EFFECT OF EPIDURAL ANALGESIA ON LABOR AND ITS OUTCOMES
Abstract
Background: Epidural analgesia is an effective and popular way to relieve labour pain but it may interfere with normal mechanism of labour. The objective of this study was to evaluate the outcome of labour in women with effective epidural analgesia in terms of duration of labour, mode of delivery and neonatal outcome. Methods: This was a quasi-experimental study conducted in the Department of Obstetrics and Gynaecology, Shaikh Zayed Federal Postgraduate Medical Institute and Hospital, Lahore. One hundred pregnant women were selected by non-probability convenient sampling method. Subjects were divided into two groups of 50 each as per convenience. Patients of any gravidity at term from 37–41 weeks were included in the sample. Epidural analgesia was applied to group B and distilled water to group A at the lumber region and the progress of labour, mode of delivery and effects on Apgar scores of neonates were evaluated. Out of hundred patients, 77 had normal duration of second stage while 23 had prolonged second stage. Among them, 18 patients (36%) were in epidural group and 5 patients (10%) in non-epidural group, while 4 patients (8%) in epidural group developed intra-partum complications; whereas among non-epidural group had such complications. 65 patients had spontaneous vaginal delivery while 35 patients had instrumental delivery. Among them 29 patients (58%) were in epidural group while only 6 patients (12%) were in non-epidural group. Babies born had Apgar score 5/10 (21.8%), 6/10 (59.4%) and 7/10 (17.8%) at 1 minute and 8/10 (74.3%) and 9/10 (24.8%) at 5 minutes in both groups and none of them needed bag and mask resuscitation. Conclusion: Epidural analgesia does prolong the duration of second stage of labour and increases the instrumental delivery rate. Neonatal outcome is satisfactory while only a few intra-partum complications are found with epidural analgesia.Keywords: Epidural analgesia, forceps, labour, parturition, Apgar score, Neonatal outcomeReferences
Waldenstrom U, Irestedt L. Obstetric pain relief and its association with rememberence of labor pain at two months and one year after birth. J Psychosom Obstet Gynaecol 2006;27:147–56.
Lawrence C, Tsen. Central neuraxial, analgesia, and anesthesia in obstetrics. In: James DK, Steer PJ, Weiner CP, Gonik B, editors. High-risk pregnancy 3rd ed. India: Elsevier; 2006; p.1473-98.
Sadeque N. Critical procedure; technique of providing epidural analgesia. Professional Med J 2005;12(1):105–9.
Henderson JJ, Dickinson JE, Evans SF, McDonald SJ, Paech MJ. Impact of intrapartum epidural analgesia on breast feeding duration. Aust NZ J Obstet Gynaecol 2003;43:372–7.
Halpern SH, Leighton BL. Misconceptions about neuraxial analgesia. Anesthesiol Clin N Am 2003;21(1):59–70.
Gupta S, Kumar AGS, Singhal H. Acute pain- labour analgesia. Indian J Anaesth 2006;50:363–9.
Sukhera AS, Ahmed S. Neonatal outcome: a comparison between epidural and general anesthesia for cesarean sections. Professional Med J 2006(1);13:72–8.
Javed L, Salick A, Faruqi JN. Epidural analgesia in labor in relation to the rate of instrumental deliveries. Ann King Edward Med Coll 2005;11:307–10.
Kuczkowski KM. Labor pain and its management with the combined spinal-epidural analgesia:what does an obstetrician need to know? Arch Gynecol Obstet 2007;275:183–5.
Minhas RM, Kamal R, Afshan G, Raheel H. Knowledge, attitude and practice of parturients regarding epidural analgesia for labor in a university hospital in Karachi. J Pak Med Assoc 2005;55:63–6.
Volmanen P, Valanne J, Alahuhta S. Breast feeding problems after epidural analgesia for labour: a retrospective cohort study of pain, obstetrical procedures and breast feeding practices. Int J Obstet Anesth 2004;13:25–9.
Gee H. Poor progress in labor. In: James DK, Steer PJ, Weiner CP, Gonik B, editors. High-risk pregnancy. 3rd ed. India: Elsevier, 2006; p.1426-42.
Naz F, Saeed M. Epidural analgesia and labour mechanism. Mother & Child 1998; 13(4):132–5.
Thorp JA, Hu DH, Albin RM, McNitt J, Meyer BA, Cohen GR, et al. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gynecol 1993;169:851–8.
Jun Zhang, Klebanoff AM, Simonian DR. Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review. Am J Obstet Gynecol 1999;180:970–7.
Lyon DS, Kunckles G, Whiteaker E, Salgado S. The effect of instituting an elective labor epidural program on the operative delivery rate. Am J Obstet Gynecol 1997;90:135–41.
Parveen S, Zaidi H, Khakwani M. Epidural analgesia in labor. Professional Med J 2006;13:396–402.
Chen SH, Chiueh HY, Hung CT, Tsai SC, Wong SY. Extensive sensory block caused by accidental subdural catherization during epidural labor analgesia. Chang Gung Med J 2006;29:607–11
Moschini V, Marra G, Dabrowska D. Complications of epidural and combined spinal–epidural analgesia in labour. Minerva Anestesiol 2006;72:47–58.
Menez-Orieux C, Linet T, Philippe HJ, Boog G. Delayed versus immediate pushing in the second stage of labor for nulliparous parturient with epidural analgesia: a meta-analysis of randomized trial. J Gynecol Obstet Biol Reprod (Paris) 2005;34:440–7.
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