A re-evaluation of the effect of pethidine on the length of labour

Effect of Pethidine Injection on the Duration of Labor and Pregnancy Outcomes: A Retrospective Cohort Study

Background and Objectives: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. Materials and Methods: This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. Results: Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. Conclusions: Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery.

Effect of pethidine administered during the first stage of labor on the acid-base status at birth

OBJECTIVE

To evaluate the association between the use of pethidine during the first stage of labor and the presence, type and timing of acidosis in the newborn at birth.

STUDY DESIGN

Secondary data analysis of a randomized controlled trial, which included term singleton pregnancies diagnosed with dystocia and requiring active management of labor. Women were randomized to receive either 100 mg of pethidine or placebo. Statistical analyses were performed using chi(2) or Fisher's exact tests for proportions and multiple linear regression for continuous outcomes.

RESULTS

Three hundred and eighty-three pregnant women with a valid arterial blood cord sample were included in the final analysis. Lower pH and bicarbonate levels, as well as higher pCO(2) levels were found in the pethidide group. A higher incidence of acidosis was found in the pethidine group (pH<7.12 OR: 8.59 95% C.I. 3.29, 22.46). The highest frequency of acidosis was encountered when pethidine-delivery interval was 5 h.

CONCLUSION

Pethidine use during the first stage of labor was associated with an increased risk of acidosis at birth.

Meperidine for dystocia during the first stage of labor: A randomized controlled trial

OBJECTIVE

This study was undertaken to evaluate whether the administration of meperidine decreases the length of labor in patients with a diagnosis of dystocia during the first stage of labor.

STUDY DESIGN

Women with term singleton pregnancies who received a diagnosis of dystocia and required an active management of labor were randomly assigned to receive either 100 mg of meperidine or placebo. The primary outcome measure was length of labor.

RESULTS

Four hundred seven pregnant women were included. There were no significant statistical differences between meperidine and placebo groups in length of labor and operative delivery rates such as forceps and cesarean section by intention-to-treat analysis. Low Apgar scores, umbilical artery acidosis, and admission to neonatal care units were increased in the meperidine group.

CONCLUSION

Because of the absence of any benefits in patients with dystocia in labor and the presence of harmful effects on neonatal outcomes, meperidine should not be used during labor for this specific indication.

Does evidenced-based practice medicalise midwifery care? Part 2

In this paper evidence-based care is defined. The evidence to support the provision of care by midwives is presented, as is the evidence to support home birth for those women at low obstetric risk. In conclusion midwives are challenged to be political and use this evidence to support changes to improve the quality of care provided to women and their families.

Relationships between partner's support during labour and maternal outcomes

The objective of this study was to measure the relationship between women's ratings of partners' participation during labour and maternal outcomes as measured by anxiety level, pain perception, dosage of pain-relieving drug used and length of labour. A convenience sample of 45 primigravid women was selected from the postpartum unit of a public hospital in Hong Kong. They were all first-time Chinese mothers, aged 18 or over, who had attended antenatal classes and had their partners present during labour. The State Scale of the State-Trait Anxiety Inventory was used to measure maternal anxiety during labour. Labour pain was measured by the Visual Analogue Scale. A series of scales were developed to measure partners' participation during labour. Women's ratings of partners' practical support were significantly lower than their ratings of partners' emotional support. There were no significant associations between level of emotional support and maternal outcome measures. However, perceived practical support was positively related to the dosage of pain-relieving drug used and total length of labour. Positive relationships between the duration of partners' presence and women's ratings of perceived support provided by partners during labour were also found.

Perinatal bupivacaine and infant behavior in rhesus monkeys

To assess the effect of perinatal epidural bupivacaine analgesia on infant behavioral development, bupivacaine (1.2 mg/kg) was administered to term-pregnant rhesus monkeys (treated, n = 11, procedural controls, n = 8) and infant behavior was evaluated for 1 year using a test battery including infant neurobehavioral tests, observation of spontaneous behavior, and structured cognitive testing. No adverse effects of bupivacaine were detected for neonatal neurobehavior, early cognitive abilities, or performance of cognitive tasks by older infants. Bupivacaine infants directed more, shorter fixations at visual stimuli during visual novelty preference testing. Observation of behavior maturation patterns showed that the increase in manipulatory activity that normally occurs at 2 months of age was delayed in bupivacaine infants, and the increase in motor disturbance behaviors that normally occurs at 10 months of age was prolonged. These results are interpreted in terms of life-history and brain maturation landmarks that appear at these ages. The data suggest that epidural bupivacaine does not cause neonatal abnormalities or specific cognitive deficits but can alter the normal course of behavioral development.

Routine care of women experiencing normal deliveries in Zambian maternity wards: a pilot study

OBJECTIVE

To describe the routine care of women during normal labour and delivery, and the immediate care of newborn babies in Zambia at different levels of health care.

DESIGN

A descriptive survey carried out between July 1994 and January 1995.

SETTING

Eleven maternity facilities, one University teaching hospital, two urban health centres and eight rural hospitals in one province in Zambia.

PARTICIPANTS

Eighty-four women in normal childbirth and their babies studied from admission to the labour ward until time of discharge from the labour ward.

MEASUREMENTS AND FINDINGS

Observations related to the care of the women during normal labour and delivery, and the immediate care of the baby. The findings show that women were confined to bed during the whole labour and delivery period, food and drinks were withheld, and no gowns were provided. None of the women were allowed to have a companion present during labour. Fetal monitoring was inconsistent and the partograph was either not used or partly lacking. All women were delivered in a lithotomy position and primiparae were fixed in stirrups during the second and third stages of labour. There was general lack of support for early mother/baby contact, prevention of hypothermia in the babies and early initiation of breast feeding.

IMPLICATIONS FOR PRACTICE

Based on our findings we suggest that many present maternity ward routines, both physiological and psychological, should be carefully studied. It is also suggested that the midwives reorient their caring practices to more culturally and evidenced-based maternity care. Refresher courses for midwives who have been working for many years are recommended.

Epidural analgesia as a risk factor for operative delivery

OBJECTIVE

To study the relationship between epidural analgesia and instrumental and non-elective cesarean delivery in the 1990s in Finland.

METHODS

The data was extracted from a nationwide birth register in 1991-1993. To adjust for other factors, hospital-based analyses were made separately for different types of hospitals and in individual-based analyses logistic regression was used.

RESULTS

In the hospital-based analyses there was no systematic correlation between rates of epidural analgesia and operative delivery, but on the individual level there was. Comparison of hospitals with different levels of epidural rates and different types of hospitals suggests that the contradictory findings in the hospital and individual-based analyses are partly due to selection bias, and partly to different hospital policies.

CONCLUSIONS

The results in previous studies and our results suggest that epidural analgesia is a risk factor for an operative delivery, but not a sufficient one, and its impact is likely to be modified by other obstetric practices and interventions.

Maternal behaviour during spontaneous and directed pushing in the second stage of labour

It has become custom and practice within the midwifery and obstetric professions in the English-speaking western world for women to be required to follow very specific instructions on how to push in the second stage of labour. There is very little literature on the behaviour of women using spontaneous pushing in the second stage of labour. In a pilot study of a randomized controlled trial comparing spontaneous (n = 15) with directed (n = 17) pushing, the behaviour of the women was observed and recorded. The findings from the observational part of the study are reported in this paper. When pushing spontaneously women do not instinctively take a deep breath, they do not start expulsive effort with the commencement of the contraction, and they use both open and closed glottis pushing. In order to assist women in the second stage of labour, those caring for them should be aware of what is normal behaviour when women are using spontaneous expulsive effort.