Initial Cervical Dilation Research Articles

Analgésie rachidienne et péridurale combinée pour le travail. Prolongation par l'adjonction d'une minidose de clonidine au sufentanil. Étude préliminaire

The effect of adding a minidose of clonidine to intrathecal sufentanil during the early first stage of a painful labour was evalluated in this preliminary open-label, non-randomised trial. Group 1 received sufentanil 5 μg + clonidine 30 μg intrathecally ( n = 10) and group 2 only intrathecal sufentanil 5 μg ( n = 11). The two groups were not statistically different regard-ing age, weight, height, primiparity (67 vs 50%), oxytocin use (37 vs 60%), initial cervical dilation (m ± DS : 2.9 ± 1.1 vs 2.9 ± 1 cm) and VAS pain scores (70 ± 14 vs 68 ± 19 mm). In group 1, analgesia was markedly prolonged with a reduced variability in duration: 146 ± 27 min vs 95 ± 44 min, ( P = 0.006). VAS pain scores were: 14 ± 20 vs 19 ± 13, 1 ± 3 vs 9 ± 12, 0 vs 5 ± 7, 48 ± 12 vs 65 ± 15, five and fifteen minutes after intrathecal injection, during maximum efficacy, and at the time additional analgesia was required, in group 1 and group 2, respectively. Analgesia evaluated with the VAS pain scores was better in group 1 compared with group 2 ( P = 0.02) and decreased somewhat slower. Side effects, such as hypotension, pruritus and sedation,were not statistically different between groups. Nausea and motor blockade did not occur. In conclusion, the addition of a minidose (30 μg) of clonidine to sufentanil 5 μg given intrathecally seems to potentiate markedly the analgesia obtained during the early first stage of labour.

Breech Delivery and Epidural Analgesia

OBJECTIVE To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks). DESIGN A retrospective study. SETTING Data Bank, Aberdeen Maternity Hospital. SUBJECTS 643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term. OUTCOME MEASURES Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates. RESULTS Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65). CONCLUSION Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.

COMPARISON OF INTRAVENOUS OXYTOCIN AND PROSTAGLANDIN E2 FOR ACCELERATING LABOUR

In a prospective study of 52 consecutive women who required acceleration of labour intravenous prostaglandin E2 (PGE2) was used as the oxytocic agent. These mothers were matched for age, parity, height, gestational age, initial cervical dilatation, and station and position of the fetal head with 52 women whose labours were accelerated with oxytocin; both drugs were equally effective. Acceleration to delivery intervals, second-stage durations, the number of assisted deliveries, and Apgar scores were similar regardless of the oxytocic used. Although PGE2 compares well with oxytocin, it offers no further advantages and is more expensive and less well tried than oxytocin.

Determinant role of initial cervical dilatation on the course of labor

Determinant role of initial cervical dilatation on the course of labor