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Adverse effect of delayed pushing on postpartum blood loss in nulliparous women with epidural analgesia


Fiedler, Anton; Brun, Romana; Randegger, Debora; Balsyte, Dalia; Zimmermann, Roland; Haslinger, Christian (2020). Adverse effect of delayed pushing on postpartum blood loss in nulliparous women with epidural analgesia. International Journal of Gynaecology and Obstetrics, 150(1):92-97.

Abstract

OBJECTIVE

To test for an association between blood loss and time until pushing (TUP) after full cervical dilation in nulliparous women with epidural analgesia.

METHODS

A prospective cohort study was performed at the University Hospital of Zurich between October 2015 and November 2016. Included were 228 nulliparous women with singleton pregnancy, planned vaginal delivery after 36 completed weeks of gestation, epidural analgesia, and guided active pushing. TUP was defined as the interval between full cervical dilation and initiation of active pushing. The primary outcome measure was blood loss, assessed by the postpartum decrease in hemoglobin (ΔHb), estimated blood loss, and rate of ΔHb ≥30 g/L. Associations between TUP and primary and secondary maternal and neonatal delivery outcomes were assessed using Spearman correlation, Mann-Whitney U test, Kruskal-Wallis test, or Fisher exact test, as appropriate.

RESULTS

Longer TUP correlated significantly with increased ΔHb (ρ=0.142, P=0.033) and higher rates of ΔHb ≥30 g/l (P=0.002). Composite adverse maternal and neonatal outcomes were unaffected.

CONCLUSION

On the grounds of increased maternal blood loss, and in contrast to the current International Federation of Gynecology and Obstetrics (FIGO) guideline, delayed active pushing is not recommended in nulliparous women with epidural analgesia.

Abstract

OBJECTIVE

To test for an association between blood loss and time until pushing (TUP) after full cervical dilation in nulliparous women with epidural analgesia.

METHODS

A prospective cohort study was performed at the University Hospital of Zurich between October 2015 and November 2016. Included were 228 nulliparous women with singleton pregnancy, planned vaginal delivery after 36 completed weeks of gestation, epidural analgesia, and guided active pushing. TUP was defined as the interval between full cervical dilation and initiation of active pushing. The primary outcome measure was blood loss, assessed by the postpartum decrease in hemoglobin (ΔHb), estimated blood loss, and rate of ΔHb ≥30 g/L. Associations between TUP and primary and secondary maternal and neonatal delivery outcomes were assessed using Spearman correlation, Mann-Whitney U test, Kruskal-Wallis test, or Fisher exact test, as appropriate.

RESULTS

Longer TUP correlated significantly with increased ΔHb (ρ=0.142, P=0.033) and higher rates of ΔHb ≥30 g/l (P=0.002). Composite adverse maternal and neonatal outcomes were unaffected.

CONCLUSION

On the grounds of increased maternal blood loss, and in contrast to the current International Federation of Gynecology and Obstetrics (FIGO) guideline, delayed active pushing is not recommended in nulliparous women with epidural analgesia.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Obstetrics
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Obstetrics and Gynecology
Language:English
Date:July 2020
Deposited On:17 Jul 2020 11:49
Last Modified:29 Jul 2020 15:28
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0020-7292
OA Status:Closed
Publisher DOI:https://doi.org/10.1002/ijgo.13175
PubMed ID:32364638

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