open access

Vol 89, No 8 (2018)
REVIEW PAPERS Obstetrics
Published online: 2018-08-31
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A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate

Wioletta Mędrzycka-Dabrowska, Katarzyna Czyż-Szypenbejl, Jakub Pietrzak
DOI: 10.5603/GP.a2018.0079
·
Pubmed: 30215467
·
Ginekol Pol 2018;89(8):460-467.

open access

Vol 89, No 8 (2018)
REVIEW PAPERS Obstetrics
Published online: 2018-08-31

Abstract

Objectives: The aim of this review was to summarise the available literature on different modalities of labour pain relief (epidural vs. parenteral) and to assess their impact on the rate of caesarean section deliveries and instrumental deliveries, and on the need to support the uterine contractile function.

Material and methods: The PubMed, Web of Science and Cochrane databases were reviewed to identify articles describing the effect of labour pain relief on the course of labour. This review includes 16 studies with 7150 patients.

Results: The analysis of the obtained data revealed that epidural analgesia (EA) or combined epidural and spinal anaesthesia (CESA) provided significantly better labour pain relief when compared with parenteral opioids. Conduction anaesthesia was not associated with an increase in the caesarean section delivery rate. Some authors concluded that conduction anaesthesia was associated with the need for assisted delivery.

Conclusions: Epidural analgesia is a well-recognised method of labour pain relief. It is associated with the parturient’s higher satisfaction when compared to parenteral opioids. EA does not directly increase the caesarean section delivery rate, yet it can lead to instrumental deliveries (vacuum-assisted, obstetrics forceps) and a need to pharmacologically support the uterine contractile function. Further studies are required to evaluate the effect of EA on the course of labour, and methods of minimising its adverse effects.

Abstract

Objectives: The aim of this review was to summarise the available literature on different modalities of labour pain relief (epidural vs. parenteral) and to assess their impact on the rate of caesarean section deliveries and instrumental deliveries, and on the need to support the uterine contractile function.

Material and methods: The PubMed, Web of Science and Cochrane databases were reviewed to identify articles describing the effect of labour pain relief on the course of labour. This review includes 16 studies with 7150 patients.

Results: The analysis of the obtained data revealed that epidural analgesia (EA) or combined epidural and spinal anaesthesia (CESA) provided significantly better labour pain relief when compared with parenteral opioids. Conduction anaesthesia was not associated with an increase in the caesarean section delivery rate. Some authors concluded that conduction anaesthesia was associated with the need for assisted delivery.

Conclusions: Epidural analgesia is a well-recognised method of labour pain relief. It is associated with the parturient’s higher satisfaction when compared to parenteral opioids. EA does not directly increase the caesarean section delivery rate, yet it can lead to instrumental deliveries (vacuum-assisted, obstetrics forceps) and a need to pharmacologically support the uterine contractile function. Further studies are required to evaluate the effect of EA on the course of labour, and methods of minimising its adverse effects.

Get Citation

Keywords

epidural analgesia, labour, delivery, caesarean section, instrumental delivery

About this article
Title

A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate

Journal

Ginekologia Polska

Issue

Vol 89, No 8 (2018)

Pages

460-467

Published online

2018-08-31

DOI

10.5603/GP.a2018.0079

Pubmed

30215467

Bibliographic record

Ginekol Pol 2018;89(8):460-467.

Keywords

epidural analgesia
labour
delivery
caesarean section
instrumental delivery

Authors

Wioletta Mędrzycka-Dabrowska
Katarzyna Czyż-Szypenbejl
Jakub Pietrzak

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