Epidural analgesia and fetal head malposition at vaginal delivery

被引:22
作者
Yancey, MK
Zhang, J
Schweitzer, DL
Schwarz, J
Klebanoff, MA
机构
[1] Tripler Army Med Ctr, Dept Obstet & Gynecol, Honolulu, HI 96859 USA
[2] NICHHD, Div Epidemiol Stat & Prevent Res, Bethesda, MD 20892 USA
关键词
D O I
10.1016/S0029-7844(00)01230-8
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective: To determine if nulliparas who delivered with on-demand epidural analgesia are more likely to have malpositioning of the fetal vertex at delivery than women delivered during a period of restricted epidural use. Methods: A retrospective cohort of nulliparous women with spontaneous labor delivered during a 12-month period immediately before the availability of on-demand labor epidural analgesia was compared with a similar group of nulliparas delivered after labor epidural analgesia was available on request. The primary outcome variable was a non-occiput anterior position or malpositioned fetal head at vaginal delivery. Results: The frequency of epidural use increased from 0.9% before epidural analgesia became available on demand to 82.9% afterward. Fetal head malpositioning at vaginal delivery occurred in 26 of 434 (6.0%) women delivered in the before period compared with 29 of 511 (5.7%) in the after period (relative risk 0.95, 95% confidence interval 0.6, 1.6). No statistically significant difference in the incidence of fetal head malpositioning was present after patients were stratified by mode of delivery (Mantel-Haenszel weighted relative risk 0.94, 95% confidence interval 0.6, 1.4). The study sample size provided 85% power to detect a two-fold increase in the incidence of fetal malpositioning from a baseline rate of 6% associated with on-demand epidural use. Conclusion: Providing on-request labor epidural analgesia to nulliparas in spontaneous labor did not result in a clinically significant increase in the frequency of fetal head malpositioning at vaginal delivery.
引用
收藏
页码:608 / 612
页数:5
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