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Delayed pushing with lumbar epidural analgesia in labour
British Journal of Obstetrics and Gynaecology
|July 1, 1983
Summary
Delaying pushing in the second stage of labor with epidural analgesia increased spontaneous deliveries and decreased operative vaginal births. This suggests a need to redefine labor management protocols for epidural analgesia.
Area of Science:
- Obstetrics
- Anesthesiology
- Perinatology
Background:
- Epidural analgesia is commonly used during labor.
- Management of the second stage of labor with epidural analgesia can influence delivery outcomes.
Purpose of the Study:
- To investigate the impact of delayed pushing on delivery outcomes in primigravidae receiving epidural analgesia.
- To compare spontaneous and operative vaginal delivery rates between delayed and conventional pushing groups.
Main Methods:
- Randomized controlled trial involving 76 primigravidae with epidural analgesia.
- Two groups: delayed pushing and conventional management in the second stage of labor.
- Maternal and infant characteristics, fetal scalp blood pH, and delivery modes were assessed.
Main Results:
- Mean waiting time before pushing increased from 27 to 123 minutes in the delayed group.
- No increase in abnormal fetal heart rate, decreased umbilical cord pH, or lower Apgar scores.
- Delayed pushing was associated with a trend towards increased spontaneous deliveries (P = 0.06).
- Delayed pushing was associated with a trend towards decreased forceps deliveries (P = 0.06).
Conclusions:
- Delaying pushing in the second stage of labor with epidural analgesia is not associated with adverse fetal outcomes.
- Delayed pushing may increase spontaneous delivery rates and decrease the need for operative vaginal delivery.
- Findings suggest a potential need to redefine the management of the second stage of labor for women receiving epidural analgesia.