A Retrospective Case-controlled Study of the Association Between Request to Discontinue Second Stage Labor Epidural Analgesia and Risk of Instrumental Vaginal Delivery

Toledo, Paloma; McCarthy, Robert J.; Ebarvia, M.J.; Wong, Cynthia A.

doi:10.1097/01.aoa.0000358425.06348.be

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Могуће је дa код женa с много јaчим порођaјним боловимa није реч о ниском прaгу зa бол, већ о дисфункционaлном порођaју који би се зaвршио оперaтивно, било с епидурaлном aнaлгезијом било без ње (23).…”

Section: перидурална аналгезија у порођају -за и противunclassified

Painless delivery: Yes or no?

Trifunović-Kubat¹,

Varjačić²

2014

Medicinski casopis

View full text Add to dashboard Cite

УВОДСавремено акушерство тежи постизању безболног порођаја, при чему не смеју бити угрожени ни живот мајке ни живот плода. Епидурална аналгезија данас се сматра методом избора за обезбољавање порођаја (1). Пут од њеног увођења до прихватања није био лак. Увођење савремене анестезије у акушерство почиње тек 1847. године, када је шкотски акушер James Simpson (2) користио етар за ублажавање порођајних болова. Проналаском локалних анестетика они се спорадично примењују и у акушерству, али већу популарност достижу тек половином двадесетог века. Савремени акушери траже одговор на следеће питање: "Које би средство или метода били идеални да блокирају само оне нерве који спроводе болни надражај, а не утичу на остале функције организма?" Тренутно не постоје ни лек ни техника с таквим степеном селективности, али је правилно изведена епидурална аналгезија ближа том идеалу од свих других расположивих техника (3). Још једно интересантно питање које се поставља јесте: "Када треба започети епидуралну аналгезију?" У aCOg препорукама из 2002. године наводи се да треба сачекати цервикалну дилатацију од бар четири-пет центиметара да би се избегла повећана инциденција царских резова (4). Ипак, још је Chestnut 1994. године (5), а последњих година и други аутори, lieberman, eltzsing, Camman (6-8), кренуо с извођењем епидуралне аналгезије при дилатацији цервикса од три и по центиметра, односно два центиметра, при чему није порастао број оперативних и инструменталних довршења порођаја, а породиље су, разумљиво, биле задовољније анестезијом. Циљ овог рада био је да се

show abstract

Section: перидурална аналгезија у порођају -за и противunclassified

Painless delivery: Yes or no?

Trifunović-Kubat¹,

Varjačić²

2014

Medicinski casopis

View full text Add to dashboard Cite

show abstract

“…Labour analgesia is an integral part of labour management. Ideal labour analgesia should effectively reduce the pain of labour as well as ensure feto-meternal safety 1 . There are many methods to serve this purpose.…”

