Canadian Journal of Anesthesia

, Volume 49, Issue 5, pp 490–492 | Cite as

Epidural analgesia does not prolong the third stage of labour

  • Ola P. Rosaeg
  • Nicola Campbell
  • Mary Lou Crossan
Obstetrical and Pediatric Anesthesia

Abstract

Purpose

To investigate whether there is an association between epidural analgesia and duration of third stage of labour, and between epidural analgesia and type of placental delivery (spontaneous vs expressed vs manual).

Methods

We examined, retrospectively, the computerized labour and delivery data of all 7,468 parturients who had vaginal deliveries from 1996 to 1999 at the Civic Campus of the Ottawa Hospital.

Results

There was no difference in duration of third stage of labour between women with and without epidural pain relief who had spontaneous or expressed (fundal pressure/gentle cord traction) placental delivery. Duration of third stage of labour was shorter in women with epidural analgesia requiring manual removal of placenta. (25.3 minvs 40.1 min,P < 0.0001). The incidence of expressed placental delivery or manual removal of placenta was not different between the groups.

Conclusions

We conclude that there is no clinically important difference in duration of third stage of labour between women with or without epidural analgesia who have spontaneous placental delivery or placental expulsion with fundal pressure/gentle cord traction. However, duration of third stage of labour was shorter in women who received epidural analgesia and required manual removal of the placenta.

L’analgésie épidurale ne prolonge pas la délivrance lors de l’accouchement

Résumé

Objectif

Rechercher une association possible entre l’analgésie épidurale et la durée de la délivrance, et entre l’analgésie épidurale et ie type d’expulsion placentaire (spontanée vs facilitée vs manuelle).

Méthode

Nous avons vérifié, rétrospectivement, les données informatiques sur ie travail et l’accouchement par voie vaginale de 7 468 parturientes, entre 1996 et 1999 au Civic Campus du Ottawa Hospital.

Résultats

La durée de la déiivrance n’a pas été différente, que les femmes aient reçu ou non une analgésie épidurale et aient connu une délivrance spontanée ou facilitée (pression utérine/légère traction ombilicale). La délivrance a été plus courte chez les femmes qui ont reçu de l’anaigésie épidurale et chez qui on a dû extraire manuellement le placenta. (25,3 min vs 40,1 min, P < 0,0001). L’incidence d’expulsion placentaire facilitée ou d’extraction manuelle n’a pas été différente entre les groupes.

Conclusion

La durée de la délivrance ne présente pas de différence clinique significative entre les femmes qui ont reçu ou non de l’analgésie épidurale, qui ont connu une délivrance spontanée ou une expulsion placentaire avec compression utérine/légère traction ombilicale. Cependant, elle a été plus courte chez les femmes qui ont reçu l’analgésie épidurale et qui ont connu une délivrance manuelle.

References

  1. 1.
    Howell CJ. Epidural versus non-epidural analgesia for pain relief in labour (Cochrane Review).In:The Cochrane Library, Issue 4, 2000. Oxford: Update Software.Google Scholar
  2. 2.
    Halpern SH, Leighton BL, Ohlsson A, Barrett JFR, Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor. A meta-analysis. JAMA 1998; 280: 2105–10.PubMedCrossRefGoogle Scholar
  3. 3.
    Zhang J, Klebanoff MA, DerSimonian R. Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review. Am J Obstet Gynecol 1999; 180: 970–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Loughnan BA, Carli F, Romney M, Doré CJ, Gordon H. Randomized controlled comparison of epidural bupivacaine versus pethidine for analgesia in labour. Br J Anaesth 2000; 84: 715–9.PubMedGoogle Scholar
  5. 5.
    Guidozzi F, Graham KM, Buchmann EJ, Christophers GJ. The effect of continuous low-dose epidural analgesia on uterine work during the active phase of the first stage of labour. S Afr Med J 1992; 81: 361–2.PubMedGoogle Scholar
  6. 6.
    Newton ER, Schroeder BC, Knape KG, Bennett BL. Epidural analgesia and uterine function. Obstet Gynecol 1995; 85: 749–55.PubMedCrossRefGoogle Scholar
  7. 7.
    Lurie S, Feinstein M, Heifetz C, Mamet Y. Epidural analgesia for labor pain is not associated with a decreased frequency of uterine activity. Int J Gynecol Obstet 1999; 65: 125–7.CrossRefGoogle Scholar
  8. 8.
    Nielsen PE, Abouleish E, Meyer BA, Parisi VM. Effect of epidural analgesia on fundal dominance during spontaneous active-phase nulliparous labor. Anesthesiology 1996; 84: 540–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Impey L, MacQuillan K, Robson M. Epidural analgesia need not increase operative delivery rates. Am J Obstet Gynecol 2000; 182: 358–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Begley CM. A comparison of ‘active’ and ‘physiological’ management of the third stage of labour. Midwifery 1990; 6: 3–17.PubMedCrossRefGoogle Scholar
  11. 11.
    Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet 1998; 351: 693–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Quadir Khan G, John IS, Wani S, Doherty T, Sibai BM. Controlled cord traction versus minimal intervention techniques in delivery of the placenta: a randomized controlled trial. Am J Obstet Gynecol 1997; 177: 770–4.CrossRefGoogle Scholar
  13. 13.
    Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour (Cochrane Review).In:The Cochrane Library, Issue 4, 2000. Oxford: Update Software.Google Scholar

Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • Ola P. Rosaeg
    • 1
  • Nicola Campbell
    • 1
  • Mary Lou Crossan
    • 1
  1. 1.Department of Anesthesiology, The Ottawa HospitalUniversity of OttawaOttawaCanada

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