Impact of Epidural Analgesia on Labor: Length of Labor, Operative Vaginal Delivery Rate and Occiput Posterior

SummaryIntroduction.Epidural analgesia (EA) is widely used as labor analgesia. It has been reported that EA can slow down the course of labor and increase the risk of operative vaginal delivery. Slower course of labor can lead to an increased risk of abnormal fetal heart rate (FHR). Some studies have also demonstrated an increase in occiput posterior position of the fetal head at delivery if EA is used. It represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery.Aim of study. To evaluate the impact of EA on the length of labor and the rate of operative vaginal delivery, and to determine whether EA increases the rate of occiput posterior of the fetal head at deliveryMaterial and methods. We carried out a retrospective case-control study based on clinical records from parturients admitted to Riga Maternity Hospital in 2013. Parturients were divided into two groups: case group comprised parturients who had EA, while parturients of control group did not have EA. Groups were further subdivided into primiparas and multiparas and comparisons were made according to parity. We excluded parturients who had obstructed labor, pathological labor, induction of the labor, history of C-section and significant anomaly of the fetus.Results. A total of 832 parturients were included in the study, 304 in EA group (220 primiparas and 84 multiparas) and 528 in control group (257 primiparas and 271 multiparas). Primiparas of EA group had longer latent phase of the first stage of labor in comparison to primiparas of control group (p=0.001), while multiparas of EA group had longer first stage (p=0.031) of labor and longer latent phase of labor (p<0.001) than their respective controls. Vacuum extraction was used in 1.27% of all deliveries with EA. Moreover, vacuum extraction was used only in primiparas an there was no statistically significant difference between EA group primiparas and control group primiparas (1.7% vs. 1.2%, p=0.593). EA did not increase the rate of occiput posterior positon of fetal head. However, primiparas with EA and occiput posterior were more likely to have an abnormal FHR tracing in comparison to primiparas with EA and without occiput posterior position of fetal head (40% vs. 9.8%, p=0.029; RR=4.09, 95% CI 1.3-12.9). There was no statistically significant link between occiput posterior position and abnormal FHR tracing in control group primiparas.Conclusion. EA does not increase the likelihood of operative vaginal delivery. However, parturients with EA have longer latent phase of the first stage of labor. Risk for occiput posterior at delivery is not increased in labor with EA. However, the risk for abnormal FHR among primiparas who receive EA is increased in case of occiput posterior position of the fetal head.

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Operative vaginal delivery: outcomes for mothers and newborns

Journal of obstetrics and women s diseases ◽

10.17816/jowd69233-42 ◽

2020 ◽

Vol 69 (2) ◽

pp. 33-42

Author(s):

Margarita D. Leonova ◽

Natalia V. Aganezova ◽

Sergey S. Aganezov ◽

Elena V. Frederiks ◽

Yulia R. Dymarskaya

Keyword(s):

