scholarly journals Labor epidural analgesia versus without labor epidural analgesia for multiparous women: a retrospective case control study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuzhi Luo ◽  
Zhaowen Chen ◽  
Xujian Wang ◽  
Changyu Zhu ◽  
Shili Su
Keyword(s):  
Blood Loss ◽  
Epidural Analgesia ◽  
Group Analysis ◽  
Labor Pain ◽  
Retrospective Case ◽  
Cervical Dilation ◽  
Apgar Scores ◽  
Significant Difference ◽  
Multiparous Women ◽  
Labor Epidural

Abstract Background Labor epidural analgesia (LEA) effectively relieves the labor pain, but it is still not available consistently for multiparous women in many institutions because of their obviously shortened labor length. Methods A total of 811 multiprous women were retrospective enrolled and firstly divided into two groups: LEA group or non-LEA group. And then they were divided into seven subgroups and analyzed according to the use of LEA and cervical dilation. The primary outcomes (time intervals, blood loss and Apgar scores) and secondary outcomes (maternal demographic characteristics and birth weight) were collected by checking electronic medical records. Results The prevalence of using LEA in multiprous women was 54.5 %. Using LEA significantly lengthened the duration of labor stage by 56 min (P < 0.001), increased the blood loss (P < 0.001) and lowered Apgar scores (P = 0.001). In the comparison of sub-group analysis, using LEA can obviously prolong the duration of first-second stage in women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.014), while there was no significant difference with 4 cm or more cervical dilation (P = 0.69). Using LEA can significantly increased the blood loss when the initiation of LEA in the women with 2 cm cervical dilation (P < 0.001) and 3 cm cervical dilation (P = 0.035), meanwhile there were no significantly differences in the women with 4 cm or more cervical dilation (P = 0.524). Using LEA can significantly lower the Apgar scores when the initiation of LEA in the women with 2 cm cervical dilation (P = 0.001) and 4 cm or more cervical dilation (P = 0.025), while there were no significantly differences in the women with 3 cm cervical dilation (P = 0.839). Conclusions Labor epidural analgesia for the multiparous woman may alter progress of labor, increase postpartum blood loss and lower Apgar scores. Early or late initiation of LEA should be defined as with cervical dilatation of less or more than 3 cm and the different effect should be understand. Trial registration ChiCTR2100042746. Registered 27 January 2021-Prospectively registered, http://www.chictr.org.cn.

scholarly journals Impact of Epidural Analgesia at Different Cervical Dilation on the Rate of Cesarean Delivery

2014 ◽  
Vol 7 (2) ◽  
pp. 153-166
Author(s):  
Xiaofeng Shen
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Labor Pain ◽  
High Rate ◽  
Care Hospital ◽  
Cervical Dilation ◽  
Maternal Characteristics ◽  
Nulliparous Women ◽  
Significant Difference

BACKGROUND: Epidural analgesia is the optimal means in controlling labor pain, whereas the correlation between epidural analgesia at different cervix dilation and corresponding risk of operative delivery remains unclear. OBJECTIVE: The aim of this study was to investigate the association between the epidural analgesia at different cervix and the rate of Cesarean in nulliparous women. METHODS: This is a perspective controlled trial conducted in a University affiliated tertiary women’s health care hospital. After approval by the Institutional Ethical Committee, 780 nulliparous women who underwent spontaneous vaginal delivery at term requesting labor analgesia were screened and 596 of them were assigned into interventions. Subjects were allocated into one of four groups received epidural analgesia initiated at different cervical dilation, i.e. from the onset of painful uterine contraction to the cervix 50.0 mm or greater. The primary outcome was the rate of Cesarean delivery. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery. RESULTS: Five hundred and thirty three subjects completed the study. Significant difference in the rate of Cesarean delivery was observed amongst the four groups (98.9% at cervix <= 10.0mm, 30.2% at cervix 11.0 – 30.0mm, 24.2% at cervix 31.0 – 50.0mm and 18.1% at cervix >= 51.0mm, P < 0.0001). The major reason led to high Cesarean rate at cervix <= 10.0 mm was poor labor progression (75.2%). No significant differences were expressed in variables of non-reassuring fetal status. CONCLUSIONS: Epidural analgesia should be avoided in controlling labor pain at the cervix below 10.0mm due to its influence on the progress of labor resulting in high rate of Cesarean. Maternal characteristics are additional aspects need to be concerned during epidural labor control in nulliparous women. TRIAL REGISTRATION: Epidural Analgesia in Different Cervix Diameter and the Rate of Cesarean Delivery (EACDRCD). ClinicalTrials.gov ID, NCT00677274. http://clinicaltrials.gov/ct2/show/NCT00677274.

