Epidural Analgesia and Neonatal Morbidity: A Retrospective Cohort Study

(1) Background: Epidural analgesia (EA), at the present time, is one of the most effective methods to reduce labor pain. In recent years its use has increased, being used between 20–70% of all deliveries; (2) Methods: Historical cohort on a total of 2947 deliveries during the years 2012–2016 at the “Mancha-Centro Hospital” of Alcázar de San Juan. The main outcome variables were four neonatal morbidity (NM) criteria: umbilical artery pH of <7.10, Apgar score at 5 min < 7, need for advanced resuscitation and composite morbidity. We used the multivariate analysis to control confounding bias. (3) Results: No statistical relationship between EA and the second stage of labor duration with none of the four criteria of NM used (p > 0.005). However, the type of delivery was associated with three criteria (pH, resuscitation, and composite morbidity). The instrumental delivery presented an OR of pH < 7.10 of 2.68 95% CI [1.15, 6.27], an OR of advanced resuscitation of 2.44 95% CI [1.17, 5.08] and OR of composite morbidity of 2.86 95% CI [1.59, 5.12]; (4) Conclusions: The EA and the second stage of labor duration are not related to the NM. While the instrumental delivery doubles the risk of NM compared to the normal vaginal delivery.

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Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

Acta Médica Portuguesa ◽

10.20344/amp.5708 ◽

2015 ◽

Vol 28 (1) ◽

pp. 70 ◽

Cited By ~ 3

Author(s):

José Manuel Costa-Martins ◽

Cláudia Camila Dias ◽

Marco Pereira ◽

Jorge Tavares

Keyword(s):

Epidural Analgesia ◽

Prospective Study ◽

Local Anesthetic ◽

Low Dose ◽

Labor Pain ◽

Neuraxial Blockade ◽

Second Stage Of Labor ◽

Second Stage ◽

Group I ◽

Group Ii

Background: Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 μg.ml-1 sufentanil vs. 0.06% ropivacaine plus 0.5 μg.ml-1 sufentanil) on the intervals between boluses and the duration of labor. Material and Methods: In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 mg.ml-1 ropivacaine + 0.5 μg.ml-1 sufentanil) and Group II (n = 57; 0.6 mg.ml-1 ropivacaine + 0.5 μg.ml-1 sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded. Results: The ropivacaine dose was greater in Group I (9.5 [7.7-12.7] mg.h-1 vs. 6.1 [5.1-9.8 mg.h-1], p < 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p < 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI [-2.44; -0.36], p = 0.009). The duration of the second stage of labor in Group I was significantly longer than that in Group II (78 min vs. 65 min, p < 0.001). Conclusions: Parturients receiving 0.06% ropivacaine exhibited less evidence of cumulative effects and exhibited faster second stage progression than those who received 0.1% ropivacaine. Keywords: Analgesia, Obstetrical; Analgesia, Patient-Controlled; Labor Pain; Ropivacaine; Sufentanil.

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Faculty Opinions recommendation of A randomized control trial of bupivacaine and fentanyl versus fentanyl-only for epidural analgesia during the second stage of labor.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718888625.793502644 ◽

2014 ◽

Author(s):

Bernard Wittels

Keyword(s):

Epidural Analgesia ◽

Randomized Control Trial ◽

Second Stage Of Labor ◽

Second Stage ◽

Randomized Control

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Prolonged interpregnancy interval: how does it impact the length of second stage of labor?

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0171 ◽

2020 ◽

Vol 48 (8) ◽

pp. 811-818

Author(s):

Nicole B. Kurata ◽

Keith K. Ogasawara ◽

Kathryn L. Pedula ◽

William A. Goh

Keyword(s):

