Observations on labor epidural analgesia and operative delivery rates

Yancey, Michael K.; Pierce, Brian; Schweitzer, Dina; Daniels, Don

doi:10.1016/s0002-9378(99)70213-9

Cited by 53 publications

(21 citation statements)

References 13 publications

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“…[38][39][40][41][42] However, epidural analgesia has been implicated to affect labor progression, with increased need for oxytocin administration, longer second stage of labor, and higher risk of operative (forceps or vacuum-assisted) vaginal delivery 34,35,43 ; although whether epidural truly increases the rate of operative vaginal delivery for dystocia remains debatable. [44][45][46][47] Compared with women who had spontaneous labor without epidural analgesia during labor in the Consortium on Safe Labor study, nulliparous women who had epidural analgesia in labor had a median duration of second stage of 66 minutes, whereas those without epidural had a median second stage of 36 minutes (ie, median was 30 min longer second stage with epidural). 10 However, the lengths of first and second stages of labor are not of normal distribution.…”

Section: Impact Of Epidural Analgesiamentioning

confidence: 99%

Second Stage of Labor

Cheng

Caughey

2015

Clinical Obstetrics &Amp; Gynecology

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Current American College of Obstetricians and Gynecologists' definition of prolonged second stage diagnoses 10% to 14% of nulliparous and 3% to 3.5% of multiparous women as having a prolonged second stage. The progression of labor in modern obstetrics may have deviated from the current labor norms established in the 1950s, likely due to differences in obstetric population characteristics and variation in clinical practice. Optimal management of the second stage in women with and without epidural remains debatable. Although prolonged second stage is associated with increased risk of maternal morbidity, conflicting data exist regarding the duration of second stage and associated neonatal morbidity and mortality.

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Section: Impact Of Epidural Analgesiamentioning

confidence: 99%

Second Stage of Labor

Cheng

Caughey

2015

Clinical Obstetrics &Amp; Gynecology

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“…In a large study, Yancey et al [20] investigated the impact of the administration of neuraxial analgesia on Cesarean section at the Tripler United States Army Hospital before and after 1993. As a result of the availability of neuraxial labor analgesia in 1993, the rate of epidural analgesia increased from 1 to 80% over 1 year.…”

Section: Neuraxial Analgesia and Labor Outcomementioning

confidence: 99%

Neuraxial analgesia: a review of its effects on the outcome and duration of labor

Jung

Kwak

2013

Korean J Anesthesiol

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Labor pain is one of the most challenging experiences encountered by females during their lives. Neuraxial analgesia is the mainstay analgesic for intrapartum pain relief. However, despite the increasing use and undeniable advantages of neuraxial analgesia for labor, there have been concerns regarding undesirable effects on the progression of labor and outcomes. Recent evidence indicates that neuraxial analgesia does not increase the rate of Cesarean sections, although it may be associated with a prolonged second stage of labor and an increased rate of instrumental vaginal delivery. Even when neuraxial analgesia is administered early in the course of labor, it is not associated with an increased rate of Cesarean section or instrumental vaginal delivery, nor does it prolong the labor duration. These data may help physicians correct misconceptions regarding the adverse effects of neuraxial analgesia on labor outcome, as well as encourage the administration of neuraxial analgesia in response to requests for pain relief.

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“…Tako su, na primer, mnogi autori utvrdili da je povećan procenat carskih rezova kod porodilja koje su primale EA [18]. Ipak, postoje brojni problemi u interpretaciji tih podataka -žene različitih starosnih grupa i pariteta, s određenim faktorima rizika, različiti protokoli vođenja porođaja i korišćene koncentracije anestetika [18,42], što otežava donošenje definitivnog zaključka, tim pre što postoji i mnogo radova koji pokazuju da procenat carskih rezova nije udružen s primenom EA [3,18,19,[42][43][44][45][46][47][48][49]. Uvođenje manjih koncentracija bupivakaina (sa 0,25% na 0,125%) s dodatkom opioida, takođe je doprinelo smanjenju procenta carskih rezova [42,43,50].…”

Section: Epiduralna Analgezija U Porođaju: Kontroverzeunclassified

“…Dosta se govori i o tome da i sama jača percepcija bola u latentnoj fazi može biti predskazivač distotič-nih problema u kasnijem toku porođaja. Moguće je da se kod žena s mnogo jačim porođajnim bolovima ne radi o niskom pragu za bol, već o disfunkcionalnom porođaju koji bi se završio operativno bilo sa EA bilo bez EA [42,45,[52][53][54].…”

Section: Epiduralna Analgezija U Porođaju: Kontroverzeunclassified