Abstract. – Purpose: To investigate if early epidural analgesia can influence fetal head engage- ment into the pelvis and if it can increase the rate of transverse and asynclitic position during labour. Materials and Methods: 195 women with combined spinal-epidural analgesia (CSE) or with- out neuraxial analgesia were studied. CSE was performed using a mixture of ropivacaine 0.02% with 0.3 μg/ml of sufentanil administered in the spinal space. Maintenance of analgesia was man- aged with intermittent epidural administration of 10-15 ml of ropivacaine (0.07%-0.10%) mixed with 0.5 μg/ml of sufentanil, based on the stage of labour and the degree of pain. 2D transabdominal ultrasound (US) was used. Serial transabdominal US examinations were performed at 45-90 min in- tervals to detect transverse and asynclitic posi- tions, using the following signs: squint sign, sun- set thalamus and cerebellum signs that best de- tails the fetal head station. After delivery, the com- plete set of clinical and US data obtained by each examination were recorded and compared in women with and without labour analgesia. Data were examined by independent reviewers. Results: There was no difference in obstetric outcome between women in whom CSE had been used and those who did not request anal- gesia during labour (p>0.05). Conclusions: Epidural analgesia initiated early during labour and using low doses does not in- crease the rate of dystocic labors. Transverse fetal head positioning with anterior or posterior asyn- clitism does not seem to be promoted by drug or technique-related mechanisms, but rather should be the consequence of cephalopelvic disproportion.

Intrapartum sonography head transverse and asynclitic diagnosis with and without epidural analgesia initiated early during the first stage of Labor.

GUIDO, Marcello;DE NUNZIO, Giorgio;BOCHICCHIO, Mario Alessandro;
2011-01-01

Abstract

Abstract. – Purpose: To investigate if early epidural analgesia can influence fetal head engage- ment into the pelvis and if it can increase the rate of transverse and asynclitic position during labour. Materials and Methods: 195 women with combined spinal-epidural analgesia (CSE) or with- out neuraxial analgesia were studied. CSE was performed using a mixture of ropivacaine 0.02% with 0.3 μg/ml of sufentanil administered in the spinal space. Maintenance of analgesia was man- aged with intermittent epidural administration of 10-15 ml of ropivacaine (0.07%-0.10%) mixed with 0.5 μg/ml of sufentanil, based on the stage of labour and the degree of pain. 2D transabdominal ultrasound (US) was used. Serial transabdominal US examinations were performed at 45-90 min in- tervals to detect transverse and asynclitic posi- tions, using the following signs: squint sign, sun- set thalamus and cerebellum signs that best de- tails the fetal head station. After delivery, the com- plete set of clinical and US data obtained by each examination were recorded and compared in women with and without labour analgesia. Data were examined by independent reviewers. Results: There was no difference in obstetric outcome between women in whom CSE had been used and those who did not request anal- gesia during labour (p>0.05). Conclusions: Epidural analgesia initiated early during labour and using low doses does not in- crease the rate of dystocic labors. Transverse fetal head positioning with anterior or posterior asyn- clitism does not seem to be promoted by drug or technique-related mechanisms, but rather should be the consequence of cephalopelvic disproportion.
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11587/362109
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 29
  • ???jsp.display-item.citation.isi??? 17
social impact