Feto-Maternal Outcome of Labour with Epidural Analgesia (original) (raw)
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A STUDY OF FETOMATERNAL OUTCOME OF EPIDURAL ANALGESIA DURING LABOUR
National Journal of Medical Research, 2013
Background: Epidural anesthesia is regional anesthesia that blocks pain in a particular region of the body. This produces pain relief with minimal side effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or to stabilize the mother’s blood pressure. Objectives: This study was conducted to assess the fetomaternal outcome of epidural analgesia in labour. Methods: This study was descriptive case series study which was conducted in department of obstetrics and gynecology, GMERS medical college, Gandhinagar, Gujarat from January 2012 to December 2012. Pregnant women who received epidural analgesia during labour were involved in the study. The inclusion criteria were primi gravida patients who had gestational age of greater than 37 weeks (confirmed by ultrasound) without any risk factors, in true labour (cervical dilatation >3 cm with regular uterine contraction) and with vertex presentation. Results: Total number of patients was 80 with the mean age of 21.9±1.7 years. Mode of delivery was spontaneous vaginal in 46 patients (57.5%), forceps delivery in 4 patients (5%), ventouse in 14 patients (17.5%) and caesarean section in 16 patients (20%). At one minute majority of the babies (n 63, 78.75%) had Apgar score of more than 7, only 5 babies (6.25%) had Apgar score less than 4, and 12 babies (15%) had Apgar score between 4-7. At 5 minutes majority of the babies (n 74, 92.5%) had Apgar score of more than 7, only one baby (1.25%) had Apgar score less than 4, and 5 babies (6.25%) had Apgar score between 4-7. Conclusion: Epidural anaesthesia provided excellent pain relief in majority of the patients. It can also be associated with increase duration of second stage of labour but not associated with fetal compromise in a properly managed patient.
Effects of Epidural Labour Analgesia in Mother and Foetus
Journal of obstetrics and gynaecology of India, 2018
Aim of study was to determine effect of epidural analgesia on progress of labour and mode of delivery, to find out its complications in labour and puerperium and to evaluate neonatal outcome in terms of APGAR score. The present study was conducted in Department of Obstetrics and Gynaecology at Government Medical College Aurangabad over period of 2 years from June 2014 to June 2016 after taking approval from institutional ethical board. Hundred low-risk primigravidas were included in the study, 50 women received epidural analgesia for relief of labour pain at 3-4 cm and 50 women served as control. The important outcome FACTORS studied were the following : (1) duration of active phase of I stage, and II stage, (2) mode of delivery, (3) APGAR scores, (4) untoward reactions and intrapartum complications, (5) overall satisfaction of the mother. The operative delivery rates were not significantly different in both the groups (8% in the control group and 6% in the study group: value NS, ...
Comparative Study of the Effect of Early Versus Late Initiation of Epidural Analgesia on Labour
International journal of Gynecology, Obstetrics and Neonatal Care, 2015
Background: Epidural analgesia also known as regional analgesia has been established as a safe and an effective method of pain relief during labor. It was thought that epidurals may possibly interfere with labor and consequently increase the rate of cesarean deliveries or instrumental deliveries or other adverse effect.. A more recent review concluded that epidural analgesia is not associated with such a risk. But, the timing of placement of epidural analgesia has been a controversial issue and how early laboring women can benefit from epidural analgesia is still debated. Hence this comparative study determines the effect of early versus late initiation of epidural analgesia on labor. Objective: To compare the effect of early versus late initiation of epidural analgesia on the duration of labour and the mode of delivery. Methodology: A randomized trial in which 100 term women in early labor at less than3 cm of cervical dilatation were assigned to either immediate initiation of epidural analgesia at first request (50 women) or delay of epidural until the cervix was dilated to at least 4 cm (50 women). Results: At initiation of the epidural, the mean cervical dilatation was 3.1 cm in the early epidural group and 4.4 cm in the late group (P value 0.0000). The mean duration from initiation to full dilatation was significantly shorter in the early compared to the late epidural group: 5.57 hours and 6.3hours respectively amongst primigravida (P = 0.0001) and 3.04 hours and 4.07 hours respectively amongst multigravida. The rates of cesarean section were not significantly different between the groups i.e. 6% and 6% in both early and late groups (P = 0.82) which was not significant. When questioned after delivery regarding their next labor, the women indicated a preference for early epidural. Conclusion: Epidural analgesia in the early labour, following the first request for epidural at cervical dilation of 2-3 cm does not prolong the progression of labor and does not increase the rate of Cesarean deliveries , instrumental vaginal deliveries , and other adverse effects in laboring women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more. Furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.
