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• W1996590624 abstract "Numerous studies have been published that show an association between the use of regional analgesia and the need for augmentation of labour [1–3]. We have found that great emphasis is given to this when non-anaesthetists discuss regional analgesia with women. However, little mention is made of work that suggests that this association may not be causal[2,3]. We had the impression that regional analgesia is often requested when contractions become painful as a result of syntocinon- being started, or the woman is advised to ‘have an epidural before the drip which makes the contractions painful’. We carried out a simple audit to determine which came first, augmentation (or the perceived need for augmentation) of labour or the use of regional analgesia. We recorded whether a syntocinon- infusion was already in progress, or had been planned, at the time of requesting regional analgesia. At the postnatal follow-up, we noted if a syntocinon-infusion had been used prior to delivery. Data were collected on 500 consecutive women requesting regional analgesia. Of these, 61% were nulliparous and 65% had a spontaneous onset of labour. Median gestation was 40 weeks (IQR 39–41 weeks) and the median cervical dilatation at the time of request was 3 cm (IQR 3–5 cm). Of the women who received regional analgesia, 302 (60%) also had intravenous syntocinon to augment labour. Of these, however, 187 (62%) were already receiving syntocinon or its use had been planned by the time regional analgesia was requested. In total, 115 women (23%) required augmentation of labour following regional analgesia (Table 1). Of the 326 women in spontaneous labour, 89 (27%) required augmentation following regional analgesia (Table 1). This compares with an overall augmentation rate of 22% for spontaneous labours in our unit over the same time period. A survey of intrapartum care for low risk primigravidas in the UK [4] found that 28% of spontaneous labours (range 13–46%) were augmented with syntocinon. In conclusion, in our unit, 60% of women with regional analgesia required augmentation of labour. However, in the majority of cases (62%), this was either planned or already in progress before the regional analgesia was commenced. Therefore, regional analgesia cannot be held solely responsible for high rates of augmentation of labour. A policy for active management of labour is likely to be associated with a higher demand for epidurals [2]." @default.
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• W1996590624 date "2003-11-18" @default.
• W1996590624 modified "2023-09-23" @default.
• W1996590624 title "Syntocinon and ‘epidurals’ in labour - which comes first?" @default.
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• W1996590624 doi "https://doi.org/10.1046/j.1365-2044.2003.03554.x" @default.
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