Author(s): Mehwish Ateeq*, Gul-e-Irum S, Sadia Aslam and Sulaiman Al Habib
Epidural analgesia is the most effective labour pain relief but is associated with increased rates of instrumental vaginal delivery/cesarean delivery. Epidural analgesia is associated with longer second-stage labor, more frequent oxytocin augmentation, hypotension, and maternal fever but not with longer first-stage labor. It is associated with improved patient satisfaction and better neonatal outcome as compared to other analgesia techniques.
Epidural analgesia is the most effective labour pain relief but is associated with increased rates of instrumental vaginal delivery/ cesarean delivery. Epidural analgesia is associated with longer second-stage labor, more frequent oxytocin augmentation, hypotension, and maternal fever but not with longer first-stage labor. It is associated with improved patient satisfaction and better neonatal outcome as compared to other analgesia techniques.
To assess the changes in labor time and delivery outcome in all pregnant women requesting epidural analgesia, who are presenting with either spontaneous or induced labour.
Descriptive Retrospective study- All pregnant patients presenting in labor room (LDR) with either spontaneous or induced labor in the last 6 months, undergoing epidural analgesia were included in the study.
Two hundered and fifty (250) pregnant women presented with spontaneous / induced labor in Sulaiman Al Habib Medical group, Olaya Branch in first 6 months of 2015 in LDR, who have received epidural analgesia were included in the study.
Two hundred and fifty (250) pregnant women presented with spontaneous / induced labor in Sulaiman al Habib Medical group Olaya Branch in first 6 months of 2015, who have received epidural analgesia, were included in the study. The impact of epidural analgesia on stages of labor, mode of delivery and neonatal outcome was assessed. Primary outcome measures of our study included number of pregnant women with spontaneous labor, number of pregnant women with induced labor, duration of second stage of labor and mode of delivery (NSVD, INSTRUMENTAL and LSCS). Secondary outcome measures included indication of operative delivery (INSTRUMENTAL, LSCS), previous medical or obstetric complications and presence of meconium and poor Apgar score.
The mean age of women was 26.50+ 5.17 (Standard deviation). Of the 250 women, 238 (95.2%) were booked while only few
12 (4.8%) were unbooked. 102(40.8%) were primiparous, 95
(38%) were multiparous and 53(21.2%) were grand multiparous.
Significantly more women presented in labor were primiparous. 174
(69.6%) women presented in spontaneous labor while 76(30.3%)
were induced due to obstetric / medical reasons. Among obstetric
/ medical indications of induction of labor majority 23 (30.2%)
were induced due to post dates while remaining were induced
due to oligohydramnios 9(11.8%), polyhydramnios 4 (5.3%),
Gestational diabetes 19 (25%) ,intrauterine growth restriction
IUGR 2 (2.6%) , PROM 6 (7.9%) , IUFD 2 (2.6%) , decreased
fetal movements 5 (6.6%) and Hypertension and pre eclampsia 6
(7.9%). Considering their medical or obstetric history 14 (5.6%)
women had history of previous 1 LSCS, 30 (12%) had history of
gestational diabetes, while 4 (1.6%) had history of pre ? eclampsia.
Regarding mode of delivery 141(56.4%) women achieved
spontaneous vaginal delivery, 40(16%) were delivered by
KIWI/ ventouse while cesarean section LSCS was performed
in 69(27.6%).
Prolonged labour was seen in 51 (20.4%) women. Among 69
cesarean section (27.6%) LSCS, 45 (65.2%) lscs were due to
failure to descent and fetal distress while 16 (23%) women had
LSCS due to failure to progress and fetal distress alone was seen in
8 (11.6%) cases. Regarding fetal outcome meconium stained liquor
and poor Apgar score of newborn was seen in 14 (5.6%) cases.
The use of Epidural analgesia is associated with prolonged second
stage and increase rate of operative delivery. In our study, high
percentage of women had operative delivery, either presented
with spontaneous or induced labour, prolonged labour, better
satisfaction and good neonatal outcome. In addition of epidural
analgesia, many other factors (primiparity, medical/obstetric
reasons, previous LSCS, induction of labor, patient wishes and
requests, impatience of doctors) also contribute in increasing the
rate of operative delivery. It also shows that epidural analgesia is
not associated with poor fetal outcome.
Consideration of appropriate counseling, good midwife care, one
to one intrapartum support and use of other analgesia techniques
could play a role in decreasing the rate of operative delivery.
| DATES | 23 | 30.2% |
|---|---|---|
| GESTATIONAL DIABETES | 19 | 25% |
| POLYHYDRAMNIOS | 4 | 5.3% |
| OLIGOHYDRAMNIOS | 9 | 11.8% |
| IUGR | 2 | 2.6% |
| IUFD | 2 | 2.6% |
| PROM | 6 | 7.9% |
| MEDICAL HISTORY (HTN) | 6 | 7.9% |
| DECREASED FETAL MOVEMENTS |
5 | 6.6% |
| FAILURE TO DESCEND + FETAL DISTRESS | 45 | 65.2% |
| FAILURE TO PROGRESS | 16 | 23% |
| FETAL DISTRESS | 8 | 11.6% |
| POOR MATERNAL EFFORT | 30 | 75% |
| FETAL DISTRESS | 10 | 25% |
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