Perinatal Outcomes ◽

Kaiser Permanente ◽

Second Stage Of Labor ◽

Second Stage ◽

Labor Duration ◽

Nulliparous Women ◽

Multiparous Women ◽

Comparison Groups ◽

Maternal And Neonatal Outcomes ◽

Interpregnancy Intervals

AbstractObjectivesShort interpregnancy intervals (IPI) have been linked to multiple adverse maternal and neonatal outcomes, but less is known about prolonged IPI, including its relationship with labor progression. The objective of the study was to investigate whether prolonged IPIs are associated with longer second stages of labor.MethodsA perinatal database from Kaiser Permanente Hawaii was used to identify 442 women with a prolonged IPI ≥60 months. Four hundred forty two nulliparous and 442 multiparous women with an IPI 18–59 months were selected as comparison groups. The primary outcome was second stage of labor duration. Perinatal outcomes were compared between these groups.ResultsThe median (IQR) second stage of labor duration was 76 (38–141) min in nulliparous women, 15 (9–28) min in multiparous women, and 18 (10–38) min in women with a prolonged IPI (p<0.0001). Pairwise comparisons revealed significantly different second stage duration in the nulliparous group compared to both the multiparous and prolonged IPI groups, but no difference between the multiparous and prolonged IPI groups. There was a significant association with the length of the IPI; median duration 30 (12–61) min for IPI ≥120 months vs. 15 (9–27) min for IPI 18–59 months and 16 (9–31) min for IPI 60–119 months (p=0.0014).ConclusionsThe second stage of labor did not differ in women with a prolonged IPI compared to normal multiparous women. Women with an IPI ≥120 months had a significantly longer second stage vs. those with a shorter IPI. These findings provide a better understanding of labor progression in pregnancies with a prolonged IPI.

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A Prospective Randomized Trial of Postural Changes vs Passive Supine Lying during the Second Stage of Labor under Epidural Analgesia

Medical Sciences ◽

10.3390/medsci5010005 ◽

2017 ◽

Vol 5 (1) ◽

pp. 5 ◽

Cited By ~ 2

Author(s):

María Simarro ◽

José Espinosa ◽

Cecilia Salinas ◽

Ricardo Ojea ◽

Paloma Salvadores ◽

...

Keyword(s):

Epidural Analgesia ◽

Randomized Trial ◽

Prospective Randomized Trial ◽

Second Stage Of Labor ◽

Second Stage ◽

Postural Changes

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Exploring caesarean delivery in the second stage of labour at a tertiary care hospital: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213863 ◽

2021 ◽

Vol 10 (10) ◽

pp. 3929

Author(s):

Pravinkumar A. Jadav ◽

Palak M. Dabhi ◽

Dhruti A. Rathod

Keyword(s):

Retrospective Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Neonatal Morbidity ◽

Transfusion Rate ◽

Care Hospital ◽

Intraoperative Complication ◽

Second Stage Of Labor ◽

Second Stage ◽

Second Stage Of Labour

Background: Caesarean section (CS) performed in the second stage of labour has many implications for maternal and neonatal morbidity as well as for subsequent pregnancies. The objectives of this study were to determine the rates of CS at full dilatation, their indications, associated maternal and neonatal complications.Methods: This retrospective study assessed all the women with a singleton fetus in cephalic presentation at term (≥37 weeks) who underwent CS in the second stage of labor between 1 August 2019 and 31 March 2020 at a tertiary care hospital. Maternal demographics, labour and delivery details as well as neonatal outcomes were collected.Results: During the study period, 2124 (36%) babies were born by CS. Of these, 49 (2.3%) were performed in the second stage of labour at ≥37 weeks of gestation. The most common indication of CS was non-descent of head in 38 (77.55%) of cases. The majority of women 38 (77.55%) delivered by CS in the second stage of labor were primiparous. The 27 (55.10%) women were in the age group of 20-25 years. Most common intraoperative complication was blood-stained urine in 20 (40.81%) women. Overall transfusion rate was 18.36%. Maximum number of babies born 44 (89.79%) were having birth weight between 2.5-3.5 kg. Out of 65 babies born, 17 (34.69%) were admitted to neonatal intensive care unit.Conclusions: Formulation of an institutional protocol and training and supervision of trainees to improve the skill of operative vaginal delivery and second stage cesarean is needed.

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Labor Pain Pathophysiology and Analgesic Options

10.2310/pm.15077 ◽

2017 ◽

Author(s):

Ben Homra ◽

Alan D. Kaye ◽

Elyse Cornett ◽

Justin Creel ◽

Matthew B. Novitch ◽

...

Keyword(s):

The United States ◽

Labor Pain ◽

Epidural Fentanyl ◽

Patient Controlled Analgesia ◽

Second Stage Of Labor ◽

Second Stage ◽

Therapeutic Massage ◽

Recent Trends ◽

Key Words Epidural ◽

Exercise During Pregnancy

Regional neuraxial blocks, such as spinal and epidural anesthetics, are used for most women in the United States for labor pain. They are the most effective methods for preserving consciousness and the ability to participate in the second stage of labor. Regional neuraxial blocks may be augmented by combining spinal and epidural techniques, postlabor nonopioids and opioids, distraction therapy, and patient-controlled analgesia. In addition, several alternative analgesic methods have been recently recommended for labor pain without consensus on their respective efficacies, including yoga, exercise during pregnancy, acupuncture, hypnotism, hydrotherapy, and therapeutic massage. This review focuses on current updates and recent trends in labor pain management, the pathophysiology of labor pain, and the basic mechanisms supporting the efficacies of systemic, inhalation, neuraxial, and local analgesia during labor. Key words: epidural, fentanyl, labor pain, local anesthetic, spinal analgesia

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