Mansor, Halimatun
(2010)
The obstetric outcome among primiparity and multiparity on epidural analgesia in Hospital Universiti Sains Malaysia.
Masters thesis, Universiti Sains Malaysia.
Abstract
Objective
To determine the obstetric outcomes of primiparity and multiparity who received epidural
analgesia during labour in Hospital Universiti Sains Malaysia (HUSM).
Methodology
A cross sectional study involving 248 pregnant mothers, primiparity and multiparity, who
received epidural analgesia (study group) and another 251 will received other methods of
analgesia during intrapartum (control group) in HUSM from January 2007 to December 2008.
All patient on epidural analgesia will be taken as a participant after consent is taken. The
epidural analgesia will be perfonned by the anesthetic team. The patient will receive epidural
analgesia (Ropivacaine 0.125% and fentanyl 0.2mg/ ml) once they are in labour. The duration of
first stage of labour will be taken at the time of ARM after epidural analgesia was given till fully
dilatation of cervix. Patient with the cervical dilatation of 3cm and 4 em will be recruited into the
study to avoid bias. The duration of second stage of labour will be taken from the time of active
pushing at full dilatation of cervix until the fetus was expelled out. The duration of third stage of
labour will be taken from the delivery of fetus until the placenta is delivered. All the duration
taken will be calculated in minutes. The mode of delivery and the used of oxytocin
augmentation will be evaluated and analyzed in both groups.
The neonatal outcomes reviewed were Apgar Score at one minute and five minutes, the
requirement of naloxone to the baby and NICU admissions. The maternal complications were
elicited from the time of epidural analgesia given till the next 24 hours.
Results
There were 499 patients in this study population which was well distributed consisting of
124(24.8%) patient for primiparity and 124(24.8%) multiparity on epidural and 124(24.8%)
primiparity and 127(25.5%) multiparity for control group which used other method of analgesia
such as IM Pethidine or Entonox.
There were significant different in mean duration first stage of labour between primiparity and
multiparity of both epidural and non epidural groups(p < 0.001). The mean duration of first stage
of labour in PE was 424.72 ± 165.70 which was longer than ME group with mean duration of
344.61 ± 142.14 minutes. The control group PC and MC showed shorter mean duration of first
stage of labour which were 327.22 ± 175.35 and 263.56 ± 139.75 minutes respectively.
Comparing between epidural and non epidural group, there was significant longer in the mean
duration of first stage of labour with p < 0.001 which were 384.67 ± 159.20 versus 295.01 ±
161.21 minutes. There was also significant association between epidural and parity , the
epidural group and parity have a longer duration first stage of labour with adjusted means 375.98
(95% CI 356.47, 395.49) and 304.08 (95% CI 284.69, 323.48) minutes comparing to each group
with p= 0.00 1. However, there was no significant interaction in mean duration first stage of
labour between epidural and parity .
In second stage of labour the PE group showed significantly longer mean duration of second
stage of labour than ME ( 21.45 ± 22.31 versus 13.82 ± 14.03) minutes. Similarly, the duration
of second stage of labour was prolonged in PC as compared to MC. There was no significant
different in mean second stage of labour between epidural group and controlled group with ( P == 0.4 70) and no significant association in mean second stage of labour in epidural with
parity, C P =0.451 ). There was significant association between primiparity and multiparity
group, with adjusted mean 21.82 minutes and 14.68 with p < 0.001. However, there was no
significant interaction between the use of analgesia and parity, p = 0.759.
There was no significant different in mean duration third stage of labour.
In mode of delivery, LSCS was highest among the PE ( 30.6%) followed by ME ( 20.2% ), PC
( 12. 1 %) and MC ( 7.1% ). LSCS was significantly higher in epidural group compared to
controlled group , ( p < 0.001 ). There were no significant different in number of ID in both
primiparity and multiparity groups as well as in epidural and non-epidural group.
The incidence of Spontaneous Onset of Labour (SPL) was significantly low in PE and ME
( 60.5% and 66.5%) compared to controlled groups ( 82.3% and 93.7% ). There was
significantly low incidence of SPL in epidural group than controlled groups ( 63 .7% versus
88.1 %), p < 0.001. SPL is likely to have SVD compared to induced labour ( 82.8% versus
64%). The incidence of LSCS followed by SPL and induced labour was 12.4% versus 33.3% ..
In multivariate analysis there was significant association between spontaneous vaginal delivery
and usage of epidural (p <0.001). Patient who had spontaneous onset of labour less likely to go
for cesarean section with OR= 0.37 and Epidural usage has 2.5 times risk for cesarean section.
There was no significant interaction between spontaneous onset of labour and used of epidural
p== 0.502.
Conclusions
There was significant longer first stage and second stage in the as compared to epidural non
epidural group. There was significant association between usage of epidural and parity in
duration of first stage and second stage of labour but no further statistical significant in the
interaction between usage of epidural and parity after adjustment the main effect of parity. The
epidural group has significant higher rate of cesarean section as compared to non epidural group
with and poor progress of labour was the most common indication. There was no significant
different in instmmental delivery. Spontaneous onset of labour had increased risk of cesarean
section rate in Epidural group with OR= 2.50. Epidural analgesia had 2.8 fold for oxytocin
augmentation. There was no significant different in Apgar score of> 7 at one minutes and five
minutes in both groups. The used of naloxone was higher in non epidural group. Epidural
analgesia gave a very good satisfaction for superior pain relief in 96% of delivered mother. There
were no significant morbidity and mortality in the mothers and neonates. Epidural analgesia is
very effective for pain relief and very safe.
| Item Type: |
Thesis
(Masters)
|
| Uncontrolled Keywords: |
Anesthesia |
| Subjects: |
R Medicine |
| Divisions: |
UNSPECIFIED |
| Depositing User: |
Mr Abdul Hadi Mohammad
|
| Date Deposited: |
12 Jun 2022 08:31 |
| Last Modified: |
14 Jun 2022 08:33 |
| URI: |
http://eprints.usm.my/id/eprint/52835 |
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