Skip to main content
SpringerLink
Log in

Effects of Patient-Controlled Epidural Analgesia on Uterine Electromyography During Spontaneous Onset of Labor in Term Nulliparous Women

  • Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

Objective

To investigate the effect of patient-controlled epidural analgesia (PCEA) on uterine electromyography (EMG) activity in term pregnant women during labor.

Methods

Nulliparous pregnant women in spontaneous term labor (N = 30) were enrolled (PCEA group, n = 20 and control group, n = 10). Five time periods (30 minutes each) were defined for noninvasive abdominal recordings and analysis of uterine EMG activity, that is, period I: before PCEA treatment with 2-cm cervical dilation; periods II to IV: each period successively at 30, 60, and 120 minutes after PCEA; and period V: second stage of labor with cervix at 10 cm dilation. Control patients without PCEA were monitored during the same times. The number of bursts/30 min, power density spectrum peak frequency, mean amplitude, and duration of uterine EMG bursts were measured to assess uterine EMG activity. Maternal, fetal, and labor characteristics were also recorded. Data were analyzed by analysis of variance followed by other tests.

Results

Electromyography parameters are significantly lower (P < .001) after PCEA (periods II to IV) compared to controls but similar between groups by period V (P > .05). Also, patients with PCEA have a slower rate of cervical dilation (P < .003, period IV only) and longer labor in both stage 1 and stage 2 (P < .05). All patients have similar (P > .05) positive labor outcomes.

Conclusions

Patient-controlled epidural analgesia initially suppresses uterine EMG and slows cervical dilation thereby prolonging labor. However, the EMG activity recovers with labor progress with no effects on delivery outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Garfield RE, Saade G, Buhimschi C, et al. Control and assessment of the uterus and cervix during pregnancy and labour. Hum Reprod Update. 1998;4(5):673–695.

    CAS  PubMed  Google Scholar 

  2. Kawarabayashi T, Kishikawa T, Sugimori H. Effect of oxytocin on spontaneous electrical and mechanical activities in pregnant human myometrium. Am J Obstet Gynecol. 1986;155(3):671–676.

    CAS  PubMed  Google Scholar 

  3. Demianczuk N, Towell ME, Garfield RE. Myometrial electrophysiologic activity and gap junctions in the pregnant rat. Am J Obstet Gynecol. 1984;149(5):485–491.

    CAS  PubMed  Google Scholar 

  4. Ekman-Ordeberg G, Stjernholm Y, Wang H, Stygar D, Sahlin L. Endocrine regulation of cervical ripening in humans—potential roles for gonadal steroids and insulin-like growth factor-I. Steroids. 2003;68(10–13):837–847.

    CAS  PubMed  Google Scholar 

  5. Word RA, Li XH, Hnat M, Carrick K. Dynamics of cervical remodeling during pregnancy and parturition: mechanisms and current concepts. Semin Reprod Med. 2007;25(1):69–79.

    CAS  PubMed  Google Scholar 

  6. Euliano TY, Marossero D, Nguyen MT, Euliano NR, Principe J, Edwards RK. Spatiotemporal electrohysterography patterns in normal and arrested labor. Am J Obstet Gynecol. 2009;200(1):54.e1–e7.

    Google Scholar 

  7. Maner WL, Garfield RE. Identification of human term and preterm labor using artificial neural networks on uterine electromyography data. Ann Biomed Eng. 2007;35(3):465–473.

    PubMed  Google Scholar 

  8. Eswaran H, Preissl H, Wilson JD, Murphy P, Lowery CL. Prediction of labor in term and preterm pregnancies using non-invasive magnetomyographic recordings of uterine contractions. Am J Obstet Gynecol. 2004;190(6):1598–1602.

    PubMed  Google Scholar 

  9. Eswaran H, Preissl H, Wilson JD, Murphy P, Robinson SE, Lowery CL. First magnetomyographic recordings of uterine activity with spatial-temporal information with a 151-channel sensor array. Am J Obstet Gynecol. 2002;187(1):145–151.