Section: Introductionmentioning

confidence: 99%

Epidural Versus Opioid Analgesia for Pain Relief In Labour : A Comperative Study

Meher¹,

Siddique

Datta

et al. 2018

J Chittagong Med Coll Teachers Ass

View full text Add to dashboard Cite

Backgroud : Pain management is an universal concern for women during labour. Ideal labour analgesia should effectively reduce the pain and have minimal adverse effects on the fetus and progress of labour. Materials and methods : The present cross sectional comparative study was carried out in the Department of Obstetrics and Gynecology, Chittagong Medical College Hospital (CMC&H) between January 2014 and July 2014 to compare the efficacy and safety between epidural analgesia and opioid analgesia on nulliparous women in labour. In this study, study population were Pregnant women with labour pain admitted in the Department of Obstetrics and Gynaecology, CMC&H. Samples were selected following inclusion and exclusion criteria. Then randomization was done to divide them in groups, group A & B each having 40 patient. Group A received epidural analgesia at the L3-4 interspace with 0.125% Bupivacaine 10 ml and Fentanyl 50 mg & group B received opioid analgesia (Inj. Pethidine and Phenargon). Then the subjects were followed up and outcome were recorded in a preformed data collection sheet. All data were analyzed by computer based software SPSS version 15. Quantitative data was analyzed by Student’s t- test. Categorical variables were analyzed by Chi square (c2) test & Fisher’s Exact Test. Results : Statistical significance was set at P value less than <0.05 and confidence interval set at 95% level. The two groups were almost identical with respect to maternal age, gestational age and pre-induction pain score (p = 0.127, p = 0.454 and p = 0.186 respectively). The onset of analgesia in epidural group was significantly earlier than that in the opioid group. The pain score at onset and at different time intervals following induction and at the time of delivery were appreciably lower in women receiving epidural analgesia with Bupivacaine 0.125% and Fentanyl than those receiving opioid analgesia with Pethidine & Phenargon injection (p < 0.001). In terms of the complications like nausea and/or vomiting there was no significant difference between the epidural and the opioid groups (p = 0.431). Four (10.0%) patients in the epidural group experienced prolonged 2nd stage of labour compared to none in the opioid group (p = 0.027). Majority of the patients in either group have had normal delivery. Only 2 (5%) patients in the epidural group and 5 (12.5%) in the opioid group required caesarean delivery and 4 (10.0%) patient in the former group and 1 (2.5%) patient in later group required instrumental delivery (p = 0.455). Fetal distress was primarily the indication for caesarean delivery in either group (p = 0.310). Instrumental delivery in the epidural group was required due to prolonged 2nd stage of labour and in opioid group due to fetal distress in 2nd stage of labour (p = 0.027). No significant differences was observed between the epidural and opioid analgesia groups in terms of APGAR scores at 1 and 5 minutes of birth (p = 0.401 and p = 0.536 respectively). Conclusion : The study concluded that epidural analgesia with Bupivacaine induces a much earlier onset of analgesia than does the opioid analgesia with Pethidine & Phenargon injection. The intensity of pain was dramatically reduced to a tolerable level following epidural analgesia and was maintained at this level up to delivery. There was no significant difference in complications between the epidural and opioid groups. JCMCTA 2017 ; 28 (2) : 21-26

show abstract

“…Pain relief is an integral part of labour management. Obstetric analgesia is essential not only for patient's comfort but also for feto-maternal safety, as pain associated physiological responses are potentially harmful for the fetus [1]. Numerous methods are used to relieve labour pain.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Epidural Analgesia During Labour

Chowdhury

Siddique

Nessa

et al. 2017

J Chittagong Med Coll Teachers Ass

View full text Add to dashboard Cite

Although labour is considered as a normal physiological process, it can produce significant pain, requiring appropriate pain management. A painful labour also had detrimental effects on the mother and fetus. Ideal labour analgesia technique should dramatically reduce the pain of labour, while allowing the parturient to actively participate in birthing experience and have minimal adverse effects on the fetus and progress of labour. Epidural analgesia and opioids are often used for management of labour pain. Epidural analgesia is an effective method for managing labour pain. Studies have indicated that the procedure has few contraindications and few side-effects. The study was done to see the efficacy and safety of epidural analgesia with conventional analgesia (Inj. Pethidine and phenergan) during labour. In this study, pregnant women with active labour (Cervical dilation 4cm) were grouped into two A & B. Group A received epidural analgesia (0.125% Bupivacaine & 50 microgram Fentanyl) & group B received conventional analgesia (Inj. Pethidine & phenergan). Then the subjects were followed up and outcomes were recorded in a preformed data collection sheet. All data were analyzed by computer based software SPSS version 15. The study demonstrated a significantly earlier onset of effective analgesia in epidural group than that in the conventional group. The pain score at onset of analgesia and at different time intervals following induction and at the time of delivery were appreciably lower in women receiving epidural analgesia than those receiving conventional analgesia (p<0.001). There was no significant difference between epidural and conventional groups in terms of complications like nausea and/or vomiting (p=0.431), prolonged 2nd stage of labour (p=0.127), mode of delivery (Normal / Instrumental / Cesarean) (p=0.455). Neonatal outcome was evaluated in terms of APGAR score at 1& 5 minutes of birth in both groups which showed no significant differences (p=0.401and p=0.536 respectively). So, epidural analgesia is an effective analgesia during labour. JCMCTA 2016 ; 27 (2) : 12 - 17

show abstract

A Retrospective Case-controlled Study of the Association Between Request to Discontinue Second Stage Labor Epidural Analgesia and Risk of Instrumental Vaginal Delivery

Cited by 3 publications

References 0 publications

Painless delivery: Yes or no?

Painless delivery: Yes or no?

Epidural Versus Opioid Analgesia for Pain Relief In Labour : A Comperative Study

Efficacy of Epidural Analgesia During Labour

Contact Info

Product

Resources

About