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Grand Rounds

Does Epidural Anesthesia Impact the Second Stage of Labor?

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BACKGROUND AND PURPOSE:

  • Modern use of low concentration epidural anesthesia generally does not induce motor block or necessarily impair pushing or walking
  • Shen et al. (Obstet Gynecol, 2017) evaluated the impact of continuing epidural infusion during the 2nd stage of labor

METHODS:

  • Prospective, double blind, randomized, placebo-controlled trial
  • Inclusion criteria
    • Healthy nulliparous women ≥ 37 weeks
    • Presented in spontaneous labor and requested an epidural
    • Cephalic singleton pregnancies
  • Patients were at < 6cm dilation at time of epidural request and did not receive oral or IV analgesia
  • All patients received epidural analgesia for the 1st stage of labor using
    • initial bolus 8–10 mL of 0.08% ropivacaine with sufentanil (0.4 micrograms/mL)
    • with patient-controlled epidural infusion of the same solution at 8mL/h
  • At full cervical dilation, women were randomized in to two arms
    • Blinded infusion of same ropivacain / sufentanil solution
    • Blinded infusion of placebo
  • The primary outcome was the duration of the second stage of labor
  • Secondary outcomes included
    • Patient perceived pain scores and satisfaction (on a scale of 11)
    • Maternal and fetal outcomes such as mode of delivery, use of episiotomy, fetal position at delivery, neonatal Apgar scores and cord gasses

RESULTS:

  • 400 patients were randomized
  • Using an intention- to- treat analysis, the duration of the second stage was similar between groups (epidural 52±27 minutes compared with saline 51±25 minutes, P=.52)
  • The spontaneous vaginal delivery rate was also similar (epidural 193 [96.5%] compared with saline 198 [99%], P=.17)
  • Pain scores were similar between groups
  • More women who received placebo reported satisfaction scores of 8 or less (epidural 32 [16%] compared with saline 61 [30.5%], P=.001)
  • There was no statistical difference in maternal and neonatal outcomes

CONCLUSION:

  • Maintaining the infusion of epidural medication into the second stage of labor does not impact length of the 2nd  stage of labor

Learn More – Primary Sources:

Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial.

 

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Decreasing Mortality in Cardiac Arrest During Pregnancy
Does Increased Hydration or Dextrose Reduce Prolonged Labor?
Risks Associated with C-Sections in the 2nd Stage of Labor

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