scholarly journals Inflammatory and oxidative alterations of water immersion and epidural analgesia during the labor

2020 ◽  
Vol 7 (8) ◽  
pp. 598-602
Author(s):  
Ümit Yasemin Sert ◽  
Özlem Uzunlar ◽  
Nezaket Kadıoğlu ◽  
Tuba Candar ◽  
Yaprak Engin Üstün
Keyword(s):  
Epidural Analgesia ◽  
Water Immersion ◽  
Demographic Data ◽  
Total Serum ◽  
Control Group ◽  
Epidural Group ◽  
Birth Process ◽  
Apgar Scores ◽  
Significant Difference ◽  
And Control

Objective: Water immersion and epidural analgesia are both pain relief methods used to perceive less pain during the labor process. There are concerns about the maternal and fetal outcomes, although studies presented no significant complication directly related to these methods. We aimed to compare the IL-1 and 6 levels, Total serum oxidant (TOS), antioxidant (TAS) and catalase levels of births with epidural analgesia, water immersion and conventional birth without analgesia. Material and Methods: A total of 88 patients were included in the study (The water immersion group included 29 patients, while the epidural analgesia and control group included 30 and 29 patients respectively). Umblical cord IL-1, IL-6, catalase, TAS, TOS levels, neonatal Apgar scores, duration of birth process and demographic data were compared between three groups Results: There was no significant difference between the three groups in terms of age, Body mass index (BMI), gravidity, parity, gestational week, and birth weight (p>0.05). TOS and IL-6 levels were significantly lower in epidural group than others (p=0.031, p=0.019 respectively). Apgar scores were significantly lower in epidural group (p<0.001). Conclusion: The water immersion and epidural analgesia were found to have no adverse effect on oxidative status and infection parameters of women.

scholarly journals Sociodemographic Factors Associated with Request for Labor Epidural Analgesia in a Tertiary Obstetric Hospital in Vietnam

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Lam D. Nguyen ◽  
Anh D. Nguyen ◽  
Michaela K. Farber ◽  
Chi T. Phan ◽  
Luong T. Khuat ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Sociodemographic Factors ◽  
Cross Sectional Study ◽  
Educational Outreach ◽  
Cross Sectional ◽  
Factors Associated ◽  
Vaginal Deliveries ◽  
Multiparous Women ◽  
Education Levels ◽  
Labor Epidural

This study is aimed at examining the sociodemographic factors associated with the utilization of labor epidural analgesia at a large obstetric and gynecology hospital in Vietnam. This was a cross-sectional study of women who underwent vaginal delivery in September 2018 at the Hanoi Obstetrics and Gynecology Hospital. The utilization of epidural analgesia during labor was determined. Univariate and multivariate regression models were applied to evaluate the association between patient demographic and socioeconomic factors and request for labor epidural analgesia. A total of 417 women had vaginal deliveries during the study period. 207 women utilized epidural analgesia for pain relief during labor, and 210 did not. Parturients older than 35 years of age (OR 2.84, 95% CI 1.11-8.17), multiparous women (OR 2.8 95% CI 1.85-4.25), women living from an urban area, women with higher income (OR 6.47, 95% CI 2.59-19.23), and women with higher level of education were more likely to utilize labor epidurals. Factors related to a parturient request for epidural analgesia during labor at our tertiary obstetric hospital included age greater than 35 years, multiparity, and high income and education levels. Educational outreach to women about the benefits of epidural analgesia can target women who do not share these demographic characteristics.

