[Delayed versus immediate pushing in the second stage of labor for nulliparous parturients with epidural analgesia: a meta-analysis of randomized trials].

OBJECTIVES

The main object of this study was to evaluate the effect of delayed pushing on the second phase of delivery and the second one was to analyze the maternal and fetal consequences.

MATERIAL AND METHOD: This was a meta-analysis of randomized prospective studies. The inclusion criteria were nulliparous women with epidural analgesia, singleton cephalic presentation at term and a spontaneous or induced labor.

RESULTS

There was a significant increase in the number of spontaneous deliveries when pushing was delayed (p=0,019). On the other hand, no significant difference could be found in the incidence of perineal trauma (p=0,64). Post-partum hemorrhage and maternal fever could not be accurately evaluated because of insufficient data in the selected publications. Concerning the neonatal outcomes, the criteria for evaluation were too heterogeneous for analysis.

CONCLUSION

In nulliparous parturients under epidural analgesia the fetal descent must be respected, so long as the fetal heart rate is unremarkable, in order to increase the probability of a spontaneous delivery, without apparent adverse consequences for the mother or the neonate.