A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence

摘要: Abstract Objective To assess the effects of delayed vs immediate pushing in second stage labour with epidural analgesia on delivery outcome, postpartum faecal continence and anal sphincter pudendal nerve function. Design Prospective, randomised, controlled trial. Setting Tertiary referral maternity teaching hospital. Population One hundred seventy nulliparous women randomised at full dilatation to or pushing. Methods A total 178 women, all continuous analgesia, were cervical dilatation, but before fetal head had reached pelvic floor, either 1 hour Labour outcome was analysed underwent assessment function, including manometry. Those who a normal neurophysiology studies, while those an instrumental endoanal ultrasound. Main measures Mode delivery; altered continence. Results Ninety 88 The spontaneous rate 56% (50/90) group 52% (46/88) group. Mean duration for 427 minutes compared 480 (P = 0.005). Eighty-four percent (76/90) received oxytocin augment labour, 21/76 (28%) only. Eighty-one (71/88) 22/71 (31%) Fetal did not differ between two groups. Episiotomy rates 73% 69% groups, respectively. 26% (23/90) 38% (33/88) complained after (NS). Manometry, ultrasound studies significantly Overall, 55% endosonographic evidence damage external sphincter, 36% abnormal studies. Conclusions Rates similar following pushing, association analgesia. Delayed prolonged by result higher injury, when