Gülçin BABAOĞLU, Banu KILIÇASLAN, Aysun Ankay YILBAŞ, Bilge ÇELEBİOĞLU

Effects of different analgesic methods used for vaginal delivery on mothers and fetuses

Background/aim: Knowledge regarding pain relief during labor remains insufficient. We aimed to determine and compare the effectiveness and safety of epidural analgesia, combined spinal-epidural analgesia, and parenteral meperidine on both mothers and fetuses. Materials and methods: This study was designed as an observational case-control study. We collected prospective data from patients whose labor pain management was conducted with meperidine in addition to retrospective cohort data of neuraxial methods; 138 patients were enrolled. Epidural analgesia group consisted of 68 patients, whereas combined spinal-epidural CSE analgesia group and meperidine group consisted of 50 and 20 patients, respectively. We compared the delivery patterns, labor durations, pain levels, side effects, maternal satisfaction levels, and neonatal outcomes of the various pain management methods. Results: Patient demographics, duration of first, second, and third labor stages, and instrumental delivery rates were comparable among groups P > 0.05 . Cesarean section tended to be less frequent in the CSE group. In the meperidine group, visual analog scale VAS values and sedation were significantly higher P

Keywords:

Labor pain, meperidine, neuraxial analgesia,

___

1. Wong CA. Advances in labor analgesia. International Journal of Womens Health 2010; 1: 139-154. doi: 10.2147/ijwh.s4553
2. Rowlands S, Permezel M. Physiology of pain in labour. Bailliere’s Clinical Obstetrics and Gynaecology 1998; 12(3): 347-362. doi: 10.1016/s0950-3552(98)80071-0
3. Silva M, Halpern SH. Epidural analgesia for labor: Current techniques. Local and Regional Anesthesia 2010; 3: 143-153. doi: 10.2147/LRA.S10237
4. Jeschke E, Ostermann T, Dippong N, Brauer D, Pumpe J et al. Identification of maternal characteristics associated with the use of epidural analgesia. Journal of Obstetrics and Gynaecology 2012; 32(4): 342-346. doi: 10.3109/01443615.2012.661491
5. Committee on Obstetric P. ACOG committee opinion #269. Analgesia and cesarean delivery rates. Obstetrics and Gynecology 2002; 99(2): 369-370. doi: 10.1016/s0029- 7844(01)01770-7
6. Cambic CR, Wong CA. Labour analgesia and obstetric outcomes. British Journal of Anaesthesia 2010; 105 Suppl 1: i50-60. doi: 10.1093/bja/aeq311
7. Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews 2011(12): CD000331. doi: 10.1002/14651858.CD000331.pub3
8. Clarke VT, Smiley RM, Finster M. Uterine hyperactivity after intrathecal injection of fentanyl for analgesia during labor: a cause of fetal bradycardia? Anesthesiology 1994; 81(4): 1083. doi: 10.1097/00000542-199410000-00041
9. Agrawal D, Makhija B, Arora M, Haritwal A, Gurha P. The effect of epidural analgesia on labour, mode of delivery and neonatal outcome in nullipara of India, 2011-2014. Journal of Clinical and Diagnostic Research 2014; 8(10): OC03-06. doi: 10.7860/JCDR/2014/9974.4930
10. Segal S, Blatman R, Doble M, Datta S. The influence of the obstetrician in the relationship between epidural analgesia and cesarean section for dystocia. Anesthesiology 1999; 91(1): 90- 96. doi: 10.1097/00000542-199907000-00016
11. MacArthur C, Wilson D, Herbison P, Lancashire RJ, Hagen S et al. Faecal incontinence persisting after childbirth: a 12 year longitudinal study. BJOG: An International Journal of Obstetrics and Gynaecology 2013; 120(2): 169-179. doi: 10.1111/1471-0528.12039
