Adverse effect of delayed pushing on postpartum blood loss in nulliparous women with epidural analgesia.
Active pushing
Delayed pushing
Duration of second stage of labor
Epidural analgesia
Postpartum blood loss
Postpartum hemorrhage
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
24
04
2018
revised:
27
08
2018
accepted:
16
04
2020
pubmed:
5
5
2020
medline:
30
9
2020
entrez:
5
5
2020
Statut:
ppublish
Résumé
To test for an association between blood loss and time until pushing (TUP) after full cervical dilation in nulliparous women with epidural analgesia. A prospective cohort study was performed at the University Hospital of Zurich between October 2015 and November 2016. Included were 228 nulliparous women with singleton pregnancy, planned vaginal delivery after 36 completed weeks of gestation, epidural analgesia, and guided active pushing. TUP was defined as the interval between full cervical dilation and initiation of active pushing. The primary outcome measure was blood loss, assessed by the postpartum decrease in hemoglobin (ΔHb), estimated blood loss, and rate of ΔHb ≥30 g/L. Associations between TUP and primary and secondary maternal and neonatal delivery outcomes were assessed using Spearman correlation, Mann-Whitney U test, Kruskal-Wallis test, or Fisher exact test, as appropriate. Longer TUP correlated significantly with increased ΔHb (ρ=0.142, P=0.033) and higher rates of ΔHb ≥30 g/l (P=0.002). Composite adverse maternal and neonatal outcomes were unaffected. On the grounds of increased maternal blood loss, and in contrast to the current International Federation of Gynecology and Obstetrics (FIGO) guideline, delayed active pushing is not recommended in nulliparous women with epidural analgesia.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
92-97Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 International Federation of Gynecology and Obstetrics.
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