Epidural analgesia and active management of labor: effects on length of labor and mode of delivery.
ABSTRACT To determine whether cervical dilatation at the time of placement of patient-requested epidural affects cesarean rates or lengths of labors in actively managed parturients.
The charts of 255 women randomized to active management of labor (n = 125) or control protocols (n = 130) were reviewed and stratified to early epidural placement (up to 4 cm cervical dilatation) versus late placement (more than 4 cm).
Women with early epidural placement had shorter labors than those with late placement (11.6 +/- 4.6 versus 13.2 +/- 5.6 hours; P = .02). Active management reduced the length of labor compared with controls regardless of epidural timing, with a reduction of 1.4 hours in early epidural placement (10.9 +/- 4.7 versus 12.3 +/- 4.3 hours; P = .04) and 3.6 hours in those with later placement (11.0 +/- 3.6 versus 14.6 +/- 6.2 hours; P = .004). Cesarean rates did not vary significantly (early 14.5% versus late 7.9%; P = .21). Early epidural placement did not lengthen the second stage of labor or increase operative vaginal delivery rates.
Early epidural placement did not affect lengths of labor or cesarean rates and was actually associated with shorter labor compared with late epidural placement. Women managed actively in labor, regardless of timing of epidural placement, had shorter labors than controls.
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ABSTRACT: Objective To develop a tool that enables the calculation of an intrapartum score and the categorisation of maternity units as either “high intrapartum intervention” or “lower intrapartum intervention”. The tool was developed as a basis for the comparison of the perception of intrapartum risk by midwives working in these maternity units. Method Three areas were included: 1) systematic reduction of the St Mary's Maternity Information System (SMMIS) data in order only to examine the variables of nulliparous Caucasian women suitable for exclusive midwifery care; 2) establishment and categorisation of the frequencies for the following practices: a) breech presentation, previous caesarean section, home birth; b) augmentation of labour, electronic fetal monitoring, epidural, delivery; 3) the sum of the intervention rates for each maternity units made up the final intrapartum score of each maternity unit. Results Intrapartum intervention rates varied considerably in the eleven maternity units under consideration. The intrapartum score enabled the categorisation of the eleven units into either “higher intrapartum intervention” or “lower intrapartum intervention” units. Conclusion Systematically collected data can be used to examine the practice of maternity units. This study suggests that the analysis of such data can provide a starting point for the audit and the comparison of the intrapartum interventions that women suitable for midwifery care undergo. Such studies could undertaken in other countries, including France.La Revue Sage-Femme 05/2006; 5(2):67-78.
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ABSTRACT: Antecedentes. La evaluación gráfica del parto fue descrito originalmente por Friedman, sin embargo, una descripción de la evolución del trabajo de parto con un manejo médico contemporáneo no ha sido completamente evaluado. Objetivo: Analizar el efecto de un manejo médico estandarizado del trabajo de parto, que incluye anestesia regional, rotura artificial de membranas y conducción ocitócica, sobre la fase activa del trabajo de parto en multíparas. Método. Análisis retrospectivo de 130 multíparas en trabajo de parto espontáneo, que ingresaron con 3 a 4 cm de dilatación. Resultados. Se observó una duración de la fase activa del trabajo de parto de aproximadamente 3,5 horas, con una progresión promedio de 1,5 cm/ h, produciéndose la mayor progresión entre los 7 y 9 cm de dilatación con 1,9 cm/h. La segunda fase del trabajo de parto presento una duración promedio de 28 minutos. Conclusiones. Nuestros resultados muestran que el manejo "médico estandarizado" del trabajo de parto no reduce los tiempos de la fase activa ni de la segunda fase en multíparas. Creemos que es necesario implementar estudios randomizados para determinar la influencia de este tipo manejo del trabajo de parto en la incidencia de cesáreas.Revista Chilena de Obstetricia y Ginecologia 01/2007; 72(3).
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ABSTRACT: Labor pain is probably the most painful event in a woman's life. By the present consensus, epidural analgesia is the most effective and least depressive treatment for labor pain. Recent systematic reviews concluded that the risk of cesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia has not increased. However, studies designed for discussing this topic in Taiwan are few. In this study, the association of the intervention timing with labor outcomes in nulliparous women in Taiwan is discussed. We performed a retrospective chart review in parturients who underwent epidural analgesia for labor pain. Only nulliparae were included and divided into four groups based on the cervical dilatation width of 1, 2, 3, and 4 cm when they underwent epidural analgesia. We retrieved each patient's demographic characteristics, the course of labor and delivery, and the management of epidural analgesia from the medical chart. A total of 799 nulliparae was included. The numbers of parturients with cervical dilatation width of 1, 2, 3, and 4 cm were 119, 338, 258, and 84 respectively. There was no significant difference in demographic factors, regimen of epidural analgesia, loading volume, and anesthesiologist in charge among the four groups. The percentages of cesarean delivery in the four groups were 27.73%, 20.71%, 15.89%, and 20.24%, respectively, and there was no significant difference among these four groups (p = 0.0651). The incidences of instrumental delivery in four groups were 13.51%, 14.59%, 18.65%, and 21.43% respectively, and there was no significant difference among these four groups either (p = 0.2278). Our results revealed that the timing of epidural intervention affects neither the cesarean delivery rate nor the instrumental delivery rate on nulliparae in Taiwan with the cervical dilatation width ranging from 1 cm to 4 cm. The fear of increasing cesarean section rate after early epidural analgesia is unfounded. Women in labor can choose pain relief at any time.Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists. 09/2013; 51(3):112-5.