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Does “Troublesome” Labor Epidural Predict Failure to Progress Labor: A Retrospective Matched Cohort Study
Abstract Number: SAT-56
Abstract Type: Original Research
Background: Problematic labor analgesic processes pose challenge to anesthesiologists. We speculate that some of these problems indicate early signs of the need of cesarean delivery (CD) from failed labor progress. This is a retrospective pilot study aimed to compare the process of normal vaginal delivery (VD) with epidural labor analgesia to women who had cesarean delivery (CD) from failed labor progress.
Methods: Labor and Delivery data from July 2015 to December 2015, at the Brigham and Women’s Hospital was reviewed. One hundred primparous partuients’ medical records were selected randomly, half of which were those who successfully delivered vaginally and the other half were those who failed labor progress and delivered via CD. Patient demographic data, and some anesthesia related information were collected. Data points include: the interval time from labor analgesia to delivery versus to operating room, total number of anesthesia intervention, average interval of anesthesia interventions, total dosage of epidural analgesia, pain complaint, number of epidural top-ups and the counts of fatal heart rate (FHR) deceleration.
Results: Compared with the VD group, CD group carried longer interval time from epidural analgesia to delivery time (p<0.001), higher number of analgesia interventions (p<0.001), higher dose of epidural consumption (p<0.001), and higher number of epidural top-off demands (p=0.015). Multivariate analysis revealed that a high gestational age and long epidural analgesia time were strongly associated with higher possibility of CD.
Discussion: Zhang et al demonstrated that for nulliparous parturient the 95% percentile length of 1st stage labor starting from 4 cm cervical dilation was averaged at 4.2 hours. Cheng and other reported longer 2nd stage labor time of 336 minutes with labor epidural, which led to the ACOG’s consensus for safe prevention of the primary CD. However, these prolonged second stage labor were not trouble free. Our preliminary data revealed that while we are allowing the prolongation of 2nd stage labor, the labor epidural may have more “trouble” for the anesthesia team. We are further investigating the fetal ultrasound data, maternal size, the nursing and other care requirements data for the extended 2nd stage labor. We will report the complete data at the SOAP meeting.
1. Zhang J. Obstet Gynecol 2010;116:1281
2. Cheng YW. Obstet Gynecol 2014;123:527
3. ACOG Consensus No 1. Obstet Gynecol 2014;123:693