Keywords
vaginal birth
perinatal injuries
How to Cite
Abstract
Background. Over the last ten years, the availability of epidural anesthesia used during delivery has increased. Although it is one of the most effective methods of relieving delivery pain, it is associated with the possibility of complications. Objectives. The aim of the study was to compare the characteristics of women using and not using epidural anesthesia to relieve labor pain and to analyze the impact of the use of epidural anesthesia on the frequency and nature of perineal and cervical lacerations. Material and methods. The retrospective study included the analysis of medical records of women giving birth in the Specialist Hospital of St. Zofia in 2015–2018. The criterion for inclusion in study was vaginal birth (≥ 37+0 weeks of pregnancy). 802 randomly selected medical records were analyzed, the study and control group were parallel. Sociodemographic data and data from obstetric history as well as perinatal injuries were analyzed. Data were analyzed by means of regression analysis tests in Statistica statistical program assuming statistical significance of p < 0,05. Results. The majority of women who used epidural anesthesia lived in the city, performed a non-medical profession and gave birth to their first child. Data analysis showed that the average length of pregnancy in the study group was 39+5 weeks of pregnancy and in the control group 39+2 weeks of pregnancy. Both in the test and control groups, there was a loss of blood in the range of 250–1500 ml. More women using epidural have lost more than 700 ml of blood. Episiotomy during labor were significantly more frequent in the study group. A higher number of vaginal mucosal cracks was noted in the study group. In the study group, the use of prostaglandins was more frequently used. Conclusions. 1. Epidural anesthesia was used more often by younger primipara, and those who received prostaglandin induction. 2. The use of epidural anesthesia was associated with a higher risk of episiotomy and vaginal mucus rupture.References
Klejewski A, Urbaniak T, Pisarska-Krawczyk M, i wsp. Stopień odczuwania bólu w zależności od stosowanych metod jego łagodzenia. Prz Lek 2012; 69(10): 1026–1030.
Majchrzak M, Mika M, Gałązka I, i wsp. Sposoby łagodzenia bólu porodowego w doświadczeniu położnic. Zdrowie i Dobrostan 2014; 2: 91–99.
Sulima M, Golnik E. Alternatywne metody łagodzenia bólu porodowego. EJMT 2013; 1(1): 32–38.
Chutkowski R, Wódarski B, Malec-Milewska M. Metody i organizacja analgezji porodu – doświadczenia własne. Ból 2016; 16(2): 7–15.
Furmanik J. Analgezja zewnątrzoponowa porodu w Polsce w 2009 roku. Anest Intens Ter 2013; 45(2): 149–152.
Ministerstwo Zdrowia. Standardy łagodzenia bólu porodowego. Dostępny na URL: /zdrowie/standardy-lagodzenia-bolu-porodowego [cyt. 13.08.2018].
Mayzner-Zawadzka E, Kruszyński Z, Gaca M, i wsp. Analgezja zewnątrzoponowa porodu – wytyczne. 2010: 1–8. Dostępny na URL: justpaste.it/znieczulenieporoduwytyczne.
Hawkins JL. Znieczulenie zewnątrzoponowe porodu. N Engl J Med 2010; 362: 1503–1510.
Weigl W, Szymusik I, Borowska-Solonynko A, i wsp. Wpływ znieczulenia zewnątrzoponowego na poród. Ginekol Pol 2010; 81: 41–45.
Malinowska-Polubiec A, Kna G, Czajkowski K, i wsp. Okołoporodowe urazy dróg rodnych. Perinatol Neonatol Ginekol 2009; 2(3): 195–202.
Czajkowski K. Poród patologiczny. W: Bręborowicz GH, red. Po- łożnictwo i ginekologia. T. 1 Warszawa: Wydawnictwo Lekarskie PZWL; 2007: 388–393.
Perez-Botella M, Garcia-Lausin L, Duran X, et al. Relation between epidural analgesia and severe perineal laceration in childbearing women in Catalonia. Midwifery 2018; 70: 76–83.
Carroll TG, Engelken M, Mosier MC, et al. Epidural analgesia and severe perineal laceration in a community-based obstetric practice. J Am Board Fam Pract 2003; 16: 1–6.
Bodner-Adler B, Bodner K, Kimberger O, et al. The effect of epidural analgesia on obstetric lacerations and neonatal outcome during spontaneous vaginal delivery. Arch Gynecol Obstet 2003; 267: 130–133.
Loewenberg-Weisband Y, Grisaru-Granovsky S, Ioscovich A, et al. Epidural analgesia and severe perineal tears: a literature review and large cohort study. J Matern Fetal Neonatal Med 2014; 27: 1864–1869.
Myrick TG, Sandri KJ. Epidural analgesia and any vaginal laceration. J Am Board Fam Med 2018; 31(5): 768–773.
MacDougall M, Waugh J, Morland D. Epidural analgesia may be protective against third and fourth degree perineal trauma. Arch Dis Child Fetal Neonatal Ed 2011; 96(Suppl. 1): Fa75, doi: http://dx.doi. org/10.1136/archdischild.2011.300162.2.
Landy HJ, Laughon SK, Bailit J, et al. Characteristics associated with severe perineal and cervical lacerations during vaginal delivery. Obstet Gynecol 2011; 117(3): 627–635.
Pakuła D, Fras P, Sosnowski D, i wsp. Wpływ znieczulenia zewnątrzoponowego na długość II okresu porodu oraz częstość wykonywania. Perinatol Neonatol Ginekol 2013; 6(4): 229–234.