Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome.

Ortiz, Javier U; Hammerl, Thomas; Wasmaier, Maria; Wienerroither, Valerie; Haller, Bernhard; Hamann, Moritz; Kuschel, Bettina; Lobmaier, Silvia M

doi:10.1055/a-0774-8617

Klinik für Anästhesiologie und Intensivmedizin (Prof. Schneider)

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Document type:: Article; Journal Article
Author(s):: Ortiz, Javier U; Hammerl, Thomas; Wasmaier, Maria; Wienerroither, Valerie; Haller, Bernhard; Hamann, Moritz; Kuschel, Bettina; Lobmaier, Silvia M
Title:: Influence of Different Methods of Intrapartum Analgesia on the Progress of Labour and on Perinatal Outcome.
Abstract:: Background Various methods of intrapartum analgesia are available these days. Pethidine, meptazinol and epidural analgesia are among the most commonly used techniques. A relatively new one is patient-controlled intravenous analgesia with remifentanil, although the experiences published so far in Germany are limited. Our goal was to study the influence of these analgesic techniques (opioids vs. patient-controlled intravenous analgesia with remifentanil vs. epidural analgesia) on the second stage of labour and on perinatal outcome. Material and Methods We conducted a retrospective study with 254 parturients. The women were divided into 4 groups based on the analgesic technique and matched for parity, maternal age and gestational age (opioids n = 64, patient-controlled intravenous analgesia with remifentanil n = 60, epidural analgesia n = 64, controls without the medicinal products mentioned n = 66). Maternal, fetal and neonatal data were analysed. Results The expulsive stage was prolonged among both primiparas and multiparas with patient-controlled intravenous analgesia with remifentanil (79 [74] vs. 44 [55] min, p = 0.016, and 28 [68] vs. 10 [11] min, p < 0.001, respectively) and epidural analgesia (90 [92] vs. 44 [55] min, p = 0.004, and 22.5 [73] vs. 10 [11] min, p = 0.003, respectively) compared with the controls. The length of the pushing stage was similar among primiparas in all groups but prolonged compared with the controls in multiparas with patient-controlled intravenous analgesia with remifentanil (15 [17] vs. 5 [7] min, p = 0.001) and epidural analgesia (10 [15] vs. 5 [7] min, p = 0.006). The Apgar, umbilical arterial pH and base excess values were similar between the groups, as were the rates of acidosis and neonatal intensive care unit admission. Conclusion Parturients with patient-controlled intravenous analgesia with remifentanil and epidural analgesia showed a prolonged expulsive stage compared with the opioid group and controls. The short-term neonatal outcome was not influenced by the three methods examined.
Journal title abbreviation:: Geburtsh Frauenheilk
Year:: 2019
Journal volume:: 79
Journal issue:: 4
Pages contribution:: 389-395
Fulltext / DOI:: doi:10.1055/a-0774-8617
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31000884
Print-ISSN:: 0016-5751
TUM Institution:: Frauenklinik und Poliklinik; Institut für Medizinische Statistik und Epidemiologie; Klinik für Anästhesiologie (DHM)
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