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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2020

01-12-2020 | Research article

Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study

Authors: Hitomi Ando, Shintaro Makino, Jun Takeda, Yojiro Maruyama, Shuko Nojiri, Hiroyuki Sumikura, Atsuo Itakura

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

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Abstract

Background

Neuraxial labor analgesia is known to increase the rate of instrumental delivery and prolong the second stage of labor; however, there is no standard method to evaluate the progress of labor under analgesia. Friedman curve is considered the gold standard for evaluating the progress of labor. However, it included not only neuraxial labor analgesia but also labor without analgesia. Thus we compared the labor curves of primiparous women undergoing labor with and without neuraxial labor analgesia, to understand the progress of labor in both groups and to arrive at a standard curve to monitor the progress of labor under neuraxial analgesia.

Methods

Primiparous women with cephalic singleton pregnancies who delivered at term from 2016 to 2017 were included. Two hundred patients who opted for combined spinal-epidural (CSE) labor analgesia were included in the CSE group and 200 patients who did not undergo CSE were included in the non-CSE group. In all, 400 cases were examined retrospectively. The evaluation parameters were cervical dilation and fetal station, and we calculated the average value per hour to plot the labor curves.

Results

The labor curve of the non-CSE group was significantly different from the Friedman curve. In the CSE group, the time from 4 cm dilation of the cervix to full dilation was 15 h; in addition, the speed of cervical dilation was different from that in the non-CSE group. The progress of labor in the CSE group was faster than that in the non-CSE group during the latent phase; however, the progress in the CSE group was slower than that in the non-CSE group during the active phase.

Conclusions

Neuraxial labor analgesia results in early cervical dilation and descent of the fetal head; thus, appropriate advance planning to manage the delivery may be essential.
Literature
1.
Fujita N, Cole NM, Nagasaka Y. Challenges and hurdles for patient safety in obstetric anesthesia in Japan. J Anesth. 2018;32(6):901–7.CrossRef
2.
Marucci M, Fiore T. Epidural analgesia for labour and delivery. Curr Evid Minerva Anestesiol. 2004;70(9):643–50.
3.
Wong CA. Advances in labor analgesia. Int J Women's Health. 2010;1:139–54.
4.
Friedman E. The graphic analysis of labor. Am J Obstet Gynecol. 1954;68(6):1568–75.CrossRef
5.
Rinehart BK, Terrone DA, Hudson C, Isler CM, Larmon JE, Perry KG Jr. Lack of utility of standard labor curves in the prediction of progression during labor induction. Am J Obstet Gynecol. 2000;182(6):1520–6.CrossRef
6.
Impey L, Hobson J, O'herlihy C. Graphic analysis of actively managed labor: prospective computation of labor progress in 500 consecutive nulliparous women in spontaneous labor at term. Am J Obstet Gynecol. 2000;183(2):438–43.CrossRef
7.
Zhang J, Troendle JF, Yancey MK. Reassessing the labor curve in nulliparous women. Am J Obstet Gynecol. 2002;187(4):824–8.CrossRef
8.
Suzuki R, Horiuchi S, Ohtsu H. Evaluation of the labor curve in nulliparous Japanese women. Am J Obstet Gynecol. 2010;203(3):226.e1–6.CrossRef
9.
WHO recommendations: intrapartum care for a positive childbirth experience. Definitions of the latent and active first stages of labour. 2018. p. 35–8. ISBN: 978-92-4-155021-5.
10.
Tsen LC, Thue B, Datta S, Segal S. Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology. 1999;91(4):920–5.CrossRef
11.
Leighton BL, Halpern SH, Wilson DB. Lumbar sympathetic blocks speed early and second stage induced labor in nulliparous women. Anesthesiology. 1999;90(4):1039–46.CrossRef
12.
Xing JJ, Liu XF, Xiong XM, Huang L, Lao CY, Yang M, Gao S, Huang QY, Yang W, Zhu YF, Zhang DH. Effects of combined spinal-epidural analgesia during labor on postpartum electrophysiological function of maternal pelvic floor muscle: a randomized controlled trial. PLoS One. 2015;10(9):e0137267.CrossRef
13.
Frigo MG, Larciprete G, Rossi F, Fusco P, Todde C, Jarvis S, Panetta V, Celleno D. Rebuilding the labor curve during neuraxial analgesia. J Obstet Gynaecol Res. 2011;37(11):1532–9.CrossRef
14.
Stoddart AP, Nicholson KE, Popham PA. Low dose bupivacaine/fentanyl epidural infusions in labour and mode of delivery. Anaesthesia. 1994;49(12):1087–90.CrossRef
15.
Zipori Y, Grunwald O, Ginsberg Y, Beloosesky R, Weiner Z. The impact of extending the second stage of labor to prevent primary cesarean delivery on maternal and neonatal outcomes. Am J Obstet Gynecol. 2019;220(2):191.e1–7.CrossRef
16.
Sano Y, Hirai C, Makino S, Li X, Takeda J, Itakura A, Takeda S. Incidence and risk factors of severe lacerations during forceps delivery in a single teaching hospital where simulation training is held annually. J Obstet Gynaecol Res. 2018;44(4):708–16.CrossRef
Metadata
Title
Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study
Authors
Hitomi Ando
Shintaro Makino
Jun Takeda
Yojiro Maruyama
Shuko Nojiri
Hiroyuki Sumikura
Atsuo Itakura
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-020-03161-x

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