scholarly journals Study of effects of combined spinal epidural analgesia on the course of labour and feto maternal outcome in comparison with the parturients receiving no analgesia

2018 ◽  
Vol 7 (10) ◽  
pp. 3990
Author(s):  
Shoba Bembalgi ◽  
Basavaraj Kallapur ◽  
Prasad S. ◽  
Shruthi M. ◽  
Amit S. Amble
Keyword(s):  
Epidural Analgesia ◽  
Perinatal Outcome ◽  
Prospective Clinical Study ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Combined Spinal Epidural ◽  
Active Labour ◽  
Vaginal Deliveries ◽  
Labour Ward ◽  
Spinal Epidural

Background: The study was aimed to evaluate the effects of combined spinal epidural analgesia on the duration and outcome of labour in nulliparous parturients in comparison with parturients not receiving any analgesia.Methods: It is a prospective clinical study. The present study was carried out in the labour ward, KIMS Hubli. Nulliparous parturients in early active labour were divided into two groups.  CSE group (n=40) and non CSE group. In present study CSE was performed with intrathecal 1.25mg of levobupivacaine with   25mcg fentanyl initially and this was followed by epidural boluses of 10ml of 0.0625% Levobupivacaine with 2mcg/ml fentanyl through the epidural catheter whenever the patients’ pain score is more than 4.Results: Mean duration of active labour was 139+/-41.2min in CSE group and 251.1+/-57.9 min in non CSE group. The rate of cervical dilatation was 2.63+/-0.66cm/hr. in CSE group as compared to 1.45+/-0.38cm/hr in non CSE group. The duration of second stage of labour was similar in both groups. The spontaneous vaginal deliveries was77.5% in CSE group as compared to 79.5% in non CSE group. Assisted vaginal deliveries were 15% in combined spinal epidural analgesia group compared to 10.3% in non CSE group which was statistically insignificant. LSCS was 7.5% in control CSE group compared to 10.3% in non CSE group. Maternal satisfaction was excellent in majority of parturients in CSE group. The perinatal outcome was not affected in CSE group. The incidence of complications were very minimal in present study.Conclusions: Authors concluded that combined spinal epidural analgesia provides safe and excellent analgesia with no significant increase in the caesarean section and instrumental delivery rates. In addition, CSE decreases the duration of first stage of labour with no effect on perinatal outcome.

scholarly journals Obstetricians’ Knowledge and Attitudes toward Epidural Analgesia in Labour

1998 ◽  
Vol 26 (5) ◽  
pp. 563-567 ◽  
Author(s):  
N. M. Vandendriesen ◽  
W. Lim ◽  
M. J. Paech ◽  
C. Michaels
Keyword(s):  
Epidural Analgesia ◽  
Response Rate ◽  
Knowledge Score ◽  
Sources Of Information ◽  
Second Stage ◽  
Knowledge And Attitudes ◽  
Adequate Knowledge ◽  
Second Stage Of Labour ◽  
Active Labour ◽  
Level Of Knowledge

A survey of all registered obstetrician/gynaecologists in Western Australia (n = 79) was conducted to obtain information regarding their level of knowledge about epidural analgesia (EA) in labour and its complications, their sources of information about EA, and their opinions regarding its role in labour and effect on progress of labour. Response rate was 68%. Most respondents had only received lectures about EA after specialist training and 20% did not achieve an adequate knowledge score. Those of less than five years’ experience achieved significantly better scores. Over a third did not favour EA in labour until active labour was established, though 90% would recommend it by late first stage in those with a potentially complicated delivery. For women with cardiac or significant medical disease aggravated by labour, 18% would wait until the late first or second stage before suggesting EA. Seventy-seven per cent believed EA prolonged the second stage of labour, though opinion varied regarding EA effects on the duration and progress of first and third stages. Up to thirty minutes delay before epidural placement is acceptable to 87%. This survey suggests that there is both a demand and a need for greater education about EA in labour, particularly with respect to EA side-effects, complications and effects on labour, in the subgroup of obstetricians who have been in obstetric practice more than five years.

scholarly journals Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome

2019 ◽  
Vol 79 (04) ◽  
pp. 389-395
Author(s):  
Javier Ortiz ◽  
Thomas Hammerl ◽  
Maria Wasmaier ◽  
Valerie Wienerroither ◽  
Bernhard Haller ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Short Term ◽  
Second Stage ◽  
Second Stage Of Labour ◽  
Arterial Ph ◽  
Intravenous Analgesia ◽  
Analgesic Technique ◽  
Umbilical Arterial Ph

Abstract Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p < 0.001, respectively) and epidural analgesia (90 [92] vs. 44 [55] min, p = 0.004, and 22.5 [73] vs. 10 [11] min, p = 0.003, respectively) compared with the controls. The length of the pushing stage was similar among primiparas in all groups but prolonged compared with the controls in multiparas with patient-controlled intravenous analgesia with remifentanil (15 [17] vs. 5 [7] min, p = 0.001) and epidural analgesia (10 [15] vs. 5 [7] min, p = 0.006). The Apgar, umbilical arterial pH and base excess values were similar between the groups, as were the rates of acidosis and neonatal intensive care unit admission. Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.

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