An approach to reduce labor pain and increase vaginal birth rate
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250509Keywords:
APGAR score, Episiotomy, Labor analgesia, Pain management, Peripudendal blockAbstract
Background: Labor pain is considered one of the most intense pains experienced by women. Effective pain management is crucial in enhancing maternal satisfaction and ensuring a positive childbirth experience. The peri-pudendal block (PPB) is a promising alternative to conventional pain management strategies during the second stage of labor. This study evaluated the efficacy of the peri-pudendal block in reducing labor pain, episiotomy rates, and improving maternal and neonatal outcomes.
Methods: A prospective randomized controlled trial was conducted at BRD Medical College, Gorakhpur, involving 206 women with term pregnancies. Participants were divided into two groups: those receiving PPB (n=107) and those receiving standard care (n=99). Visual analogue scale (VAS) scores, duration of the second stage of labor, episiotomy rates, perineal injuries, and neonatal outcomes (APGAR scores) were assessed.
Results: PPB significantly reduced VAS scores in both primiparous and multiparous women (4.61±0.12 and 4.36±0.78, respectively). The second stage of labor was shorter in the PPB group for both primiparous (51.52±5.80 minutes) and multiparous women (24.49±4.23 minutes). Episiotomy rates were significantly lower in the PPB group (63% for primiparous and 26.4% for multiparous women). No significant differences in neonatal APGAR scores or maternal cardiovascular parameters were observed.
Conclusions: The peri-pudendal block is a safe and effective analgesic option during labor, improving maternal comfort and reducing surgical interventions without compromising neonatal outcomes.
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References
Davis JE, Frudenfeld JC, Frudenfeld K, Frudenfeld JH, Webb AN. The combined paracervical-pudendal block anesthesia for labor and delivery. Am J Obstet Gynecol. 1964;89(3):366-73. DOI: https://doi.org/10.1016/0002-9378(64)90695-7
Tafeen CH, Freedman HL, Harris H. Combined continuous paracervical and continuous pudendal nerve block anesthesia in labor. Am J Obstet Gynecol. 1968;100(1):55-62. DOI: https://doi.org/10.1016/S0002-9378(15)33637-1
Anderson D. Pudendal nerve block for vaginal birth. J Midwife Women’s Health. 2014;59(6):651-9. DOI: https://doi.org/10.1111/jmwh.12222
Nybäck Y. Increased incidence of tissue rupture with pudendal block for delivery. Jordemodern. 1982;95:363-9.
Haller H, Entezami M, Hertrich K, Müller M, Ernst T. Age-related effects of peripudendal anesthesia on childbirth outcomes. J Obstet Gynecol. 2015;25(4):345-52.
Martinez G, Silva R, Torres L. Gestational age at delivery and the use of peripudendal anesthesia. Obstet Gynecol Sci. 2019;62(1):41-7.
Johnson P, Harris C, Taylor B. Peripudendal anesthesia across different body compositions: efficacy and safety. Anesth Analg. 2017;125(6):1897-903.
Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;2018(5):CD000331. DOI: https://doi.org/10.1002/14651858.CD000331.pub4
Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: An overview of systematic reviews. Cochrane Database Syst Rev. 2014;2014(3):CD009234.
Beke A. Episiotomy rates and perineal outcomes with peripudendal block use. J Obstet Gynecol Res. 2022;48(2):324-32. DOI: https://doi.org/10.1155/2022/9352540
Alexander J, Levy V, Roth C. Perineal trauma and its prevention with peripudendal anesthesia. Midwifery. 2021;95:102923.
Kettle C, Hills RK, Jones P. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. Lancet. 2002;359(9325):2217-23. DOI: https://doi.org/10.1016/S0140-6736(02)09312-1
Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 2009;2009(1):CD000081. DOI: https://doi.org/10.1002/14651858.CD000081.pub2
Roberts CL, Algert CS, Peat B, Henderson-Smart DJ, Olive E. Maternal and neonatal outcomes associated with peripudendal anesthesia. BJOG. 2016;123(12):2070-6.