Outcome of labor with epidural analgesia in primigravida at term
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2019
Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look into the effects of labour analgesia on maternal and fetal outcomes and compare the same with that of opioid analgesics. Methods: It was a prospective randomized controlled trial on 100 patients where parturients were randomly allocated to either group 1-(n=50 patients) who received epidural analgesia or group 2 (n=50) who received intramuscular tramadol. The two groups were compared for duration of labour, analgesic efficacy as assessed by using Visual Analogue Scale (VAS) ,type of deliverynormal/instrumental/operative interventions ,1 and 5 min neonatal Apgar score and neonatal breast-feeding behavior between the two groups. Results: Epidural analgesic gave better pain relief than tramadol which was found to be stastically significant (p<0.001) on comparing the VAS scores and also gave statistically significantly higher satisfaction levels. Duration of both first and second stage of labor was comparable between the two groups and instrumental deliveries and caesarean sections were also comparable to that in tramadol group. There was a trend of higher neonatal Apgar scores in the epidural group than in the tramadol group. Conclusions: Use of effective analgesia in labour, does not prolong second stage of labor and may facilitate good labour outcome both for the mother and the fetus and should be offered to patients in tertiary setups and equipped centres when the patients are apprehensive about labor pains.
Cureus
Background and aim: The aim of this study was to compare the effects of epidural analgesia on relief of labor pain, progress, and outcome of labor in primigravid parturients to those who did not receive any analgesia. Methods: This was a hospital-based, quasi-experimental study conducted on 70 primigravid parturients at term with a single fetus in a cephalic presentation in active labor. Parturients who were willing to receive epidural analgesia formed group S (n=35) and parturients who refused epidural analgesia formed group C (n=35). The primary objective was to compare alleviation of pain measured by the Visual Analogue Scale (VAS) score. Secondary objectives were to compare the duration of labor, mode of delivery, and neonatal outcome. Results: Pain intensity was significantly lower in group S compared to group C at all measured points of time (p<0.001). There was a quick fall in mean VAS score in group S from 7.94 to 3.86 within 20 min with the bolus dose, it further dropped to 1.03 after 3 h. Further, 88.6% of parturients in groups rated their pain relief as excellent and good satisfaction score. Prolongation of active phase of the first stage of labor (>6 h) was not significant (17.1 % in epidural group versus 5.7% in control group; p=0.259). However, prolongation of the second stage of labor (> 2h) was significant (18.2% in study group versus 0% in control group; p=0.024). The rate of cesarean section, instrumental vaginal delivery, and neonatal outcome was similar in both groups. No adverse effects were observed on maternal vitals, fetal heart rate and Apgar score at 5 min. Conclusion: Epidural analgesia alleviated labor pain in all primigravid parturients who opted for it, without an increase in cesarean section and instrumental vaginal birth. Improved parturients' satisfaction with associated neonatal safety provides a positive birth experience. There was no effect on duration of active phase of the first stage of labor, but the duration of the second stage of labor was slightly prolonged.
Labor course and delivery in epidural analgesia: a case-control study
Background: We aimed to establish if epidural analgesia is associated with a higher incidence of operative vaginal delivery, longer duration of labor and more frequent use of oxytocin than labor without analgesia. Methods: We analyzed a cohort of 207 women with no risk factors who delivered with epidural analgesia in the labor unit of Spedali Civili, Brescia, Italy, during 2001. Length of the first and second stage of labor, mode of delivery, neonatal cord blood pH, neonatal Apgar score and neonatal outcomes were evaluated. Results: Epidural analgesia was performed on request in 6%: in this group (group A) there were 141 (68%) nulliparae and 66 (32%) pluriparae; mean ( + standard deviation) gestational age at delivery was 39.4 + 1.3 weeks (range: 34.1-41.5 weeks). In this group, 184 (89%) had vaginal delivery and 23 (11%) delivered by Cesarean section. Among controls (group B), 368 (89%) had a vaginal delivery and 46 (11%) delivered by Cesarean section; vacuum extraction was used in 18 deliveries (9%) in group A and in 13 deliveries (3%) in group B 1 . The duration of the second stage of spontaneous labor in the nulliparae of group A was significantly longer than in group B. No statistically significant differences were found between mean umbilical artery pH values of groups A and B. Conclusion: Our results confirm that epidural analgesia does not affect the rate of Cesarean delivery, while increasing the use of oxytocin augmentation, the duration of the second stage of labor and the rate of instrumental vaginal delivery.