    PubMed  Google Scholar 

  10. Schlembach D, Maner WL, Garfield RE, Maul H. Monitoring the progress of pregnancy and labor using electromyography. Eur J Obstet Gynecol Reprod Biol. 2009;144(suppl 1):S33–S39.

    PubMed  Google Scholar 

  11. Garfield RE, Maner WL, MacKay LB, Schlembach D, Saade GR. Comparing uterine electromyography activity of antepartum patients versus term labor patients. Am J Obstet Gynecol. 2005; 193(1):23–29.

    PubMed  Google Scholar 

  12. Leman H, Marque C, Gondry J. Use of the electrohysterogram signal for characterization of contractions during pregnancy. IEEE Trans Biomed Eng. 1999;46(10):1222–1229.

    CAS  PubMed  Google Scholar 

  13. Garfield RE, Maner WL, Maul H, Saade GR. Use of uterine EMG and cervical LIF in monitoring pregnant patients. BJOG. 2005; 112(suppl 1):103–108.

    PubMed  Google Scholar 

  14. Euliano TY, Nguyen MT, Darmanjian S, et al. Monitoring uterine activity during labor: a comparison of 3 methods. Am J Obstet Gynecol. 2013;208(1):66.e1–e6.

    Google Scholar 

  15. Lavand’homme P. Chronic pain after vaginal and cesarean delivery: a reality questioning our daily practice of obstetric anesthesia. Int J Obstet Anesth. 2010;19(1):1–2.

    PubMed  Google Scholar 

  16. Alexander JM, Lucas MJ, Ramin SM, McIntire DD, Leveno KJ. The course of labor with and without epidural analgesia. Am J Obstet Gynecol. 1998;178(3):516–520.

    CAS  PubMed  Google Scholar 

  17. Haydon ML, Larson D, Reed E, Shrivastava VK, Preslicka CW, Nageotte MP. Obstetric outcomes and maternal satisfaction in nulliparous women using patient-controlled epidural analgesia. Am J Obstet Gynecol. 2011;205(3):271.e1–e6.

    Google Scholar 

  18. Clark A, Carr D, Loyd G, Cook V, Spinnato J. The influence of epidural analgesia on cesarean delivery rates: a randomized, prospective clinical trial. Am J Obstet Gynecol. 1998;179(6 pt1):1527–1533.

    CAS  PubMed  Google Scholar 

  19. Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002;186(5 suppl nature):S69–S77.

    CAS  PubMed  Google Scholar 

  20. Gerli S, Favilli, Acanfora MM, Bini V, Giorgini C, Di Renzo GC. Effect of epidural analgesia on labor and delivery: a retrospective study. J Maternal Fetal Neonatal Med. 2011;24(3):458–460.

    Google Scholar 

  21. Willdeck-Lund G, Lindmark G, Nilsson BA. Effect of segmental epidural analgesia upon the uterine activity with special reference to the use of different local anaesthetic agents. Acta Anaesth Scand. 1979;23(6):519–528.

    CAS  PubMed  Google Scholar 

  22. McCaughey HS Jr,Corey EL, Eastwood D, Thornton WN. Effects of synthetic anesthetics on the spontaneous motility of human uterine muscles in vitro. Obstet Gynecol. 1962;19(3):233–240.

    Google Scholar 

  23. Carsten ME, Miller JD. A new look at uterine muscle contraction. Am J Obstet Gynecol. 1987;157(5):1303–1315.

    CAS  PubMed  Google Scholar 

  24. Wong CA, Scavone BM, Peaceman AM, et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Engl J Med. 2005;352(7):655–665.

    CAS  PubMed  Google Scholar 

  25. Lucovnik M, Kuon RJ, Chambliss LR, et al. Use of uterine electromyography to diagnose term and preterm labor. Acta Obstet Gynecol Scand. 2011;90(2):150–157.

