ORIGINAL ARTICLE   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2018 December;177(12):689-95

DOI: 10.23736/S0393-3660.17.03670-1

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Conducting an epidural analgesia in University Hospital Center “Sisters of Mercy”: Croatian experience

Katarina KLIČAN-JAIĆ ¹, Ivana ROSO ¹ ✉, Maja PEŠIĆ ¹, Ivka DJAKOVIĆ ², Nada BILIĆ ¹

¹ Department of Anesthesiology, Intensive Care Medicine and Pain Management, “Sestre milosrdnice” University Hospital Center, Zagreb, Croatia; ² Department of Ginecology and Obstetrics, “Sestre milosrdnice” University Hospital Center, Zagreb, Croatia

BACKGROUND: Epidural analgesia (EA) is a golden standard in suppressing a delivery-associated pain. Its goal is to make the parturient women more comfortable, to ensure satisfactory progress of labor and potentate active labor participation. Nowadays, with the increasingly involved participation of women in childbirth, EA represents the ideal method for suppressing pain, whilst not affecting consciousness and with no side effects for the child.
METHODS: In the Clinical Department of Obstetrics, “Sestre milosrdnice” University Hospital Center, from January 1 to December 31, 2016, we have conducted a retrospective longitudinal cohort study. The incidence of EA in relation to the total number of births, the incidence of epidural anesthesia for cesarean section in women with EA and the indications for an emergency cesarean section were examined. Incidences of the EA applied for labor induction and for other indications, as well as the frequency of vacuum extraction for women where EA was applied, were additionally examined.
RESULTS: We found one non-significant and two significant differences. The percentage of EA is relatively high in relation to the statistical data. By studying the rate of specific indications for cesarean section in parturient women who received EA, we observed a non-significantly higher rate of dystocia in comparison to the frequency of this indication in parturient women who delivered without EA. There is a significantly higher incidence of induced labors with EA. The fact is that the profession’s position and the indication for induction of labor as well as for the completion of labor by cesarean section have changed today. On the other hand, the induction of labor is related to the pathology of pregnancy, which carries a higher risk for the cesarean section. The incidence of vacuum extractions is significantly higher in vaginal deliveries with EA what is in accordance with statistical data. This may be minimized by reducing the total dose of local anesthetic administered.
CONCLUSIONS: There is often a need for an EA in the case of a medical indication, such as non-compliance or spastic delivery, in which case the obstetrician decides on its application earlier. Those indications increase the need for a cesarean section and therefore the EA is not directly related to an increased risk for cesarean section. On the other hand, our results may lead to a conclusion that EA increases the risk of instrumental completed delivery what is in accordance with statistical data. An increased incidence of instrumental delivery seems to be an acceptable risk, considering the positive effect of this analgesic method, but may also be a consequence of primarily dysfunctional labor. Higher incidence of induced labors with EA is explained by the fact that the profession’s position and the indication for induction of labor as well as for the completion of labor by cesarean section have changed today. This report also emphasizes the importance of giving an accurate and timely information to our patients, about the benefits and shortcomings of EA as a method of suppressing the labor pain.

KEY WORDS: Analgesia, epidural - Anesthesia, epidural - Cesarean section - Labor pain