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Comparison of the expulsive efforts between labor epidural group and no-analgesia group and the effects of the expulsive efforts on women receiving epidural analgesia for labor and their neonates.A prospective observational study
Abstract Number: T210-219
Abstract Type: Original Research
Background: At our institution, labor epidural analgesia has been provided since 2005. For safe and smooth delivery under epidural analgesia, induction of effective voluntary maternal expulsive efforts is important. Anesthesiologists have been striving to recognize this benefit with midwives and obstetricians. However, midwives and obstetricians consider that dedication of women with epidural analgesia toward expulsive efforts is poor and induction of expulsive efforts is difficult. To date, no study has evaluated expulsive efforts and compared expulsive efforts between women with labor epidural and those without analgesia. Even the effects of expulsive efforts on parturients and neonates have not been studied. Therefore, we compared expulsive efforts between the labor epidural group and no-analgesia group and evaluated the effect of expulsive efforts on the parturient and the neonate.
Methods: Midwives in charge of delivery evaluated expulsive efforts in the labor epidural group and the non-analgesia group using a visual analogue scale (0 points: insufficient, 100 points: sufficient). The evaluation items were as follows: (1) parturients’ response to coaching on expulsive efforts (timing of expulsive efforts and how to apply force during expulsive efforts), and (2) eagerness of the parturients toward expulsive efforts. Evaluation scores of the expulsive efforts were compared between the two groups. We also analyzed correlations of the evaluation score of expulsive efforts with duration of labor, volume of blood loss during labor, umbilical artery pH (UApH), Apgar score, Edinburgh scores on days 2–4 postpartum, and type of breastfeeding.
Results: Sixty patients in the labor epidural group and 100 patients in the no-analgesia group were evaluated. Evaluation scores of the expulsive efforts were not significantly different between the two groups. Evaluation scores of expulsive efforts showed no correlation with the duration of labor, volume of blood loss during labor, UApH, the Apgar score, and the type of breastfeeding. However, the timing of expulsive efforts and Edinburgh scores showed a negative correlation (Spearman rank correlation coefficient: −0.188, p = 0.02). In multivariate analysis, the timing of expulsive efforts and eagerness scores were independent variables of the Edinburgh score.
Discussion: Evaluation scores of expulsive efforts in women who have labor epidural analgesia are not lower than those without analgesia. A negative correlation between the timing of expulsive efforts and Edinburgh scores indicates that anesthesiologists should pay more attention to parturients whose expulsive efforts are evaluated as insufficient, regardless of whether the delivery involves labor analgesia .