Clinical Research Of The Effects Of Epidural Analgesia On Virginal Delivery Maternal And Neonatus

BackgroundHigher rate of cesarean section(CS) is an obstetric phenomenon at present in our country, otherwise, it will be an obstetrical research focus if reducing the rate of CS. One of the important causes is gravida or her family members selecting CS actively, that may increase the rate of CS. Fear of labor pain can not be neglected as one of the important factors.To found a method,that can release labor pain and affect less maternal-neonatus, may be an important step in reducing the rate of CS at a sense. ObjectiveTo investigate the security and effectiveness of epidural analgegia on virginal delivery maternal-neonatus, in order to provide basises for widely carrying out labor analgesia.Methods60parturient cases in the term of maternal,scheduled for virginal delivery from June2012to May2013, who were no systemic diseases and obstetric complications,were randomly divided into epidural analgesia (EA) group and non-analgesia (NA)roup,30in each.In EA group, gravida in labour signs was sent into labor room,where an upper limb vein was punctured and0.9%normal saline200to300ml in total infused at constent speed.The values of noninvasive blood pressure(NBP), heart rate(HR) and pulse oxygen saturation(SpO2) were recorded as baseline. It was informed to the gravida how to use an analgesic pump during labor.Epidural space was punctured at L2-3level on the Left lateral position. A catheter was inserted and fixed properly, then gravida lied on supine.5ml of1%lidocaine as a test dosage was injected into the space, and puncture with a needle for measuring pain was taken after5minutes so as to eliminate spinal blockade and confirm segment blockade. An initial dosage of analgesic fluid(0.1%ropivacaine plus5μg of sufentanyl, total volume of10ml) was injected into the space. After that, the cathetre was connected with pump. A background dosage of6ml/h(height less than160cm)or8ml/h(height more than160cm),3ml as a bolus, locktime at15minutes were setted. NBP, HR and SpO2were recorded again after initial dosage. Bromage score was also recorded. In NA group,0.9%normal saline200ml to300ml was given to gravida in labor signs only when her was sent into labour room and parametres taken just as EA group. Umbilical venous blood was drawn for blood gas analysis at the right time as feotus was delivered. Apgar scores were taken by midwife, obstetrician and anesthesiologist respectively at1,5and10minutes after neonatus was delivered. Mean value of the scores as an immediate score was recorded for analysis. Also stage of labor, weather the cases of urinary catheterization, oxytocin used, during the stage, cut of perineum, postpartum hemorrhage, visual analogue score(VAS) as orifice of the uterus expansed to6to7cm, lactation starting time, Neonatal Behavioral Neurological Assessment was carried out by same paediatric health worker after72hours neonatus delivered. Obstetrician and anesthesiologist took an inspection tour to the gravida every other2hours to deal with adverse events or abnormal states associated to obstetrics or labor analgesia to insure gravida and foetus safety during labour.ResultsGeneral conditions of pregnant women were no statistic differences in the two groups. Either the first or second stage of labor was prolonged in EA group than that of NA group(P<0.001). Rate of oxytocin used, urinary catheterization were higher in EA group than that of NA group (9vs.2,P<0.05;16vs.4, P<0.01respectively); There were no statistical differences in the cases of both post-labor hemorrhage (4vs.0) and cut of perineum (13vs.11,.P>0.05)between two groups. VAS score in EA group was much less than that of in NA group(P<0.001)and the Bromage scores just the same in two groups(P>0.05). There was no statistical difference in initial time of lactation between the two group (34.1±1.4vs.37.6±1.3,P>0.05). There was a statistical significant difference in Apgar score of neogenesis between EA and NA group at1,5minutes after delivery(7.241±0.077vs.7.282±0.058, P<0.05). Blood gas analysis in UVS:there were no statistical differences in other parameters besides pH, which value in EA group was a little lower than that of NA group. Conclusionl.This study showed that the epidural analgesia we had taken can provide a satisfactory labor-pain relief during delivery stages without affecting on post-labor lactation、increasing bleeding after delivery or blocking motor nerve, there was no adverse influence on virginal delivery women.2.There were no actually significant side-effects on newborns found during labor pain relief with epidural analgesia, it is safe for neonates and deserved to spread clinicly.