Why the study?
Does continuous infusion epidural analgesia throughout delivery improve pain relief or affect delivery outcomes in nulliparous women?
Does continuous infusion epidural analgesia throughout delivery improve pain relief or affect delivery outcomes in nulliparous women?
Continuing epidural analgesia throughout the second stage of labor provides effective pain relief without increasing the rate of instrumental vaginal delivery or prolonging the second stage.
Answers are grounded in this paper and cite their sources.
Continuous epidural was associated with high pain-relief rates without prolonging labor or raising instrumental deliveries; leaves open whether RCTs would alter practice.
Two groups of nulliparous women with fetuses in singleton vertex presentation received continuous infusion epidural analgesia (EDA) with bupivacaine: group A (90 parturients) without infusion analgesia in the second stage of labor and group B (90 parturients) with infusion analgesia throughout delivery. The groups were compared regarding pain relief, duration of the second stage, persistent malrotation of the fetal head, and rate of instrumental vaginal delivery. The continuous infusion EDA gave satisfactory pain relief in 93.3% of the parturients in group A and 97.8% in group B. The duration of second stage was the same in both groups. There were more persistent mal-rotations of the fetal head in group A, but the malrotation did not affect the mode of deli: very. The rate of instrumental vaginal delivery was 25.5% in both groups. The main cause of operative intervention was delay in the second stage. When the continuous infusion technique is used, it seems unreasonable to discontinue the EDA and thereby deprive the parturient of analgesia during the second stage.
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Johnsrud et al. (1988) studied this question.
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