[Epidural analgesia during labour: maternal, fetal and neonatal aspects]

The most effective technique for eliminating labour and childbirth pain is continuous lumbar epidural analgesia. The preoccupation regarding the possible negative effects on the time taken for labour and on dystocias in general represents one of the greatest hindrances in the way of its wider use. The purpose of the present study is to monitor the effects of continuous lumbar epidural analgesia on delivery times, on the state of the fetus, on the incidence of dystocic deliveries and on neonatal outcome.

Comparative prospective study. The data relating to the deliveries of 148 nulliparas and 51 pluriparas at term, submitted to epidural analgesia at the Obstetric Clinic of the University of Parma in 1999-2000 were compared with data from 144 nulliparas in labour and 60 pluriparas without epidural analgesia, selected in random fashion out of 4251 women who delivered children in the same period. The anesthetic procedure employed consisted in an injection of 20 mg/10 ml ropivacaine and 50 mg fentanyl in the epidural space at intervals of 1-2 h.

The duration of the dilatation period was not influenced by administration of epidural analgesia while the expulsion period was longer in the course of epidural analgesia. There were no significant differences between delivery modalities in the 2 groups either as regards vaginal operative delivery or the number of cesarean sections for dystocia. The cardiotocographic profile was similar in the 2 groups. The neonatal outcome (Apgar index at 1' and 5' and transfer to the intensive care department) did not show significant differences, confirming the absence of noteworthy side-effects even from the neonatal standpoint.

The use of low concentrations of ropivacaine (0.2%) associated with fentanyl in the epidural space proved to be a safe and effective technique for controlling labour and delivery pain.