Regional Anesthesia for Labor, Operative Vaginal Delivery and Cesarean Delivery: A Narrative Review

Abstract Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). Methods NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p<0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p＞0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p<0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p＞0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p<0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p＞0.05). There was a negative correlation between the rate of NA and rate of overall CD, r=-0.782 (95%CI [-0.948, -0.534], p＜0.001), and between the utilization rate of NA and rate of MRCD, r=-0.914 (95%CI [-0.989, -0.766], p＜0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p＞0.05). Conclusions: Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

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The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective studyThe initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

10.21203/rs.2.13558/v2 ◽

2020 ◽

Author(s):

Yun ZHAO ◽

YING GAO ◽

Guoqiang SUN ◽

Lin YU ◽

Ying LIN

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Negative Correlation ◽

Labor Analgesia ◽

Utilization Rate ◽

Maternal Request ◽

Neonatal Asphyxia ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery ◽

Multiparous Women

Abstract Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change is overall cesarean delivery (CD) and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods The neuraxial labor analgesia（NA） was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not according to her own requirement. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from May 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p<0.001); the rate of CD was decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p<0.001); the rate of MRCD was decreased from 10.8% in May 2015 to 5.7% in April 2016 (p<0.001), but the rate of multiparous women had no change (p＞0.05). There was a negative correlation between the rate of NA and that of overall CD, r=-0.803 (95%CI[-0.951, -0.642], p=0.002), and also a negative correlation between the utilization rate of NA and that of MRCD, r=-0.790 (95%CI[-0.971, -0.497], p=0.004). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women underwent CD remained unchanged from May 1st 2015 to April 30th 2016. Conclusions: Our study shows that the rates of CD and MRCD in our department significantly were decreased over a year period (2015. 05.01~2016. 04.30), which may be due to the increasing use of NA during vaginal delivery by the help of NPLD. Key Words: Neuraxial Labor Analgesia; Cesarean Delivery; Maternal Request Cesarean Delivery

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The initiation of a neuraxial analgesia service on the rate of cesarean delivery in Hubei, China. a 1-year restrospective study

10.21203/rs.2.13558/v1 ◽

2019 ◽

Author(s):

Yun ZHAO ◽

YING GAO ◽

Guoqiang SUN ◽

Lin YU ◽

Ying LIN

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Negative Correlation ◽

Labor Analgesia ◽

Utilization Rate ◽

Specialized Training ◽

Neonatal Asphyxia ◽

Neuraxial Analgesia ◽

Operative Vaginal Delivery ◽

And Training

Abstract Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change of overall cesarean delivery(CD) and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods The neuraxial labor analgesia was initiated in May 1st 2015. A multidisciplinary NPLD team from America was invited to our hospital to give education and training for 7 days. After training, the application of neuraxial labor analgesia became a routine operation in our hospital, and every parturient can choose to use neuraxial analgesia or not according to her own requirement. The rates of neuraxial labor analgesia(NA), CD, MRCD, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from May 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 ( p< 0.001); the rate of CD decreased from 50.4% in May 2015 to 36.3% in April 2016 (, p< 0.001); the rate of MRCD decreased from 10.8%in May 2015 to 5.7% in April 2016( p< 0.001). There was a negative correlation between the rate of NA and that of overall CD, r=-0.803 (95%CI[-0.951,-0.642], p =0.002), and also a negative correlation between the utilization rate of NA and that of MRCD, r=-0.790 (95%CI[-0.971,-0.497], p =0.004). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in vaginal delivery women and the rates of intrapartum CD, neonatal asphyxia, and PPH in CD women remained unchanged from May 2015 to April 2016.Conclusions Our study shows that the rates of CD and MRCD in our department significantly decreased over a year period(2015 05~2016. 04), which may be due to the increasing use of NA during vaginal delivery.

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Neonatal Outcomes and Operative Vaginal Delivery Versus Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0030-1247605 ◽

2010 ◽

Vol 27 (06) ◽

pp. 493-499 ◽

Cited By ~ 18

Author(s):

Stephen Contag ◽

Rebecca Clifton ◽

Steven Bloom ◽

Catherine Spong ◽

Michael Varner ◽

...

