Rebuilding the labor curve during neuraxial analgesia

Frigo, Maria Grazia; Larciprete, G.; Rossi, Federica; Fusco, Paolo; Todde, C.; Jarvis, Sheba; Panetta, Valentina; Celleno, D.

doi:10.1111/j.1447-0756.2011.01568.x

Cited by 13 publications

(18 citation statements)

References 12 publications

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“…2 This can explain the result of a statistically significant difference of the length of the labor between the two groups in our study, perhaps in association with the small size of our sample. Our results are consistent with the literature, 5 and in a recent study Frigo et al 20 proposed a rebuilding of the labor curve during neuraxial analgesia.…”

Section: Discussionsupporting

confidence: 96%

Epidural Analgesia During Labor: Impact on Delivery Outcome, Neonatal Well-Being, and Early Breastfeeding

Gizzo

Gangi

Saccardi

et al. 2012

Breastfeeding Medicine

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Section: Discussionsupporting

confidence: 96%

Epidural Analgesia During Labor: Impact on Delivery Outcome, Neonatal Well-Being, and Early Breastfeeding

Gizzo

Gangi

Saccardi

et al. 2012

Breastfeeding Medicine

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“…There is a strong association between prolonged second stage and increased maternal morbidity, with the mode of birth being a significant contributing factor. Large retrospective and prospective observational studies report increased rates of chorioamnionitis, third‐ and fourth‐degree lacerations, uterine atony, postpartum hemorrhage, intrapartum fever, and hysterectomy following prolonged second stage or pushing for more than 3 or 4 hours. One of these studies selected duration of pushing rather than time since complete dilatation, collecting data from the PEOPLE study, but all others used time since complete dilatation without distinguishing any resting time from time spent pushing.…”

Section: Duration Of Second Stagementioning

confidence: 99%

“…41 Table 2 displays the results of observational studies reporting mean second-stage length and the incidence of prolonged second stage, which is variously defined in the literature. [42][43][44][45][46][47][48][49][50] The length of second stage varies considerably and is affected by parity and epidural analgesia use, as well as other population characteristics and care practices (eg, how often cervical dilatation is assessed and how soon surgical intervention is performed). [51][52][53][54] The average duration of both the first and second stages of labor have trended up in recent decades, and it is postulated that increased rates of epidural analgesia use and other maternal demographics are at least partly responsible.…”

Section: Occiput Posterior Fetus In Second Stagementioning

confidence: 99%

A Review of Evidence‐Based Practices for Management of the Second Stage of Labor

Kopas¹

2014

J Midwife Womens Health

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Management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. This review of second-stage labor care practices discusses risk factors for perineal trauma and prolonged second stage and scrutinizes a variety of care practices including positions, styles of pushing, use of epidural analgesia, and perineal support techniques. Current evidence for management of the second stage of labor supports the practices of delayed pushing, spontaneous (nondirected) pushing, and maternal choice of positions. Perineal compresses, perineal massage with a lubricant, and controlling the rate of fetal extension during crowning may prevent severe perineal trauma at birth. Supine positioning is not recommended. Upright positions and directed pushing can shorten the time from onset of second stage to birth and may be indicated in certain situations, although directed pushing has some associated risks. If the fetus is in the occiput posterior position, immediate pushing is not recommended, and manual rotation can be effective in correcting the malposition. Women should be informed of the potential effects of epidural analgesia on labor progress. Consultation and intervention to expedite birth may be indicated when birth is not imminent after 2 hours of active pushing, or 4 hours complete dilatation, for nulliparous women; or one hour of pushing, or 2 hours complete dilatation, for multiparous women. Each woman should be individually assessed and apprised of the potential risks to her and her fetus of a prolonged second stage of labor, and some women may choose to continue pushing beyond these time limits.

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“…Gambling and colleagues indicated that the use of CSEA was associated with significantly longer labor compared with the use of intravenous opioids [21]. However, two other studies found that the use of CSEA did not increase the incidence of prolonged labors [22, 23]. There is still insufficient evidence regarding whether or not CSEA prolongs labor, and adequately powered randomized control trials are needed to clarify such questions.…”

Section: Discussionmentioning

confidence: 99%

Effects of combined spinal epidural labor analgesia on episiotomy: a retrospective cohort study

Zhou

Gong

et al. 2017

BMC Anesthesiol

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BackgroundAccording to some published studies, neuraxial analgesia may be associated with prolonged labor and an increased risk for instrumental vaginal delivery. However, its effects on episiotomy are unknown. This study aimed to examine the incidence of episiotomy with and without combined spinal–epidural analgesia (CSEA) during labor.MethodsThis was a retrospective cohort study, in which the computerized medical records of nulliparous women with singleton, cephalic and live births were reviewed and women with and without CSEA were matched based on their propensity scores. Univariate and multivariate analyses were used to examine the association between CSEA and the incidence of episiotomy during vaginal delivery.ResultsIn the cohort study with 11,994 vaginal deliveries, 5748 received CSEA and 6246 did not receive CSEA. 4116 CSEA women were successfully matched with 4116 Non-CSEA women. In the univariate analysis, the incidence of episiotomy was 47.4% in the CSEA group and 44.7% in the Non-CSEA group. However, after a multivariable logistic regression analysis, CSEA did not increase the risk of episiotomy (adjusted OR, 1.080; 95% confidence interval [CI], 0.988–1.180).ConclusionsThe use of CSEA during labor and vaginal delivery did not increase the risk of episiotomy.

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Rebuilding the labor curve during neuraxial analgesia

Abstract: The pattern of labor progression in contemporary obstetrics differs significantly from the Friedman curve. Based on these observations, we can obtain a more comprehensive knowledge of the partogram's modifications due to the analgesia.

Cited by 13 publications

References 12 publications

Epidural Analgesia During Labor: Impact on Delivery Outcome, Neonatal Well-Being, and Early Breastfeeding

Epidural Analgesia During Labor: Impact on Delivery Outcome, Neonatal Well-Being, and Early Breastfeeding

A Review of Evidence‐Based Practices for Management of the Second Stage of Labor

Effects of combined spinal epidural labor analgesia on episiotomy: a retrospective cohort study

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