Cesarean Delivery

2002 ◽  
Vol 96 (3) ◽  
pp. 546-551 ◽  
Author(s):  
Shiv K. Sharma ◽  
James M. Alexander ◽  
Gary Messick ◽  
Steven L. Bloom ◽  
Donald D. McIntire ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Epidural Analgesia ◽  
Labor Pain ◽  
Cesarean Deliveries ◽  
Nulliparous Women ◽  
Lower Pain ◽  
Intravenous Analgesia ◽  
Obstetric Management ◽  
Labor Epidural ◽  
To Receive

Background Controversy concerning increased cesarean births as a result of epidural analgesia for relief of labor pain has been attributed, in large part, to difficulties interpreting published studies because of design flaws. In this study, the authors compared epidural analgesia to intravenous meperidine analgesia using patient-controlled devices during labor to evaluate the effects of labor epidural analgesia, primarily on the rate of cesarean deliveries while minimizing limitations attributable to study design. Methods Four hundred fifty-nine nulliparous women in spontaneous labor at term were randomly assigned to receive either epidural analgesia or intravenous meperidine analgesia. Epidural analgesia was initiated with 0.25% bupivacaine and was maintained with 0.0625% bupivacaine and fentanyl 2 microg/ml at 6 ml/h with 5-ml bolus doses every 15 min as needed using a patient-controlled pump. Women in the intravenous analgesia group received 50 mg meperidine with 25 mg promethazine hydrochloride as an initial bolus, followed by 15 mg meperidine every 10 min as needed, using a patient-controlled pump. A written procedural manual that prescribed the intrapartum obstetric management was followed for each woman randomized in the study. Results A total of 226 women were randomized to receive epidural analgesia, and 233 women were randomized to receive intravenous meperidine analgesia. Protocol violations occurred in 8% (38 of 459) of women. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 7% [16 of 226; 95% confidence interval, 4-11%] vs. intravenous meperidine analgesia, 9% [20 of 233; 95% confidence interval, 5-13%]; P = 0.61). Significantly more women randomized to epidural analgesia had forceps deliveries compared with those randomized to meperidine analgesia (12% [26 of 226] vs. 3% [7 of 233]; P &lt; 0.001). Women who received epidural analgesia reported lower pain scores during labor and delivery compared with women who received intravenous meperidine analgesia. Conclusions Epidural analgesia compared with intravenous meperidine analgesia during labor does not increase cesarean deliveries in nulliparous women.

Effect of Labor Epidural Analgesia with and without Fentanyl on Infant Breast-feeding

2005 ◽  
Vol 103 (6) ◽  
pp. 1211-1217 ◽  
Author(s):  
Yaakov Beilin ◽  
Carol A. Bodian ◽  
Jane Weiser ◽  
Sabera Hossain ◽  
Ittamar Arnold ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Breast Feeding ◽  
Epidural Fentanyl ◽  
High Dose ◽  
Significant Difference ◽  
Labor Epidural ◽  
To Receive ◽  
Breast Fed ◽  
Fentanyl Group ◽  
Intermediate Dose

Background The influence of labor epidural fentanyl on the neonate is controversial. The purpose of this study was to determine whether epidural fentanyl has an impact on breast-feeding. Methods Women who previously breast-fed a child and who requested labor epidural analgesia were randomly assigned in a double-blinded manner to one of three groups: (1) no fentanyl group, (2) intermediate-dose fentanyl group (intent to administer between 1 and 150 microg epidural fentanyl), or (3) high-dose epidural fentanyl group (intent to administer &gt; 150 microg epidural fentanyl). On postpartum day 1, the mother and a lactation consultant separately assessed whether the infant was experiencing difficulty breast-feeding, and a pediatrician assessed infant neurobehavior. All women were contacted 6 weeks postpartum to determine whether they were still breast-feeding. Results Sixty women were randomly assigned to receive no fentanyl, 59 were randomly assigned to receive an intermediate dose, and 58 were randomly assigned to receive high-dose fentanyl. On postpartum day 1, women who were randomly assigned to receive high-dose fentanyl reported difficulty breast-feeding (n = 12, 21%) more often than women who were randomly assigned to receive an intermediate fentanyl dose (n = 6, 10%), or no fentanyl (n = 6, 10%), although this did not reach statistical significance (P = 0.09). There was also no significant difference among groups in breast-feeding difficulty based on the lactation consultant's evaluation (40% difficulty in each group; P = 1.0). Neurobehavior scores were lowest in the infants of women who were randomly assigned to receive more than 150 microg fentanyl (P = 0.03). At 6 weeks postpartum, more women who were randomly assigned to high-dose epidural fentanyl were not breast-feeding (n = 10, 17%) than women who were randomly assigned to receive either an intermediate fentanyl dose (n = 3, 5%) or no fentanyl (n = 1, 2%) (P = 0.005). Conclusions Among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than woman who were randomly assigned to receive less fentanyl or no fentanyl.

scholarly journals Effectiveness of Spinal Analgesia for Labor Pain Compared with Epidural Analgesia

