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  • Review: delayed pushing reduces rotational or mid pelvic instrumental deliveries but increases duration of the second stage of labour in women having epidural analgesia

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Therapeutics
Review: delayed pushing reduces rotational or mid pelvic instrumental deliveries but increases duration of the second stage of labour in women having epidural analgesia

https://doi.org/10.1136/ebm.10.4.122

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    Roberts CL, Torvaldsen S, Cameron C, et al. Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis. BJOG 2004;111:1333–40.
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 Q In women with uncomplicated pregnancies having effective epidural analgesia in the first stage of labour, what is the effectiveness of delayed compared with early pushing?

    Clinical impact ratings GP/FP/Obstetrics ★★★★★★☆ Obstetrics ★★★★★★☆

    METHODS

    Embedded ImageData sources:

    Medline, CINAHL, EMBASE/Excerpta Medica (all from inception to October 2003), the Cochrane Central Register of Controlled Trials (searched October 2003), and bibliographies of relevant papers.

    Embedded ImageStudy selection and assessment:

    randomised controlled trials (RCTs) of delayed versus early pushing in women having effective epidural analgesia in the first stage of labour and an uncomplicated pregnancy. Studies were assessed for allocation concealment, losses to follow up, and intention to treat analysis.

    Embedded ImageOutcomes:

    instrumental deliveries, and maternal and infant morbidity.

    MAIN RESULTS

    9 trials (2953 women) met the selection criteria. All trials included women at term with spontaneous …

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    Footnotes

    • For correspondence: Dr C L Roberts, University of Sydney, Sydney, New South Wales, Australia. christine.robertsperinatal.usyd.edu.au

    • Source of funding: National Health and Medicine Research Council.