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Indian Journal of Obstetrics and Gynecology

Volume  8, Issue 1, January-March 2020, Pages 31-37
 

Original Article

Fetomaternal Outcome in Pregnant Females Following Epidural Analgesia in Labor

Shraddha Agarwal1, Anvi Munshi2, Shivangi Gondaliya3, Tanushree Agrawal4, Shreeja Desai5, Komal Patel6

1Associate Professor, 3Third-year Resident, 4,5,6Second-year Resident, Department of Obstetrics and Gynaecology, SMIMER Hospital & Medical College, Surat, Gujarat 395010, India. 2Senior Resident, Department of Obstetrics and Gynaecology, Government Medical College, Surat, Gujarat 395001, India.

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DOI: http://dx.doi.org/10.21088/ijog.2321.1636.8120.5

Abstract

Introduction: The McGill Pain Questionnaire1 ranks labor pain in the upper part of pain scale between cancer pain and amputation of digit. So in modern obstetrics, pain relief during childbirth to the parturient has become more demanding and sophisticated. Epidural analgesia is gold standard technique that has been used extensively nowadays but it has drawbacks like delayed onset and some degree of motor block. Recent trend of using local anesthetic in very low dose along with opioid could overcome them. Objective: The objective of this study was to assess the onset, effectiveness, duration and extent of epidural analgesia with ropivacaine in combination with fentanyl and its practical application and acceptability by the parturient. The study also aims to know its effect on progress of labor, mode of delivery, side effects and complications to the mother or fetus. Material and method: This observational study was conducted in OBGY department of SMIMER Surat, from Jan 2017 to Jun 2018. Full-term nulliparous patients from labor room were taken for study. Patients having a single fetus with vertex presentation, with CPD ruled out clinically and those expected to deliver normally were included in the study. Epidural analgesia was given when cervix dilatation was equal to or more than 3 cm. After epidural test dose, 15 ml of 0.2% Ropivacaine with 2 mcg/ml fentanyl was given as first dose with the help of lumbar epidural needle inserted at L3–L4 interspinous space. Pain was assessed by VAS score which if found more than 3, another top up dose equal to first dose was repeated. VAS score <3 was considered as effective analgesia. Observation: Total 40 patients were included in the study. Onset of analgesia was significantly faster as most patients achieved VAS <3 in 10 min. Eighty percent (32/40) of patients graded the adequacy of analgesia as god to excellent i.e. VAS <3. The mean number of top up doses given in this study was 1.35. The mean duration of active stage of first stage of labor was 147.43 min and second stage was of 37.35 min. 82.5% (32/40) mothers had spontaneous vaginal delivery, 10% (4/40) patients had LSCS delivery and only 7.5% (3/40) had instrumental delivery. Thus the rate of operative delivery was very low in this study. No patient had motor block, only 3/40 (7.5%) subjects suffered nausea and vomiting and 4/40 (10%) had urinary retention. Apgar score was >7 at 1 and 5 min in all babies. Conclusion: The use of newer epidural anesthetic agent like ropivacaine in addition with low dose of opioids like fentanyl provides better analgesic effect during labor with minimal motor blockade of abdomino-pelvic muscles which encourages the parturients to actively participate in expulsion of fetus resulting in shorter duration of labor and lower rate of operative deliveries.


Keywords : Epidural analgesia; Labor pains; VAS score.
Corresponding Author : Anvi Munshi