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Neonatal Outcomes ◽

Operative Vaginal Delivery

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Outcomes of Operative Vaginal Delivery during Trial of Labor after Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0037-1598080 ◽

2017 ◽

Vol 34 (08) ◽

pp. 765-773 ◽

Cited By ~ 2

Author(s):

Clifton Brock ◽

Shravya Govindappagari ◽

Cynthia Gyamfi-Bannerman

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Maternal Morbidity ◽

Secondary Analysis ◽

Perinatal Outcomes ◽

Neonatal Morbidity ◽

Logistic Regression Models ◽

Trial Of Labor ◽

Operative Vaginal Delivery ◽

Uterine Scar

Objective The objective of this study is to determine the maternal and neonatal morbidity associated with attempting operative vaginal delivery (OVD) compared with the alternative of a laboring repeat cesarean delivery (LRCD) in women attempting a trial of labor after cesarean delivery (TOLAC). Methods This is a secondary analysis of a multicenter prospective study designed to assess perinatal outcomes of OVD in women with a prior uterine scar. The study includes women who attempted TOLAC and reached +2 station with a fully dilated cervix. Composites on neonatal and maternal morbidity were compared between women in whom OVD was attempted and those who underwent LRCD by fitting multivariate logistic regression models. Results In total, 6,489 women attempting TOLAC reached 2+ station with a fully dilated cervix. Of these, 5,640 (86.9%) had a spontaneous vaginal delivery, 762 (11.7%) underwent attempted OVD, and 87 (1.3%) had an LRCD. Compared with attempting OVD, LRCD was associated with greater neonatal morbidity (odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.13–5.15) and less maternal morbidity (OR: 0.28; 95% CI: 0.14–0.55). Maternal morbidity of OVD is driven by perineal injury. Conclusion In laboring women with a previous uterine scar, attempting OVD is associated with greater maternal and less neonatal morbidity than LRCD.

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785: Operative vaginal delivery is a safe option in women undergoing a trial of labor after prior cesarean delivery (TOLAC)

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.11.518 ◽

2017 ◽

Vol 216 (1) ◽

pp. S452-S453

Author(s):

Erin Krizman ◽

Patricia Grzebielski ◽

Emmanuel Sampene ◽

Matthew Shanahan ◽

Jesus Iruretagoyena ◽

...

Keyword(s):

Cesarean Delivery ◽

Vaginal Delivery ◽

Trial Of Labor ◽

Safe Option ◽

Operative Vaginal Delivery

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Operative Vaginal Delivery

10.2310/obg.19024 ◽

2018 ◽

Author(s):

Sarah T Cigna ◽

Jennifer Mendillo Keller ◽

Nancy Gaba

Keyword(s):

Informed Consent ◽

Cesarean Delivery ◽

Vaginal Delivery ◽

Informed Consent Process ◽

Candidate Selection ◽

Consent Process ◽

Operative Delivery ◽

Operative Vaginal Delivery ◽

History Of ◽

Practice Skills

The history of operative vaginal delivery dates back to 1500 B.C. In modern practice, the use of obstetrical forceps to achieve a vaginal delivery has been steadily declining. However, there has been a movement to revive this skill as a means for avoiding a cesarean delivery. Although the use of forceps and vacuum devices to assist in vaginal delivery can be extremely helpful in expediting delivery in emergency and other indicated situations, there are potentially serious complications for both the mother and fetus that must be addressed during the informed consent process. The operator must also be well versed in forceps and vacuum technique to prevent these complications from occurring. This involves training during residency and afterward to teach and practice skills. Appropriate candidate selection and proper technique for forceps and vacuum deliveries are crucial for optimizing safety for the patients while providing an alternative to a cesarean delivery. This review contains 12 figures, 5 tables and 34 references Keywords: forceps, vacuum, operative delivery, history of, complications, technique, tutorial

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