Gynecology and Women’s Health Care, 2021
Introduction: Childbirth can be extremely painful. Labor pain is multifactorial and very complex, as it is a combination of visceral pain and somatic pain, in addition to psychological factors. Thus, the provision of effective pain relief during labor is an important element for a positive maternal experience. Epidural anesthesia is the most frequently used method of pain control In normal vaginal delivery (NVD), labor epidurals provide effective analgesia for laboring parturient. Objective: of the present study was to review the maternal and fetal risks associated with epidural analgesia for pain relief during labor, and to investigate whether the use of epidural analgesia during labor was a risk factor for AVD and CS delivery. Methods: We performed a 1-year (2020) prospective cohort analysis of the patients presenting at four obstetricled maternity units part of major academic medical centers in Beirut, Lebanon from January 2020 until December 2020. All eligible patients were appr...
Fetomaternal outcome in parturient women with and without epidural labour analgesia
IP innovative publication pvt. ltd, 2019
Introduction: Labour analgesia is being preferred by the parturient women these days due to increased awareness, comfortness and low threshold to perceive pain. The effects of epidural and parenteral analgesia on duration and mode of deliveries have been studied since last few decades. Aim was to study the effects of epidural labour analgesia on the duration of labour, mode of delivery, fetal outcome and patient satisfaction and comfortness. This was a prospective, comparative and observational study. Material and Methods: One hundred parturient women with full term single live gestation with vertex presentation with spontaneous onset of labour, meeting the inclusion criteria were divided into two groups. Group C: Parturient women who opted out of labour analgesia were taken as controls. Group E: Parturient women who opted for labour analgesia were taken as cases. Statistical Analysis: Independent-Samples t test, Cross tabs and Repeated Measure ANOVA were used. SPSS for windows (version 17.0) was employed for data analysis. p<0.05 was considered as significant and p<0.01 considered as highly significant. Results: Demographic parameters like age, weight, height, BMI were comparable between the two groups E and group C (p>0.05) The gestational age between the groups C and E were comparable as p >0.05 No significant difference in Bishops score between Group E and Group C (p>0.05) There was no difference stastistically in terms of mode of delivery (Normal delivery, Instrumental delivery, Caesarean delivery) between the groups. Instrumental delivery was seen more in group E. No change in normal or ceasarean deliveries. Shortening of active phase was seen in group E (P <0.01 from 2 nd hour). Prolonged second stage of labour was seen in group E (P=0.001) which is statistically significant. Decreased pain score in group E with p value of 0.006 which is highly significant statistically. There was improvement of APGAR at 1 minute in group E with significant p value. No significant difference between the groups for APGAR score at 5 minute. No significant difference between the groups in terms of requirement of NICU admission. Conclusion: Many safe techniques are available for parturient women to bypass the painful labour process and enjoy the birth of the baby. Labour analgesia is one of the most commonly used method in developed countries. Due to lack of awareness and false perception of ending up in caesserian sections, labour analgesia has not gained much popularity in India. Our study aims to study the incidence of casserian sections, instrumental deliveries and the effects of labour analgesia in newborns. Epidural is a regional technique which is safe as to reduce the labour pain and to experience the joy of motherhood, without pain. The prs and cons of labour analgesia should be explained to al labour women and to be given an option of opting it to enjoy the process of painless labour.
Objective. To investigate whether the use of epidural analgesia during induced labour was a risk factor for instrumental vaginal delivery and caesarean section (CS) delivery. Study Design. This was a retrospective case series of primigravidae women being induced at term for all indications with a normal body mass index (BMI) at booking and under the age of 40 years. Results. We identified 1,046 women who fulfilled the inclusion criteria of which 31.2% had an epidural analgesia. Those with an epidural analgesia had significantly greater maternal age, higher BMI, greater percentage of oxytocin usage, and a longer first and second stage of labour. Women with an epidural analgesia had a higher instrumental delivery (37.9% versus 16.4%; í µí± < 0.001) and CS delivery rate (26% versus 10.1%; í µí± < 0.001). Multivariable analysis indicated that the use of an epidural was not a risk factor for a CS delivery but was a risk factor for an instrument-assisted delivery (adjusted OR = 3.63; 95% CI: 2.51–5.24; í µí± < 0.001). Conclusion. Our study supports the literature evidence that the use of an epidural increases the instrumental delivery rates. It has also added that there is no effect on CS delivery and the observed increase is due to the presence of confounding factors.