Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group.
Am J Obstet Gynecol
; 182(5): 1165-72, 2000 May.
Article
em En
| MEDLINE
| ID: mdl-10819854
ABSTRACT
OBJECTIVE:
This study was undertaken to determine whether a policy of delayed pushing for nulliparous women with continuous-infusion epidural analgesia reduces the risk of difficult delivery (cesarean delivery, operative delivery from a midpelvic position, low-pelvic procedures with rotation >45 degrees ). STUDYDESIGN:
In this multicenter, randomized, controlled trial women in the delayed pushing group (n = 936) were advised to wait > or =2 hours after full dilatation before commencement of pushing. Women in the early pushing group (n = 926) were advised to commence pushing as soon as they had been randomly assigned.RESULTS:
Difficult delivery was reduced with delayed pushing (relative risk, 0.79; 95% confidence interval, 0.66-0.95). The greatest effect was on midpelvic procedures (relative risk, 0.72; 95% confidence interval, 0.55-0.93). Although there was little evidence for an effect on low-pelvic procedures, spontaneous delivery was more frequent among women who practiced delayed pushing (relative risk, 1.09; 95% confidence interval, 1.00-1.18). Abnormal umbilical cord blood pH (<7.15 venous value or <7.10 arterial value) was more frequent in the delayed pushing group (relative risk, 2.45, 95% confidence interval, 1.35-4. 43). However, scores for a summary indicator, the Neonatal Morbidity Index, were similarly distributed in the 2 groups.CONCLUSION:
Delayed pushing is an effective strategy to reduce difficult deliveries among nulliparous women.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Segunda Fase do Trabalho de Parto
/
Analgesia Epidural
Tipo de estudo:
Clinical_trials
/
Etiology_studies
Limite:
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
Am J Obstet Gynecol
Ano de publicação:
2000
Tipo de documento:
Article
País de afiliação:
Canadá