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Epidural top-ups received
within 60 minutes of the second stage of labor had shown to increase the
likelihood of spontaneous vaginal delivery.
According to the recent study conducted by Allana
Munro and colleagues, epidural top-ups were required by females facing
difficult labor and those with higher assisted vaginal and cesarean deliveries.
The observational and retrospective study was
conducted to evaluate the relationship of epidural top-ups in the second stage
of labor with neonatal and obstetrical problems. The study was based on a
hypothesis that epidural top-up helps to lower operative deliveries by
correcting insufficient analgesia in the second stage of labor.
The data for the study was extracted by
conducting a population-based cohort search by utilizing perinatal data from 1
Jan 2013 to 31 Dec 2014. Top-up cases were evaluated by using database
information. The descriptive statistics were used to compare different delivery
methods and neonatal features among women either with top-ups or without
top-ups. Predictive factors of the delivery method were determined using
logistic regression.
A total of 1462 females at their second stage of
labor received epidural analgesia for one hour, but only 7% of women required a
top-up approach. The females who received top-ups showed 89% labor induction,
303 min longer second-stage, 41% assisted vaginal and 26% cesarean deliveries
as compared to females without top-ups (76%, 171 min, 17% and 11% respectively).
Women found with predictors of harsh labor, high assisted vaginal and cesarean
deliveries need top-ups epidurals. This governs the role of top-ups in the
second stage of labor.
Canadian Journal of Anesthesia
The impact of analgesic intervention during the second stage of labour: a retrospective cohort study
Allana Munro et al.
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