The impact of epidural analgesia on the duration of the second stage of labor

Shmueli, Anat; Salman, Lina; Orbach‐Zinger, Sharon; Aviram, Amir; Hiersch, Liran; Chen, Rony; Gabbay‐Benziv, Rinat

doi:10.1111/birt.12355

Cited by 42 publications

(32 citation statements)

References 27 publications

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“…Oxytocin administration was also associated with decreased rate of normal vaginal delivery; in a previous study only 51.1% of parturients who received augmentation with oxytocin achieved a normal vaginal delivery compared with 76.5% of parturients who did not need augmentation (RR 0.67; CI 0.63‐0.71) 14 . Nulliparity has been shown to be a risk factor for an increased length of second stage of labor 15 . A recent study showed that a BMI of ≥‐30 increased risk of an intrapartum cesarean delivery by 77% 16 …”

Section: Discussionmentioning

confidence: 97%

“…Risk factors for having an operative delivery included: ECR, nulliparity, oxytocin, male neonatal sex, and maternal BMI > 35 kg/m 2 . These factors have been shown in previous studies to decrease the rate of normal vaginal delivery 13‐15 . Risk factors for ECR analysis included: BMI ≥ 35 kg/m 2 , nulliparity, cervical opening ≥ 3 cm, male neonatal sex, fetal weight > 3.5 kg and catheter depth over 5 cm.…”

Section: Methodsmentioning

confidence: 99%

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The relationship between resited epidural catheters after secondary epidural catheter failure and vaginal delivery: A retrospective case‐control study

Orbach‐Zinger

Eidelman

Wazwaz

et al. 2020

Acta Anaesthesiol Scand

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Background There are cases where epidural analgesia is initially effective but subsequently fails and needs to be resited. We evaluated the rate of normal vaginal delivery and operative delivery among parturients who had resited epidurals compared to parturients with epidurals that were not resited. Methods A retrospective electronic medical review of parturients with a singleton gestation attempting normal vaginal delivery under epidural analgesia between the years 2012‐2016 was conducted. Resited epidurals were defined as epidurals that were considered effective but subsequently removed and reinserted. For each resited epidural, two previous and two consecutive deliveries of parturients with normally functioning epidural catheter inserted by the same anesthesiologist were matched controls (non‐resited epidurals). Results There were 35,984 attempted vaginal deliveries with 118 resited epidurals and 472 non‐resited epidurals. When adjusted for nulliparity, oxytocin administration, sex and weight of the baby, and maternal BMI, labor epidural catheter replacement was not associated with need for instrumental or caesarean delivery, (OR 1.5, 95% CI 0.91‐2.49, P = .11). Conclusions Need for labor epidural catheter replacement does not appear to be associated with need for operative delivery based on this single‐centre cohort analysis.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

The relationship between resited epidural catheters after secondary epidural catheter failure and vaginal delivery: A retrospective case‐control study

Orbach‐Zinger

Eidelman

Wazwaz

et al. 2020

Acta Anaesthesiol Scand

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“…There is evidence that epidural analgesia will lengthen the second stage of labour. Shmueli et al 1 retrospectively demonstrated that the use of epidural analgesia extended the second stage of labour by 95 min (193 vs 98 min of the 95th percentile for epidural vs no epidural, respectively). Cheng et al 2 found that epidural analgesia was associated with more than a 2-hour (the difference of the 95th percentile threshold) prolongation of the second stage of labour for both nulliparous and multiparous women.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial

Zhou

et al. 2020

BMJ Open

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ObjectiveTo explore whether an ultrasound-guided pudendal nerve block (PNB) could decrease anaesthetic use, thereby shortening the length of the second stage of labour in women undergoing epidural analgesia.DesignProspective, single-centre, randomised, double-blind, controlled trial.SettingAn obstetric centre in a general hospital in China.Participants72 nulliparous women were randomised, and 71 women completed the study.InterventionAn ultrasound-guided bilateral PNB was administered to all study participants; the PNB group were given 0.25% ropivacaine 10 mL, while the control group were given 10 mL saline.Main outcome measureThe primary outcome measure was the duration of the second stage of labour. Secondary outcomes included additional bolus administration, total hourly bupivacaine consumption, difference in thickness between the contracted and relaxed rectus abdominis muscle before (DRAM1) and 30 min after (DRAM2) PNB, urge to defecate, maternal cooperation, preservation of the lower limb motor function, tightness of the perineum, and Numeric Rating Scale (NRS) score for pain.ResultsThe duration of the second stage of labour was shorter in the PNB group than in the control group (difference of 33.8 min (95% CI 15.6 to 52.0), p<0.001). Additional bolus administration and total hourly bupivacaine consumption were lower in the PNB group than in the control group (p<0.001). DRAM2 was greater (p<0.001), rate of parturient women with the urge to defecate was higher (p=0.014), maternal cooperation was superior (p=0.002), and lower limb motor function preservation was greater (p=0.004) in the PNB group relative to the control group. Tightness of the perineum was eliminated from the results due to the inconsistent application of the criteria by the nursing staff. There was no significant difference in NRS scores between the groups.ConclusionsNulliparous women with epidural analgesia who received an ultrasound-guided bilateral PNB may reduce their need for bupivacaine and consequently shorten the length of the second stage of labour, therein indicating that a bilateral PNB may serve as an additional effective adjunct method of labour analgesia.Trial registration numberChiCTR-IOR-16009121.

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“…Despite the clear benefit of pain reduction, management measures should not interfere with the normal birth process. The literature has become increasingly focused on the maternal and fetal effects of intrapartum analgesia 5 , 6 , 7 , although little is known still about the use of i. v. PCA with remifentanil in a German population 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Trotz des klaren Nutzens der Schmerzreduktion sollten steuernde Maßnahmen den physiologischen Ablauf der Geburt nicht beeinträchtigen. Die Literatur hat sich mit den maternalen und fetalen Auswirkungen der intrapartalen Analgesie zunehmend beschäftigt 5 , 6 , 7 , wobei zum Einsatz der i. v. PCA mit Remifentanil in einem deutschen Kollektiv bisher noch wenig bekannt ist 8 .…”

Section: Introductionunclassified

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

Ortiz

Hammerl

Wasmaier

et al. 2019

Geburtshilfe Frauenheilkd

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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.

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The impact of epidural analgesia on the duration of the second stage of labor

Abstract: Our findings suggest a significant prolongation of the second stage in women receiving epidural analgesia. Recommendations for management of second stage should be reconsidered by contemporary data.

Cited by 42 publications

References 27 publications

The relationship between resited epidural catheters after secondary epidural catheter failure and vaginal delivery: A retrospective case‐control study

The relationship between resited epidural catheters after secondary epidural catheter failure and vaginal delivery: A retrospective case‐control study

Ultrasound-guided bilateral pudendal nerve blocks of nulliparous women with epidural labour analgesia in the second stage of labour: a randomised, double-blind, controlled trial

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

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