Treatment of acute pain during labor and delivery is necessary to prevent chronic pain. Future studies should focus on the long-term effects of different analgesic regimens on the development of chronic pain after labor and delivery.

Introduction Doppler ultrasound cardiotocography is a non‐invasive alternative that, despite its poor specificity, is often first choice for intrapartum monitoring. Doppler ultrasound suffers from signal loss due to fetal movements and is negatively correlated with maternal body mass index (BMI). Reported accuracy of fetal heart rate monitoring by Doppler ultrasound varies between 10.6 and 14.3 bpm and reliability between 62.4% and 73%. The fetal scalp electrode (FSE) is considered the reference standard for fetal monitoring but can only be applied after membranes have ruptured with sufficient cervical dilatation and is sometimes contra‐indicated. A non‐invasive alternative that overcomes the shortcomings of Doppler ultrasound, providing reliable information on fetal heart rate, could be the answer. Non‐invasive fetal electrocardiography (NI‐fECG) uses a wireless electrode patch on the maternal abdomen to obtain both fetal and maternal heart rate signals as well as an electrohysterogram. We aimed to validate a wireless NI‐fECG device for intrapartum monitoring in term singleton pregnancies, by comparison with the FSE. Material and methods We performed a multicenter cross‐sectional observational study at labor wards of 6 hospitals located in the Netherlands, Belgium, and Spain. Laboring women with a healthy singleton fetus in cephalic presentation and gestational age between 36 and 42 weeks were included. Participants received an abdominal electrode patch and FSE after written informed consent. Accuracy, reliability, and success rate of fetal heart rate readings were determined, using FSE as reference standard. Analysis was performed for the total population and measurement period as well as separated by labor stage and BMI class (≤30 and >30 kg/m2). Results We included a total of 125 women. Simultaneous registrations with NI‐fECG and FSE were available in 103 women. Overall accuracy is −1.46 bpm and overall reliability 86.84%. Overall success rate of the NI‐fECG is around 90% for the total population as well as for both BMI subgroups. Success rate dropped to 63% during second stage of labor, similar results are found when looking at the separate BMI groups. Conclusions Performance measures of the NI‐fECG device are good in the overall group and the separate BMI groups. Compared with Doppler ultrasound performance measures from the literature, NI‐fECG is a more accurate alternative. Especially, when women have a higher BMI, NI‐fECG performs well, resembling FSE performance measures.

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Objective To assess the effect on mode of delivery of the routine use of labour epidural analgesia (EA) compared with analgesia on request.Design Randomised non-inferiority trial.Setting One university and one non-university teaching hospital in The Netherlands.Population Women with a singleton pregnancy in cephalic presentation beyond 36 + 0 weeks' gestation.Methods Participants were randomly allocated to receive either routine EA or analgesia on request. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed, with confidence intervals (CI) calculated for the differences in percentages or means.Main outcome measures Rate of operative delivery (instrumental vaginal or caesarean), labour characteristics, and adverse labour and neonatal outcomes.Results A total of 488 women were randomly allocated to the routine EA (n = 233) or analgesia on request group (n = 255).In the routine EA group, 89.3% (208/233) received EA. According to ITT analysis, 34.8% (81/233) women in the routine EA group had an operative delivery, compared with 26.7% (68/ 255) in the analgesia on request group (difference 8.1%, 95% CI À0.1 to 16.3). The difference in rate of operative deliveries according to the PP analysis was statistically significant (difference 8.9%, 95% CI 0.4 to 17.4). Inferiority of EA could not be rejected, as in both analyses the upper bound of the confidence interval exceeded the pre-specified inferiority criterion of +10%. Women in the routine EA group had more adverse effects, including hypotension (difference 9.5%, 95% CI 4.2 to 14.9), and motor blockade (difference 6.8%, 95% CI 1.1 to 12.5).Conclusion Non-inferiority of routine EA could not be demonstrated in this trial. Routine EA use is likely to lead to more operative deliveries and more maternal adverse effects. The results of our study do not justify routine use of EA.Keywords Caesarean section, epidural analgesia, instrumental vaginal delivery, labour analgesia analgesia, mode of delivery, operative delivery.Please cite this paper as: Wassen MMLH, Smits LJM, Scheepers HCJ, Marcus MAE, Van Neer J, Nijhuis JG, Roumen FJME. Routine labour epidural analgesia versus labour analgesia on request: a randomised non-inferiority trial. BJOG 2015;122:344-350.

Introduction and hypothesisThe aim of this study was to compare the number of temporary catheter replacements and urinary tract infections after indwelling catheterization for 2 versus 5 days following an anterior colporrhaphy.MethodsTwo hundred forty-six patients were randomly assigned to 2 or 5 days of indwelling catheterization. Outcome measures were temporary catheter replacements because of post-voiding residual >200 mL after removal of the indwelling catheter, urinary tract infections, and hospital stay. All patients were analyzed according to the intention to treat principle.ResultsCompared to the 5-day protocol group, in the 2-day protocol group more patients needed temporary catheter replacement (9% versus 28%, odds ratio (OR) 4.0, confidence interval (CI) 1.9–8.3, p < 0.01), whereas less patients had a urinary tract infection (37% versus 22%, OR 0.5, CI 0.3–0.9, p = 0.02) and median hospital stay was lower.ConclusionsRemoval of an indwelling catheter after 2 versus 5 days following anterior colporrhaphy is associated with more temporary catheter replacements, but less urinary tract infections and a shorter hospital stay.