Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial

Authors

  • S. Vause,

    Specialist Registrar (Obstetrics and Gynaecology) , Corresponding author
    1. Leeds General Infirmary
      Correspondence: Dr S. Vause, Department of Obstetrics and Gynaecology, North Manchester General Hospital, Delauney's Road, Crumpsall, Manchester M8 6RL, UK.
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  • H. M. Congdon,

    Specialist Registrar (Obstetrics and Gynaecology)
    1. Leeds General Infirmary
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  • J. G. Thornton

    Reader/Honorary Consultant (Obstetrics and Gynaecology)
    1. Leeds General Infirmary
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Correspondence: Dr S. Vause, Department of Obstetrics and Gynaecology, North Manchester General Hospital, Delauney's Road, Crumpsall, Manchester M8 6RL, UK.

Abstract

Objective To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries.

Design A randomised controlled trial.

Setting The delivery suite at Leeds General Infirmary.

Sample One hundred and thirty-five nulliparous women with an effective epidural in labour.

Methods The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner). epidural analgesia in labour reduces operative vaginal deliveries.

Main outcome measure Rate of instrumental vaginal delivery.

Results There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31,95% CI 0.62–2.78). No adverse effects were noted.

Conclusion Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.

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