Epidural analgesia/anesthesia as a method of birth anesthesia: effect on the course of childbirth, on the parturient and fetus
Objective. To assess the effect of epidural anesthesia/analgesia (EA) on the course of labor, childbirth and the fetus.
Materials and methods. Analysis of the main indicators of the perinatal center for 2013-2018, taking into account the implementation of EA. The outcome of childbirth was analyzed in 521 patients who underwent EA by continuous administration of a local anesthetic into the epidural space – continuous epidural infusion (CEI). Questionnaire among 100 women in labor, of which 55 used EA (group 1) and 45 – did not (group 2).
Results and discussion. Among 521 persons the EA was performed: for obstetric indications (46.2 %), due to somatic pathologies (23.6 %), exclusively at the request of the mother (55.6 %). At the same time, the woman’s desire and insistence were combined with other indications in 13 % of cases. Out of 521 cases of the use of EA in childbirth cesarean section (CS) was applied in 88 (16.8 %) cases. The frequency of emergency CS performed in childbirth during the period under review was 4 %. Against the background of EA CS was used 4.2 times more often. CS in EA was performed in connection with fetal distress in 60 cases (68.1 %). At the same time, Apgar was <6 points in 6 cases, which is 6.8 % of the total number of CS. This indicates hyperdianostic fetal stress in women with EA. The effect of opening the cervix and EA on the frequency of CS has been studied: optimal for EA is the opening of the cervix by 4-5 cm, when the frequency of CS is minimal (6.3 %). When performing EA childbirth ended with vacuum extraction of the fetus in 9.5 % of mothers. According to the birthcenter, the frequency of vacuum extraction is 3.3 %. In EA, vacuum extraction was performed almost 2.8 times more often. According to the study, the vast majority of women believe that analgesia should only be indicated. One in four women in group 1 expressed their attitude to pain relief in this way: “If it is possible, why not?”. In group 1, 96 % of women were focused on EA. Whereas in group 2, mothers were almost equally familiar with all possible methods of analgesia, although the level of knowledge about EA is also high. It was found out that the largest share were women who had no problems in the postpartum period (53 % and 64 %, respectively). The vast majority of mothers (92 %) are satisfied with the analgesic effect of EA. It suggests that, according to the most of women, EA should be used as a method of analgesia during childbirth.
Conclusions. EA performance is optimal when opening the cervix by 4-5 cm. Early use of EA up to 3 cm and/or non-smoothed cervix in primiparous women is limited, because against its background significantly increases the frequency of CS. The frequency of urgent CS and vacuum extraction with the use of EA increases. The obtained data did not reveal a negative effect of EA on the fetus (newborn). Most mothers are satisfied with EA and consider it the best method of analgesia for childbirth. The use of EA is insignificant, but still increases the risk of complications in the postpartum period.
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