12. Barrett G, Pendry E, Peacock J, Victor C, Thakar R et al. Women’s sexual health after childbirth. BJOG: An International Journal of Obstetrics and Gynaecology 2000; 107(2): 186-195. doi: 10.1111/j.1471-0528.2000.tb11689.x
13. Saurel-Cubizolles MJ, Romito P, Lelong N, Ancel PY. Women’s health after childbirth: a longitudinal study in France and Italy. BJOG: An International Journal of Obstetrics and Gynaecology 2000; 107(10): 1202-1209. doi: 10.1111/j.1471-0528.2000. tb11608.x
14. Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. American Journal of Obstetrics and Gynecology 2002; 186(5 Suppl Nature): S94-109 doi: 10.1067/ mob.2002.121549
15. Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain relief in labour. Cochrane Database of Systematic Reviews 2010(9): CD007396. doi: 10.1002/14651858.CD007396.pub2
16. Kuhnert BR, Linn PL, Kennard MJ, Kuhnert PM. Effects of low doses of meperidine on neonatal behavior. Anesthesia and Analgesia 1985; 64(3): 335-342. doi: 10.1213/00000539- 198503000-00006
17. Tsui MH, Ngan Kee WD, Ng FF, Lau TK. A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labour. BJOG: An International Journal of Obstetrics and Gynaecology 2004; 111(7): 648-655. doi: 10.1111/j.1471-0528.2004.00160.x
18. Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database of Systematic Reviews 2018; 5: CD000331. doi: 10.1002/14651858.CD000331.pub4
19. Sultan P, Murphy C, Halpern S, Carvalho B. The effect of low concentrations versus high concentrations of local anesthetics for labour analgesia on obstetric and anesthetic outcomes: a meta-analysis. Canadian Journal of Anaesthesia 2013; 60(9): 840-854. doi: 10.1007/s12630-013-9981-z
20. Thorp JA, Hu DH, Albin RM, McNitt J, Meyer BA et al. The effect of intrapartum epidural analgesia on nulliparous labor: A randomized, controlled, prospective trial. American Journal of Obstetrics and Gynecology 1993; 169(4): 851-858. doi: 10.1016/0002-9378(93)90015-b
21. Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. New England Journal of Medicine 1997; 337(24): 1715-1719. doi: 10.1056/ NEJM199712113372402
22. Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT et al. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. New England Journal of Medicine 2005; 352(7): 655-665. doi: 10.1056/NEJMoa042573
23. Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. JAMA 1998; 280(24): 2105-2110. doi: 10.1001/jama.280.24.2105
24. Fyneface-Ogan S, Mato CN, Anya SE. Epidural anesthesia: views and outcomes of women in labor in a Nigerian hospital. Annals of African Medicine 2009; 8(4): 250-256. doi: 10.4103/1596-3519.59580
25. Dickinson JE, Paech MJ, McDonald SJ, Evans SF. Maternal satisfaction with childbirth and intrapartum analgesia in nulliparous labour. Australian and New Zealand Journal of Obstetrics and Gynaecology 2003; 43(6): 463-468. doi: 10.1046/j.0004-8666.2003.00152.x
26. Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database of Systematic Reviews 2012; 10: CD003401. doi: 10.1002/14651858.CD003401.pub3
27. Abrao KC, Francisco RP, Miyadahira S, Cicarelli DD, Zugaib M. Elevation of uterine basal tone and fetal heart rate abnormalities after labor analgesia: a randomized controlled trial. Obstetrics and Gynecology 2009; 113(1): 41-47. doi: 10.1097/AOG.0b013e31818f5eb6
28. Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review. American Journal of Obstetrics and Gynecology 2002; 186(5): S69-S77. doi: 10.1016/s0002-9378(02)70182-8
29. Tomson G, Garle RI, Thalme B, Nisell H, Nylund L et al. Maternal kinetics and transplacental passage of pethidine during labour. British Journal of Clinical Pharmacology 1982; 13(5): 653-659. doi: 10.1111/j.1365-2125.1982.tb01432.x