    PubMed  Google Scholar 

  26. Garfield RE, Maner WL. Physiology and electrical activity of uterine contractions. Semin Cell Dev Biol. 2007;18(3):289–295.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Garfield RE, Saade G, Buhimschi C, et al. Control and assessment of the uterus and cervix during pregnancy and labour. Hum Reprod Update. 1998;4(5):673–695.

    CAS  PubMed  Google Scholar 

  28. Vasak B, Graatsma EM, Hekman-Drost E, et al. Uterine electromyography for identification of first-stage labor arrest in term nulliparous women with spontaneous onset of labor. Am J Obstet Gynecol. 2013;209(3):232.e1–e8.

    Google Scholar 

  29. Hassan M, Terrien J, Muszynski C, Alexandersson A, Marque C, Karlsson B. Better pregnancy monitoring using nonlinear correlation analysis of external uterine electromyography. IEEE Trans Biomed Eng. 2013;60(4):1160–1166.

    PubMed  Google Scholar 

  30. Haran G, Elbaz M, Fejgin MD, Biron-Shental T. A comparison of surface acquired uterine electromyography and intrauterine pressure catheter to assess uterine activity. Am J Obstet Gynecol. 2012;206(5):412.e1–e5.

    Google Scholar 

  31. Cheek TG, Samuels P, Miller F, Tobin M, Gutsche BB. Normal saline i.v. fluid load decreases uterine activity in active labour. Br J Anaesth. 1996;77(5):632–635.

    CAS  PubMed  Google Scholar 

  32. Behrens O, Goeschen K, Luck HJ, Fuchs AR. Effects of lumbar epidural analgesia on prostaglandin F2 alpha release and oxytocin secretion during labor. Prostaglandins. 1993;45(3):285–296.

    CAS  PubMed  Google Scholar 

  33. Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002;186(5 suppl nature):S69–S77.

    CAS  PubMed  Google Scholar 

  34. Rahm VA, Hallgren A, Hogberg H, Hurtig I, Odlind V. Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Acta Obstet Gynecol Scand. 2002;81(11):1033–1039.

    PubMed  Google Scholar 

  35. Radev R. Uterine contractile activity in the postoperative period depending on the type of anesthesia. Akush Ginekol (Sofiia). 1990;29(4):26–30.

    CAS  Google Scholar 

  36. Lieberman E, Davidson K, Lee-Parritz A, Shearer E. Changes in fetal position during labor and their association with epidural analgesia. Obstet Gynecol. 2005;105(5 pt 1):974–982.

    PubMed  Google Scholar 

  37. Fraser WD, Marcoux S, Krauss I, Douglas J, Goulet C, Boulvain M. Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group. Am J Obstet Gynecol. 2000;182:1165–1172.

    CAS  PubMed  Google Scholar 

  38. Roberts CL, Torvaldsen S, Cameron CA, Olive E. Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis. BJOG. 2004;111(12):1333–1340.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics, Preterm Birth Prevention and Treatment Research Unit, Guangzhou Women & Children’s Medical Center, Guangzhou Medical University, 9 Jinsui Road, 510623, Guangzhou, China

    Yuanjuan Ye MD, Lei Liu MD, Shao-Qing Shi MD, Robert E. Garfield PhD, Guozheng Zhang MD & Huishu Liu MD, PhD

  2. Department of Anesthesia, Guangzhou Women & Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Xingrong Song MD

Authors
  1. Yuanjuan Ye MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xingrong Song MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lei Liu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shao-Qing Shi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert E. Garfield PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guozheng Zhang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Huishu Liu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Huishu Liu MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ye, Y., Song, X., Liu, L. et al. Effects of Patient-Controlled Epidural Analgesia on Uterine Electromyography During Spontaneous Onset of Labor in Term Nulliparous Women. Reprod. Sci. 22, 1350–1357 (2015). https://doi.org/10.1177/1933719115578926

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/1933719115578926

Keywords

Search

Navigation