The outcome of labour with epidural analgesia - a retrospective study
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Date
2001-05
Authors
Ahmad, Mas Adi
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
The objectives of this study are to determine the association between epidural
analgesia and the mode of delivery by SVD and non SVD ; to determine the effect of
epidural analgesia on the duration of the first and second stages of labour; and to
evaluate the influence of gravidity, oxytocin augmentation, previous scar and foetal
birth weight on the above effects and associations. A retrospective study was carried out in the Department of Obstetrics and
Gynaecology, Universiti Sains Malaysia, utilizing data of deliveries over a 16 month
period from February 1999 until May 2000. This comprises randomly selected patients
delivering without epidural analgesia within the first 8 months and all patients
delivering with epidural analgesia in the other 8 months of the study period. Inclusion
criteria are singleton pregnancy with cephalic presentation while exclusion criteria are multiple pregnancy, precipitate labour and patients with indications for elective
caesarean section.
Labour and delivery data were obtained from patients' case notes and analyzed
for associations and significance with Chi Square Test or T-Test. Statistical significance
was taken asP value of less than 0.05. Seventy five patients with epidural analgesia and 96 patients without epidural
analgesia have been analyzed in this study. Epidural analgesia was associated with a
significant ( p = 0.001 ) increase in non SVD. The Odds Ratio for a patient with
epidural analgesia delivering by non SVD was 4.05 as compared to a patient without
epidural analgesia. Patients' gravidity, oxytocin augmentation, presence of previous
scar and foetal birth weight did not alter this association but significance was only
demonstrated in non previous scar and patients with fetal weight of 3200 gm or less.
Epidural analgesia was associated with longer mean duration of the first stage of
labour compared to non epidural patients ( p = 0.003 ). This association was only
altered by oxytocin augmentation and presence of previous scar. Significance in the
associations were only demonstrated in patients with fetal weight of 3200 gm or less
and patients without previous scar. Epidural analgesia was associated with a longer mean duration of the second
stage ( p = 0.001 ). This association was not altered by the patients' gravidity, oxytocin
augmentation, presence of previous scar or the fetal birth weight. However,
significance was only demonstrated in multigravida, oxytocin-augmented patients, non
previous scar patients and both larger and smaller foetus (3200 gm or less and more
than 3200 gm ). Epidural analgesia significantly increased the risk of non SVD and increased the
mean duration of the first and second stages of labour. Only oxytocin augmentation and
presence of previous scar altered the association between epidural analgesia and a
longer mean duration of first stage of labour, while the other factors did not.
None of the evaluated factors, that is patients' gravidity, oxytocin augmentation,
previous scar and foetal birth weight altered the positive risk association between
epidural analgesia and non SVD; or the association between epidural analgesia and a
longer mean duration of the second stage.
Description
Keywords
Epidural analgesia