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Epidural Analgesia During The Second Stage Of Labor And Obstetric Outcomes: A Randomized Controlled Trial
Abstract Number: SA-31
Abstract Type: Original Research
The effect of epidural analgesia on the second stage of labor remains controversial.(1) In clinical practice, the epidural infusion is sometimes reduced or turned off when second stage is prolonged.
The IRB (Clinical Research Ethics Committee) of Nanjing Maternity and Child Health Care Hospital, China, approved this randomized, double-blind trial with written informed consent. Inclusion criteria: Nulliparous parturient with a term, cephalic, singleton pregnancy, ASA 1 or 2, who requested epidural analgesia and achieved full cervical dilation. Exclusion criteria: prior use of opioids, induction of labor, cervical dilation ≥6cm at epidural request, delivery in 1 hour after epidural placement and cesarean delivery before full dilation.
Epidural analgesic solution (0.08% ropivacaine + 4 mcg/ml sufentanil) was infused at 8ml/hour with PCEA in the first stage of labor. At full dilation, parturients were randomized in a blinded fashion to: NORMAL SALINE (Control Group, n=200) or STANDARD EPIDURAL SOLUTION (Study Group, n=200), both infused at 8ml/hr. Physician- or self- bolus was allowed for breakthrough pain. 100-mm visual analog scale (VAS) assessed pain at 30’ intervals. Second stage duration, VAS-pain, satisfaction score (10-point scale), delivery mode, and neonatal outcomes were compared. p<0.05 was considered significant.
560 parturients were screened for eligibility, 160 had exclusion criteria. Demographic and obstetric factors were similar between groups. The duration of the second stage was similar (52±27 min in Study Group vs. 51±25 min in Control Group, p=0.52, Fig.1). VAS pain increased in Control Group and decreased in Study Group in the second stage(p=0.02 within groups), but were similar between groups (p=0.96 between groups). No difference in cesarean delivery (p=0.25) or forceps delivery rate (p=0.28). More women in Study Group had complete satisfaction (score ≥9: 84% vs. 70% in Control Group, p=0.001). No significant differences between groups in Apgar scores or umbilical cord blood values (p=NS for all).
Continuing epidural analgesia in the second stage had no effect on the duration of second stage, the incidence of cesarean or instrumental delivery, or neonatal outcomes. Maternal satisfaction was improved with continuation of medication (Registration identifier: ChiCTR-IOR-15005875).
(1). Obstet Gynecol 2014; 123:527-535