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Javad Rahmati ◽  
Mohammadali Shahriari ◽  
Ali Shahriari ◽  
Masoomeh Nataj ◽  
Zeinab Shabani ◽  
...  
Keyword(s):  
Single Dose ◽  
Epidural Analgesia ◽  
Bolus Dose ◽  
Labor Pain ◽  
Efficient Technique ◽  
Spinal Analgesia ◽  
Maternal Satisfaction ◽  
Epidural Group ◽  
Significant Difference ◽  
Spinal Group

Objectives: This study aimed to compare the analgesic effect of single-dose spinal versus epidural analgesia for labor pain to verify if applying a single dose spinal analgesia is an efficient technique for labor pain management as an alternative for epidural analgesia. Methods: A total of 128 women in the active phase of labor were randomly allocated into two groups of spinal analgesia (n = 64) and epidural analgesia (n = 64). The latter received a bolus dose of 16 mL of 0.125% bupivacaine and 50 μg fentanyl and repeated 5 - 10 mL of bolus dose. The former received 2.5 mg hyperbaric bupivacaine plus 50μg fentanyl. Pain intensity was measured using the visual analog scale (VAS). The duration of analgesia, mode of delivery, the duration of labor, side effects, and maternal satisfaction were also compared. Results: There were no significant differences in the rate of cesarean section, duration of labor, postpartum hemorrhage, and the frequency of the fetal heart deceleration until 30 min after analgesia between the two groups. Measured pain after 30 (P = 0.0001) and 90 min (P = 0.01) was significantly lower in the spinal group than the epidural group. However, there was no significant difference between the spinal and epidural groups concerning the VAS scores at 150, 210, and 270 minutes. Maternal satisfaction was higher in the spinal group (P = 0.002). The mean duration of analgesia was longer in the spinal group than the epidural group (P = 0.0001). Conclusions: According to the findings, single-dose spinal analgesia, compared to epidural analgesia, is a safe, fast, and efficient technique for labor analgesia, which can be easily performed. In addition, it provides a high satisfaction level in the parturient.

scholarly journals Duration of the Third Stage of Labor and Estimated Blood Loss in Twin Vaginal Deliveries

2020 ◽  
Vol 10 (03) ◽  
pp. e330-e334
Author(s):  
Julie R. Whittington ◽  
Megan Pagan ◽  
Kristen Daugherty ◽  
Kelly Cummings ◽  
Songthip T. Ounpraseuth ◽  
...  
Keyword(s):  
Blood Loss ◽  
Twin Pregnancy ◽  
Retrospective Case ◽  
The Third ◽  
Third Stage Of Labor ◽  
Vaginal Deliveries ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Third Stage ◽  
History Of

Objective The main aim of this study was to characterize the duration of the third stage of labor and estimated blood loss in twin vaginal deliveries. Study Design This was a retrospective case–control study. The data was collected from deliveries at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, from January 2013 to June 2017. Women were identified who had twin gestation, were delivered vaginally, and whose maternal age was greater than 18 years old. Women were excluded if they had an intrauterine fetal demise, delivered either/both fetuses via cesarean, history of a previous cesarean or a fetus with a congenital anomaly. If a subject met criteria to be included in the study, the next normal singleton vaginal delivery was used as the control subject. Results There were 132 singleton vaginal deliveries and 133 twin vaginal deliveries analyzed. There was no significant difference in the length of the third stage of labor between twin and singleton vaginal deliveries except in the 95th percentile of the distribution. Mothers delivering twins had an increase in third-stage duration by 7.618 minutes (95% confidence interval [CI]: 0.73, 14.50; p = 0.03) compared with those who delivered singletons. The twin group had a higher estimated blood loss than singleton deliveries. The increase in blood loss in the twin group was 149.02 mL (95% CI: 100.2, 197.8), 257.01 mL (95% CI: 117.9, 396.1), and 381.53 mL (95% CI: 201.1, 562.1) at the 50th, 90th, and 95th percentiles, respectively. When the third stage of labor was at the 90th percentile or less in twin pregnancy (14 minutes), estimated blood loss was less than 1000 mL. Conclusion Twin pregnancy is a known risk factor for postpartum hemorrhage. As the duration of the third stage prolongs, the risk for hemorrhage also increases. We recommend delivery of the placenta in twin pregnancies by 15 minutes to reduce this risk. Key Points

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