of the moment the baby was born.

Fifty pregnant women with indication for cesarean delivery were included in this randomized, double-blind, placebo-controlled clinical study and allocated into two groups of 25 participants each (Midazolam and Control group). Midazolam (0.0125 mg.kg^-1) or a placebo solution was administered immediately before spinal anesthesia and the anxiolytic effect was assessed using a visual analogue scale before and after administration. We registered the Apgar score at 1 and 5 minutes, the Ramsay scale and recall of the moment of birth, that was assessed 90 minutes after birth.

Pregnant women from the Midazolam group presented a 1.3-point reduction in anxiety on the visual analogue scale, while the Control group showed virtually no change (p = 0.027). We observed no statistically significant changes in Apgar scores, level of maternal consciousness and recall of the moment of delivery.

Low-dose midazolam can provide anxiety management in pregnant women undergoing cesarean delivery with no significant undesirable effects.