Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2010
Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.
Сравнительное исследованиеСтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Gillesby Erica, Burns Suzan, Dempsey Amy, Kirby Shirley, Mogensen Kami, Naylor Kelly, Petrella Joann, Vanicelli Rebecca, Whelan Breon
Аннотация
OBJECTIVE: To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue.
DESIGN: Randomized clinical trial.
SETTING: Labor and delivery unit of a not-for-profit community hospital.
PATIENTS/PARTICIPANTS: Convenience sample of nulliparous laboring women with epidural anesthesia.
INTERVENTIONS: Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation.
MAIN OUTCOME MEASURES: The length of pushing, total length of the second stage, and maternal fatigue.
RESULTS: A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05).
CONCLUSIONS: We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group.
DESIGN: Randomized clinical trial.
SETTING: Labor and delivery unit of a not-for-profit community hospital.
PATIENTS/PARTICIPANTS: Convenience sample of nulliparous laboring women with epidural anesthesia.
INTERVENTIONS: Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation.
MAIN OUTCOME MEASURES: The length of pushing, total length of the second stage, and maternal fatigue.
RESULTS: A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05).
CONCLUSIONS: We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group.