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PubMed1993

Epidural analgesia for labor in a community hospital.

Epidural analgesia offers excellent relief from the pain of uterine contractions during labor. It is well tolerated by both mother and baby. However, recent reports suggest that epidurals increase the rate of both cesarean sections and instrumental deliveries, with their attendant costs and morbidities. At our community hospital, 100 consecutive labors using epidural anesthetics were contrasted with 100 consecutive labors managed without them. No significant differences were found in birth weights, Apgar scores, cesarean section rate, or complications. Forceps use was greatly increased, from 13% to 37% (p < 0.01).

Adult↗
PubMed1983

Portsmouth operative delivery trial: a comparison vacuum extraction and forceps delivery.

A total of 304 women, for whom operative delivery was considered necessary in the second stage of labour, were randomly assigned to delivery by vacuum extraction or forceps. Of those allocated to forceps a higher proportion of babies were actually delivered with the allocated instrument; however, the caesarean section rate was also higher in this group. Maternal trauma, use of analgesia and blood loss at delivery were significantly less in the group allocated to vacuum extraction. Vacuum extraction did, however, appear to predispose to an increase in mild neonatal jaundice. More serious neonatal morbidity was rare in both groups and the trial was of insufficient size to rule out a clinically important differential effect of the two instruments on these measures of outcome. Another trial is now needed to address this still open question more rigorously.

Adult↗
PubMed1975

Continuous epidural anaesthesia with a low frequency of instrumental deliveries.

The results of 204 cases of regional analgesia by means of continuous epidural block during labour and delivery are reported. The frequency of instrummental intervention using forceps or the vacuum extractor is low, less than 15% for primi- and multi-gravidas combined, although pathological conditions were recognized prior to blockade in almost one-third of the parturients. Moreover, the frequency of emergency Caesarean section has dropped significantly since epidural anaesthesia was introduced into the clinic. The 1 min Apgar scores of babies born to mothers given epidural anaesthesia are similar to those of babies born to mothers receiving conventional analgesic agents. The amount of blood lost by mothers given epidural anaesthesia was, on average, 15% less than in a control group. It is concluded that the essential feature of our technique of administering continuous regional analgesia is a selective block of small pain fibres with the deep tactile sensations largely intact, and the motor pathways virtually unaffected. This has been achieved using small doses of bupivacaine 0.25% concentration and meticulous observation of the individual patient.

Anesthesia, Epidural↗
PubMed1981

Comparison of maternal and fetal effects of vacuum extraction with forceps or cesarean deliveries.

Results of 90 vacuum extraction (VE) deliveries were compared with effects on the mother and fetus of forceps delivery or cesarean section. Forceps delivery increased the incidence of birth canal trauma threefold and the incidence of anemia sevenfold (18% for VE versus 48% for forceps delivery, and 4 versus 30%, respectively) (P less than or equal to .001). When cesarean section was the alternative operation, the incidence of blood loss was significantly increased (72%, versus 18% with VE), as was febrile morbidity (48%, versus 6% with VE) (P less than or equal to .001). Hospitalization time and costs in the present and future for cesarean section deliveries are markedly higher than for VE. Maternal requirements for anesthesia are markedly reduced with VE because of the gentleness of the operation. A failed trial of VE in 7 patients did not constitute any greater hazard to the mother than initial management by cesarean section. However, babies born by cesarean section after failed VE had a slightly lower Apgar score at 1 minute (P less than or equal to .05) but not at 5 minutes, as compared with babies born by cesarean section attempted initially. Otherwise, Apgar scores of infants born by VE did not differ from those of infants delivered by forceps or cesarean section. Infants delivered by VE had a higher incidence of transient cosmetic deformations, including "chignon" and cephalhematoma, whereas infants delivered by forceps had forceps marks and facial lacerations more frequently. Neither perinatal mortality nor serious traumatic complications were attributable to VE, due to its judicious use for a limited time of approximately 15 minutes.

Anesthesia, Obstetrical↗