Key result
Extradural bupivacaine was associated with a significantly lower incidence of maternal desaturation during the second stage of labour (0.1 min/h) compared to no analgesia (3 min/h, p<0.05).
Why the study?
Does the type of analgesia influence the incidence of maternal hypoxaemia and neonatal outcomes during labour and delivery?
Cohort (n=51)
Does the type of analgesia influence the incidence of maternal hypoxaemia and neonatal outcomes during labour and delivery?
Absolute Event Rate: 0.1% vs 3%
p-value: p=<0.05
Extradural bupivacaine is associated with a lower incidence of maternal desaturation during labour compared to other analgesia methods or no analgesia, though maternal oxygenation did not correlate with neonatal outcomes.
May support extradural bupivacaine to limit maternal desaturation in labour; hypothesis-generating for neonatal outcomes and requires randomized confirmation.
The effect of analgesia on the incidence of hypoxaemia was assessed in an unrandomised trial in 51 parturients from the last hour of the first stage of labour until delivery. Women were retrospectively divided into four groups: no analgesia, pethidine with intermittent Entonox, extradural bupivacaine (either infusion of 0.125% or top-ups of 10 ml of 0.25%): and extradural infusion of 0.1% bupivacaine with 2 micrograms.ml-1 fentanyl. The lowest median incidence of desaturation (SpO2 < 94%) was in the extradural bupivacaine group: 0 min.h-1 in the last hour of the first stage and 0.1 min.h-1 in the second stage. The incidence was significantly lower than in the pethidine/Entonox group (1.4 min.h-1) in the last hour of the first stage (p < 0.001) and the extradural bupivacaine/fentanyl group (0.9 min.h-1) and no analgesia group (3 min.h-1) in the second stage (p < 0.05 in both cases). There was no correlation between maternal oxygenation during the second stage and measures of neonatal outcome including Apgar score and umbilical artery and vein blood gases.
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Griffin et al. (1995) conducted a cohort in Maternal hypoxaemia during labour and delivery (n=51). Extradural bupivacaine vs. No analgesia, pethidine/Entonox, or extradural bupivacaine/fentanyl was evaluated on Incidence of desaturation (SpO2 < 94%) in min.h-1 during the second stage of labour (p=<0.05). Extradural bupivacaine was associated with a significantly lower incidence of maternal desaturation during the second stage of labour (0.1 min/h) compared to no analgesia (3 min/h, p<0.05).