Management of the second stage of labor in nulliparas with continuous epidural analgesia

Beth A. Plunkett*, Alexander L Y Lin, Cynthia A. Wong, William A Grobman, Alan M Peaceman

*Corresponding author for this work

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objective: To determine if waiting for a strong urge to push in nulliparas with continuous low-concentration epidural analgesia shortens the pushing duration in the second stage. Methods: Nulliparas with standardized patient-controlled epidural analgesia (0.0625% bupivacaine with fentanyl 2 μg/mL) were randomly assigned to pushing immediately upon complete cervical dilatation (n = 85) or waiting for a strong urge to push (n = 117). Urge to push and patient satisfaction were quantified on 100-mm visual analogue scales. Duration of pushing and total duration of the second stage were analyzed as survival time data. Results: Women who delayed pushing and those who pushed immediately were similar with respect to maternal characteristics. Women who delayed pushing had a stronger urge to push (P < .01) and a longer second stage (P < .05) than women who pushed immediately. There was no significant difference in the time spent pushing (median 57 versus 62 minutes, respectively) or the median level of patient satisfaction (80 mm for both groups). There were no significant differences in the overall rates of cesarean delivery (6% versus 12%, respectively), cesarean delivery during the second stage (2% in each group), spontaneous vaginal delivery (70% versus 69%, respectively), or neonatal or maternal morbidity. Conclusion: In nulliparas with continuous low-concentration epidural analgesia, delaying pushing until a strong urge is felt does not reduce the duration of pushing in the second stage of labor.

Original languageEnglish (US)
Pages (from-to)109-114
Number of pages6
JournalObstetrics and gynecology
Volume102
Issue number1
DOIs
StatePublished - Jul 1 2003

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Second Labor Stage
Epidural Analgesia
Patient Satisfaction
Mothers
First Labor Stage
Patient-Controlled Analgesia
Bupivacaine
Fentanyl
Visual Analog Scale
Morbidity
Survival

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Plunkett, Beth A. ; Lin, Alexander L Y ; Wong, Cynthia A. ; Grobman, William A ; Peaceman, Alan M. / Management of the second stage of labor in nulliparas with continuous epidural analgesia. In: Obstetrics and gynecology. 2003 ; Vol. 102, No. 1. pp. 109-114.
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abstract = "Objective: To determine if waiting for a strong urge to push in nulliparas with continuous low-concentration epidural analgesia shortens the pushing duration in the second stage. Methods: Nulliparas with standardized patient-controlled epidural analgesia (0.0625{\%} bupivacaine with fentanyl 2 μg/mL) were randomly assigned to pushing immediately upon complete cervical dilatation (n = 85) or waiting for a strong urge to push (n = 117). Urge to push and patient satisfaction were quantified on 100-mm visual analogue scales. Duration of pushing and total duration of the second stage were analyzed as survival time data. Results: Women who delayed pushing and those who pushed immediately were similar with respect to maternal characteristics. Women who delayed pushing had a stronger urge to push (P < .01) and a longer second stage (P < .05) than women who pushed immediately. There was no significant difference in the time spent pushing (median 57 versus 62 minutes, respectively) or the median level of patient satisfaction (80 mm for both groups). There were no significant differences in the overall rates of cesarean delivery (6{\%} versus 12{\%}, respectively), cesarean delivery during the second stage (2{\%} in each group), spontaneous vaginal delivery (70{\%} versus 69{\%}, respectively), or neonatal or maternal morbidity. Conclusion: In nulliparas with continuous low-concentration epidural analgesia, delaying pushing until a strong urge is felt does not reduce the duration of pushing in the second stage of labor.",
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Management of the second stage of labor in nulliparas with continuous epidural analgesia. / Plunkett, Beth A.; Lin, Alexander L Y; Wong, Cynthia A.; Grobman, William A; Peaceman, Alan M.

In: Obstetrics and gynecology, Vol. 102, No. 1, 01.07.2003, p. 109-114.

Research output: Contribution to journalArticle

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N2 - Objective: To determine if waiting for a strong urge to push in nulliparas with continuous low-concentration epidural analgesia shortens the pushing duration in the second stage. Methods: Nulliparas with standardized patient-controlled epidural analgesia (0.0625% bupivacaine with fentanyl 2 μg/mL) were randomly assigned to pushing immediately upon complete cervical dilatation (n = 85) or waiting for a strong urge to push (n = 117). Urge to push and patient satisfaction were quantified on 100-mm visual analogue scales. Duration of pushing and total duration of the second stage were analyzed as survival time data. Results: Women who delayed pushing and those who pushed immediately were similar with respect to maternal characteristics. Women who delayed pushing had a stronger urge to push (P < .01) and a longer second stage (P < .05) than women who pushed immediately. There was no significant difference in the time spent pushing (median 57 versus 62 minutes, respectively) or the median level of patient satisfaction (80 mm for both groups). There were no significant differences in the overall rates of cesarean delivery (6% versus 12%, respectively), cesarean delivery during the second stage (2% in each group), spontaneous vaginal delivery (70% versus 69%, respectively), or neonatal or maternal morbidity. Conclusion: In nulliparas with continuous low-concentration epidural analgesia, delaying pushing until a strong urge is felt does not reduce the duration of pushing in the second stage of labor.

AB - Objective: To determine if waiting for a strong urge to push in nulliparas with continuous low-concentration epidural analgesia shortens the pushing duration in the second stage. Methods: Nulliparas with standardized patient-controlled epidural analgesia (0.0625% bupivacaine with fentanyl 2 μg/mL) were randomly assigned to pushing immediately upon complete cervical dilatation (n = 85) or waiting for a strong urge to push (n = 117). Urge to push and patient satisfaction were quantified on 100-mm visual analogue scales. Duration of pushing and total duration of the second stage were analyzed as survival time data. Results: Women who delayed pushing and those who pushed immediately were similar with respect to maternal characteristics. Women who delayed pushing had a stronger urge to push (P < .01) and a longer second stage (P < .05) than women who pushed immediately. There was no significant difference in the time spent pushing (median 57 versus 62 minutes, respectively) or the median level of patient satisfaction (80 mm for both groups). There were no significant differences in the overall rates of cesarean delivery (6% versus 12%, respectively), cesarean delivery during the second stage (2% in each group), spontaneous vaginal delivery (70% versus 69%, respectively), or neonatal or maternal morbidity. Conclusion: In nulliparas with continuous low-concentration epidural analgesia, delaying pushing until a strong urge is felt does not reduce the duration of pushing in the second stage of labor.

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