Reducing likelihood of instrumental delivery with epidural anaesthesia

Two conclusions follow from these results. First, women should be made aware of the increased risk of an instrumental delivery with a traditional epidural since such information would enable them to make informed choices about alternatives. Second, techniques that can reduce the frequency of this ad...

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Bibliographic Details
Published in:The Lancet (British edition) 2001-07, Vol.358 (9275), p.2-2
Main Authors: Thornton, JG, Capogna, Giorgio
Format: Article
Language:English
Subjects:
Anesthesia
Anesthesia, Obstetrical
Back pain
Births
Childbirth & labor
Clinical trials
Female
Health risk assessment
Humans
Infant, Newborn
Narcotics
Obstetric Labor Complications - etiology
Obstetric Labor Complications - prevention & control
Obstetrics
Pain
Pregnancy
Randomized Controlled Trials as Topic
Risk Factors
Side effects
Women
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Summary:Two conclusions follow from these results. First, women should be made aware of the increased risk of an instrumental delivery with a traditional epidural since such information would enable them to make informed choices about alternatives. Second, techniques that can reduce the frequency of this adverse effect should be evaluated. One technique is a combined spinal epidural (CSE), which consists of intrathecal opioid with or without local anaesthetic, followed by intermittent local anaesthetic and opioid in the epidural space. Another epidural method is a continuous low-dose infusion (LDI) of opioid and local anaesthetic. Since motor power is often retained with these techniques, they are sometimes referred to as "mobile" or "walking" epidurals. Their use could reduce the need for instrumental delivery by permitting more mobility in labour and by enabling women to push better. The effect of these techniques on obstetric and fetal outcomes are reported by the Comparative Obstetric Mobile Epidural Trial (COMET) investigators in today's Lancet.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(00)05295-8