The effects of epidural analgesia on uterine activity and labor

Miller, Anthony C.

doi:10.1016/s0959-289x(97)80046-5

Cited by 30 publications

(11 citation statements)

References 139 publications

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“…Delaying maternal pushing until the fetus's head is visible or until one hour after reaching full cervical dilation may reduce the incidence of instrumental delivery and its attendant morbidity 32. Although patients receiving epidural analgesia had a longer second stage labour, this was not associated with poorer neonatal outcome in our analysis.…”

Section: Discussionmentioning

confidence: 67%

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

Liu

Sia

2004

BMJ

148

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Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.

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Section: Discussionmentioning

confidence: 67%

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

Liu

Sia

2004

BMJ

148

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“…3,11,12 Turkish study has stated that there should be good interpersonal relationship between obstetricians and anaesthetists and there should be mutual respect, understanding and support from professional point of view as their combined management is required for effective labour outcome. 13,14 Our study has shown that non-pharmacological means are the least practised method of labour analgesia. Studies have shown that continuous support, immersion in water, relaxation, acupuncture and massage relieved labour pain and improved patient satisfaction.…”

Section: Discussionmentioning

confidence: 77%

Attitude of obstetricians regarding labour analgesia and limitations in practising it

Kannan

Rengasamy

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Parturient experience labour pain of varying degrees which intensifies as labour progresses. Providing adequate pain relief during labour is important for positive experience of child birth.Methods: This cross-sectional survey was conducted among obstetricians working in five teaching hospitals in Tamil Nadu in 2015. Obstetricians working in these medical colleges were given structured questionnaire to be filled by them. It had questions regarding the obstetricians knowledge, experience and attitude towards labour analgesia and limitations in its practise.Results: Majority of them considered epidural labour analgesia as most effective (91%).Only 55% of them have had practical experience of conducting deliveries under epidural. Parenteral injection of opioid (tramadol hydrochloride) or NSAIDs remain the most commonly practised method. 82% of the participants don’t discuss about labour analgesia services while providing antenatal care.Conclusions: Obstetricians should sensitize the antenatal women regarding labour pain and its management. Supportive role should be provided by midwives. Where resources are limited non-pharmacological means of pain relief should also be encouraged.

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“…12 Previously, the association of neonatal morbidity and mortality with longer labour (second stage longer than two hours) had justified expediting delivery, leading to increased rates of instrumental delivery. 13 Delaying pushing until the fetus's head is visible or until one hour after reaching full cervical dilation may reduce the incidence of instrumental delivery and its attendant morbidity. 13 Although women receiving epidural analgesia had a longer second stage labour, this was not associated with poorer neonatal outcome in our analysis.…”

mentioning

confidence: 99%

“…13 Delaying pushing until the fetus's head is visible or until one hour after reaching full cervical dilation may reduce the incidence of instrumental delivery and its attendant morbidity. 13 Although women receiving epidural analgesia had a longer second stage labour, this was not associated with poorer neonatal outcome in our analysis.…”

mentioning

confidence: 99%

Exploring perspectives on death

2004

BMJ

View full text Add to dashboard Cite

The effects of epidural analgesia on uterine activity and labor

Cited by 30 publications

References 139 publications

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review

Attitude of obstetricians regarding labour analgesia and limitations in practising it

Exploring perspectives on death

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