To study the role of epidural analgesia in anaemic parturients

Amita Chaudhary, Amrita Singh, Kiran Pandey, Anil Verma, Sangeeta Arya


Background: To study the safety of epidural analgesia, effect on cardiotocographic parameters, fetal outcome and obstetric outcome of epidural analgesia in anaemic parturients and maternal satisfaction as well as pain relief among antenatal cases admitted in Upper India Sugar Exchange, GSVM Medical College, Kanpur, UP, India.

Methods: This prospective study was conducted in anaemic parturients with cephalic presentation, singleton pregnancy having 36-42 weeks of gestation. Subjects of present study were divided into 2 groups. Control group included anaemic parturients not undergoing epidural analgesia. Study group included anaemic parturients who will be undergoing epidural analgesia. All these patients were followed up to delivery. When cervix was 3cm dilated, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Top up dose (0.0625% bupivacaine) was injected through catheter on parturients demand. For effect on CTG parameters, NST was taken 15minutes before analgesia and every 30 minutes after analgesia. Following every top up dose 10 minute monitoring for uterine contractions and effect for adequate analgesia was noted. Side effects and complaints noted at 5, 15, 30, 45, 60, 90, 120, 150 and 180 min interval. Fetal condition was also monitored and evidence of fetal distress, on clinical and/or cardiotocographic monitoring, was recorded. Patients walking duration was recorded in relation to study time from epidural insertion to delivery time. Labour was managed and mode of delivery and time of delivery was noted. Assessment of neonatal outcome was done with the help of Apgar scoring at 1 and 5minute after delivery and NICU admissions.

Results: Maximum numbers of patients are lying between age groups of 18-23 and 24-29 years and are of gestational age group 37-40 weeks in both study and control group. The duration of 1st stage of labour in maximum number of primigravida patients is 5-8 hours and in multigravida it was 2-4 hours in both epidural and control group. The visual analogue scale is according to pain perceived during the course of labour and delivery by the epidural and control group. The degree of pain relief is statistically highly significant between epidural and control groups. Occurrences of maternal tachycardia are 5 times more in cases in whom epidural analgesia was not given.

Conclusions: There is no statistically significant difference in the duration of 2nd stage of labour in both the groups of primigravida as well as there is no effect on the duration of second stage of labour in multigravida parturients in both the groups. Pain relief was more in the epidural group and was more satisfied after their delivery. There was no difference in effect on fetal outcome in epidural and control groups. There was no significant effect on cardiotocographic parameters except for the fact that for about 30 minutes post epidural top-up, there was fetal bradycardia which easily subsided with conservative management with left lateral position and oxygen. Maternal tachycardia was less in epidural group. This was highly significant because anaemic parturients are more prone to develop signs of cardiac failure during labour due to increase in stroke volume due to increase in heart rate due to pain.


Cardiotocographic, Epidural analgesia, Maternal tachycardia

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