[Interventions during labor for reducing instrumental deliveries].

Area of Science:

• Obstetrics and Gynecology
• Reproductive Medicine
• Clinical Interventions

Context:

• Instrumental vaginal deliveries are common obstetric interventions.
• Labor management strategies significantly influence delivery outcomes.
• Epidural analgesia is a widely used pain management technique during labor.

Purpose:

• To review evidence-based interventions for reducing operative vaginal deliveries.
• To analyze the impact of various labor management techniques on instrumental delivery rates.
• To guide clinical practice in optimizing labor and delivery outcomes.

Summary:

• Partograms and continuous labor support are associated with fewer instrumental deliveries (EL1).
• Early amniotomy should be avoided due to increased fetal heart rate abnormalities (EL2) without reducing instrumental deliveries (EL1).
• Early oxytocin for dysfunctional labor (EL2) and manual rotation (EL3) may decrease operative vaginal deliveries.
• Upright/lateral positions do not reduce instrumental deliveries (EL2).
• High-concentration epidural analgesia increases operative vaginal deliveries (EL1), potentially due to posterior presentations (EL2).
• Low-concentration epidural analgesia with lipophilic opioids reduces this effect (EL1).
• Delayed pushing in nulliparous women with epidural analgesia reduces difficult instrumental deliveries (EL1).
• Fundal pressure maneuvers are ineffective and dangerous (EL2, EL4) and should be prohibited.

Impact:

• Provides evidence-based recommendations for labor management to increase spontaneous vaginal births.
• Highlights the nuanced effects of epidural analgesia on instrumental delivery rates based on anesthetic type and concentration.
• Informs clinical decision-making to improve patient safety and reduce operative interventions during childbirth.