Clinical Question Does discontinu...

Clinical Question

Does discontinuing epidural analgesia in the secondary stage of labor reduce rates of instrumented delivery or change patient satisfaction with labor?

Evidence-Based Answer

Based onward three good studies of 462 patients, discontinuing epidural analgesia in the next to the first stage of labor does not significantly change rates of instrumented delivery or other delivery issues but it increases rates of inadequate pain relief.

Practice Pointers

The American society of Obstetricians and Gynecologists (1) supports the use of epidural analgesia during labor. The policy states that epidurals should not be denied because of the patient's insurance and that supply with nourishments should not be restricted from managing regional anesthesia. (1) Because epidural analgesia provides the highest even of pain relief, the physician and patient should decide when it should be used. However, there are pertain tos that epidural analgesia increases rates of instrumented deliveries. To change into this risk, physicians sometimes discontinue epidural analgesia during the inferior stage of labor. Torvaldsen and colleagues reviewed the literature to determine if this practice improves outcomes

The authors set five studies, three of which were upright quality. They did not find a statistically significant difference in rates of instrumented delivery or cesarean delivery, duration of the next to the first stage of labor, low Apgar scores, or fetal malposition at delivery. The barely statistically significant difference was an increased rate of inadequate pain relief during the secondary stage of labor. Some women may be willing to accept discomfort in the inferior stage of labor even if the risk of poor issues is small. A larger studious mood is needed to determine if there is a www.aafp.org/afp American Family Physician Cochrane Review difference in issues There is inadequate data to support the practice of discontinuing epidural analgesia in the next to the first stage of labor.

CLARISSA KRIPKE, MD Tor valdsen s et al. Discontinuation of epidural analgesia late in labour for reducing the adverse deliver y issues associated with epidural analgesia. Cochrane Database Syst Rev 2004;(4):CD004457

REFERENCES

(1) American body of Obstetricians and Gynecologists. ACOG committee opinion no.295:pain relief during labor. Obstet Gynecol 2004;104:213

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