Blood Loss ◽

Vaginal Delivery ◽

Good Condition ◽

Injury Rate ◽

Control Group ◽

Vacuum Extraction ◽

Group Iii ◽

Operative Vaginal Delivery ◽

Group I ◽

Abdominal Delivery

Hypothesis/aims of study. The frequency of surgical abdominal delivery in Russia, as in the world, continues to grow, reaching 29.3% in 2017. Operative vaginal delivery is an alternative to abdominal delivery in the second stage of labor. This study was aimed at analyzing the outcome of labor for mothers and newborns using different operative vaginal delivery methods. Study design, materials and methods. We studied 293 cases of childbirth in the period from 2015 to 2018. Three groups were distinguished: (I) the main group consisting of 172 women delivered by the operation of applying obstetric forceps (OF); (II) the comparison group including 85 patients delivered by the operation of vacuum extraction (VE) with the fetal head being near the pelvic floor; and (III) the control group comprising 34 cases of vaginal birth without use of instrumental delivery. In group I, 114 patients were delivered by the low forceps operation (subgroup IA), and 60 individuals by the mid forceps operation (subgroup IB). Results. Vaginal lacerations were found in 21.3% of cases in group I, less often less often in groups II (10.6%, p 0.05) and III (2.9%, p 0.05). Vaginal hematoma occurred in one patient of group III (2.9%) and three women of group I (1.7%, p 0.05). There were no cases of damage to the anal sphincter. The greatest blood loss was recorded in subgroup IB (554 44.9 ml), when compared to subgroup IA (473 20.7 ml; p 0.05), group II (418 24.9 ml; p 0.05), and group III (347 33.4 ml; p 0.05). There were no differences in blood loss between the outlet OF and VE groups (p 0.05). Most newborns were born in good condition (84.5%, 77.6%, and 88.2% of cases in groups I, II, and III, respectively). Cephalohematoma in newborns was more common after VE (32.9%) than after OF (9.2%, p 0.01) and in control (5.9%, p 0.01). No retinal hemorrhage was recorded in newborns. There were no significant differences in the frequency of children being transferred to the childrens hospital (7.5%, 9.4%, and 8.8% of cases in groups I, II, and III, respectively; p 0.05). Conclusion. The use of OF is an effective and safe method of vaginal operative delivery. It does not increase the fetal injury rate, the frequency of newborn cephalohematoma being 3.5 times less than with VE. Complications of OF and VE (except for a greater number of vaginal lacerations in cases of OF), blood loss, and the course and duration of the postpartum stay in the maternity ward are comparable.

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Operative vaginal delivery in case of persistent occiput posterior position after manual rotation failure: a 6-month follow-up on pelvic floor function

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-018-4794-5 ◽

2018 ◽

Vol 298 (1) ◽

pp. 111-120 ◽

Cited By ~ 5

Author(s):

Paul Guerby ◽

Olivier Parant ◽

Elodie Chantalat ◽

Christophe Vayssiere ◽

Fabien Vidal

Keyword(s):

Pelvic Floor ◽

Vaginal Delivery ◽

Pelvic Floor Function ◽

Operative Vaginal Delivery ◽

Floor Function ◽

Occiput Posterior Position ◽

Manual Rotation ◽

Posterior Position

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Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position

Journal of Perinatology ◽

10.1038/jp.2014.103 ◽

2014 ◽

Vol 34 (12) ◽

pp. 898-900 ◽

Cited By ~ 14

Author(s):

E Hirsch ◽

R Elue ◽

A Wagner ◽

K Nelson ◽

R K Silver ◽

...

Keyword(s):

Vaginal Delivery ◽

Perineal Laceration ◽

Operative Vaginal Delivery ◽

Occiput Posterior Position ◽

The Impact ◽

Posterior Position

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EFFECT OF HYPNOBIRTHING ON THE PROGRESS OF THE LATENT PHASE OF LABOR IN PRIMIGRAVIDA

Belitung Nursing Journal ◽

10.33546/bnj.360 ◽

2018 ◽

Vol 4 (2) ◽

pp. 219-225

Author(s):

Wiwik Mudihayati ◽

Syarif Thaufik Hidayat ◽

Nur Khafidhoh ◽

Ari Suwondo

Keyword(s):

Uterine Contraction ◽

Cervical Dilatation ◽

Control Group ◽

Fetal Head ◽

Control Group Design ◽

Significant Difference ◽

Speed Up ◽

And Control ◽

Latent Phase ◽

First Stage Of Labor

Background: The first stage of labor is a tiring moment for mothers, which may cause exhaustion, dehydration, risk of infection, uterine atony, and postpartum hemorrhage. Hypnobirthing is considered effective to speed up early labor process. Objective: This study aimed to examine the effect of hypnobirthing on the progress of the latent phase of labor.Methods: This study was a quasi experiment with posttest only control group design. Thirty-two primigravida mothers in the latent phase of labor were selected using purposive sampling, with 16 assigned in the experiment and control group. The progress of labor was measured by four indicators recorded in partograph, namely frequency and duration of uterine contraction, cervical dilatation, and descent of the fetal head. Independent t-test was used for data analysis.Results: Result showed that there was a significant difference in the frequency of uterine contraction (p=0.001), duration of contraction (p=0.001), cervical dilatation (p=0.007), and descent of the fetal head (p=0.001) between the experiment group and control group.Conclusion: Hypnobirthing technique is significant in accelerating the progress of the latent phase of labor in primigravida mothers.

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