Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-12T19:40:55.111Z Has data issue: false hasContentIssue false

18 - Obstetrical anaesthesia

Published online by Cambridge University Press:  05 September 2009

Stephen Halpern
Affiliation:
University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
Ann Møller
Affiliation:
KAS Herlev, Copenhagen
Tom Pedersen
Affiliation:
Rigshospitalet, Copenhagen
Get access

Summary

Neuraxial analgesia (epidural, and combined spinal–epidural techniques) effectively relieves labour pain. Whether or not these modalities affect progress of labour has been controversial. This chapter discusses the effect of neuraxial analgesia on caesarean section rates, instrumental delivery rates and the duration of labour. There is strong, homogeneous evidence to show that neuraxial analgesia does not increase the caesarean section rate. There is also strong, consistent evidence to show that there is an increase in the incidence of instrumental vaginal delivery in patients who have neuraxial analgesia. Further, there appears to be a dose–response relationship – parturients exposed to high concentrations of local anaesthetic are at higher risk for instrumental vaginal delivery than those exposed to low concentrations. While there appears to be a prolongation of the second stage of labour with neuraxial analgesia, these results are inconsistent and dependent on the obstetric protocol at a particular institution. In conclusion, neuraxial analgesia does not cause an increased incidence of caesarean section but may increase the incidence of instrumental vaginal delivery. This effect can be reduced by reducing the concentration of local anaesthetic. The effect on the length of first and second stage of labour is variable but is likely clinically unimportant.

Introduction

Since the introduction of anaesthesia to obstetric practice by James Young Simpson in 1847, there have been controversies concerning its use.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Obstetrical anaesthesia
    • By Stephen Halpern, University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.019
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Obstetrical anaesthesia
    • By Stephen Halpern, University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.019
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Obstetrical anaesthesia
    • By Stephen Halpern, University of Toronto, Obstetrical Anaesthesia, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
  • Edited by Ann Møller, KAS Herlev, Copenhagen, Tom Pedersen, Rigshospitalet, Copenhagen
  • Book: Evidence-based Anaesthesia and Intensive Care
  • Online publication: 05 September 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544613.019
Available formats
×