Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome

Abstract

Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p < 0.001, respectively) and epidural analgesia (90 [92] vs. 44 [55] min, p = 0.004, and 22.5 [73] vs. 10 [11] min, p = 0.003, respectively) compared with the controls. The length of the pushing stage was similar among primiparas in all groups but prolonged compared with the controls in multiparas with patient-controlled intravenous analgesia with remifentanil (15 [17] vs. 5 [7] min, p = 0.001) and epidural analgesia (10 [15] vs. 5 [7] min, p = 0.006). The Apgar, umbilical arterial pH and base excess values were similar between the groups, as were the rates of acidosis and neonatal intensive care unit admission. Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.

Auswirkungen geburtshilflicher Analgesie mit systemischen Opioiden auf das Neugeborene – eine Übersichtsarbeit

“…Jedoch konnten andere Studien diese Beobachtungen nicht bestätigen: Mehrere Studien konnten keinen Unterschied zwischen Neugeborenen von Müttern nach geburtshilflicher Meptazinolo der Pethidintherapie bezüglich der APGAR-Werte, der Inzidenzen von Apnoen und der Notwendigkeit von atmungsunterstützenden Maßnahmen feststellen [24,27,29]. Nach aktueller Datenlage kann demnach keine klare Aussage zur Verwendung von Pethidin oder Mepatzinol getroffen werden.…”

“…Vier Studien untersuchten das Outcome von Neugeborenen deren Mütter 3 verschiedene Schmerztherapien unter der Geburt erhalten hatten: 1) Systemische Opioide 2) Epiduralanalgesie oder 3) keines der genannten Verfahren [30][31][32][33]…”

“…Zahlreiche Studien fanden jedoch wiederum keinerlei Unterschiede beim Vergleich von systemischer Analgesie mit Opioiden und PCA, periduraler Analgesie oder keiner Medikamentengabe [21,30,31,34] und stehen damit im Widerspruch zu den im vorherigen Abschnitt aufgeführten negativen Auswirkungen von systemischen Opioiden auf die Neugeborenen.…”

Comparison of the outcomes of normal vaginal delivery with and without spinal anesthesia in mothers admitted to the maternity ward of Firoozabadi Hospital

“…Therefore, pain management is a crucial matter that has been taken into consideration in recent deliveries and is getting more acceptable among pregnant women. [ 4 ] Labor pain causes worry and fear[ 5 6 ] and this may lead to a preference for cesarean section than vaginal delivery. [ 7 ] During the recent decades, a majority of cesarean sections were performed because of the fear of vaginal delivery pain.…”

“…[ 12 ] Although epidural anesthesia is the gold standard of anesthesia for delivery, there are some concerns about its side effects. [ 4 13 ] Recently, in epidural anesthesia, low-dose anesthetic drugs in combination with opioids were being used, which led to numbness of legs, but opioids could cross the placenta and make the fetus drowsy. [ 14 ]…”