The success rate of vaginal birth after caesarean section and labour outcomes in women with intrapartum epidural analgesia vs parenteral opioid: preliminary result

• Main Authors: Husin, Roziah, Abdulwahab, Dalia F, Awang, Mokhtar
• Format: Conference or Workshop Item
• Language: English
• Published: 2014
• Subjects: RG Gynecology and obstetrics
• Online Access: http://irep.iium.edu.my/40813/1/40813.pdf; http://irep.iium.edu.my/40813/

Introduction: Neuraxial analgesia(epidural), is one of the most effective treatment for labour pain, however this benefit was offset by possible association with increased risk of caesarean section and prolonged labour. The American college of Obstetrician and Gynaecologist recommended delaying the administration of epidural analgesia when possible until cervical dilatation reach at least 4-5 cm, due to increase risk of CS up to 12 folds based on early studies Objective: To compare the effect of epidural with parenteral opioid analgesia on the outcome of labour, successes rates of vaginal birth in women undergoing trial of scar. Method: A prospective study conducted in Hospital Tengku Ampuan Afzan in 2014, all consented women for trial of scar were counselled for either intrapartum epidural or parenteral opioid while in labour with the cervical dilatation of 3-4 cm. Result: Total of 14 ladies with the mean age of 31.9(range 23-42) year, mean gestational age was 39.4 (SD=1.6) weeks, mean parity was 1.3 (11/14 cases were parity one), were recruited to this study from high risk labour room, divided into two equal groups, given intra partum epidural analgesia and parenteral pethidine. A seventy one per cent (5/ 7) cases in the epidural group were induction of labour (IOL), versus 57.1% (4/7) cases in the pethidine group. The mean duration of the first stage of labour was 7.4 (SD=1.6) hrs, 5(SD=3.5) hrs for the epidural and pethidine groups respectively. Only 28.6%(4/14) cases had spontaneous vaginal delivery, two cases from each group, another 28.6%(4/14) cases had assisted delivery, three from the pethidine group, all indicated for fetal distress (FD) apart from one was indicated for poor progress from the pethidine group. About 42.8(6/14) cases delivered abdominally, the majority 66.7 %(4/6) cases were from the epidural group, but statistically was not significant (P=0.435). Three out of four cases the indication was for poor progress and one for (FD), while the two cases from the pethidine group indicated for poor progress and FD. The duration of the second stage was 25.3(SD=11) minutes in the epidural group versus 18(SD=15) minutes in the pethidine group. None of the two groups have a maternal or neonatal complications. Conclusion: Epidural analgesia may be associated with prolonged labour, with lower rate of successful vaginal birth after CS, without increasing the complications rate. However large sample size is required to evaluate the statistical significance.