Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial (see comments)

摘要

OBJECTIVE: To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries. DESIGN: A randomised controlled trial. SETTING: The delivery suite at Leeds General Infirmary. SAMPLE: One hundred and thirty-five nulliparous women with an effective epidural in labour. METHODS: The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner. MAIN OUTCOME MEASURE: Rate of instrumental vaginal delivery. RESULTS: There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31, 95% CI 0.62-2.78). No adverse effects were noted. CONCLUSION: Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.