ABSTRACT
In this prospective observational study, 28 high risk patients were analyzed after giving epidural analgesia (EA) for labor pain relief over a period of 3 years. 5 cc Bupivacaine (0.125%) + 1 cc Fentanyl (10 mcg) were given and the maternal pain relief and fetal outcome were analyzed. Onset time of analgesia and level of analgesia was assessed by pin prick method.21 patients were primigravidae. 15 patients had a single risk factor while 13 patients had 2 risk factors affecting simultaneously. Pregnancy Induced Hypertension (PIH) was the commonest high risk condition occurring in 20 patients. Average analgesia onset time was 7.8 minutes. Analgesia lasted for > 2 hrs after administration of first dose in 23 patients. Rate of LSCS was 7.1% (2 patients) and instrumental delivery was 14.2 % (4 patients). 24 babies had an Apgar score of >/= 7. Complete pain relief was observed in 10 patients while 16 had moderate, 1 had slight and 1 had no pain relief. No major maternal or fetal complications were reported. EA is a very safe and effective form of analgesia in the interest of maternal and fetal welfare not only in normal pregnant gravidas, but also in high risk patients.
ABSTRACT
A study was carried out among 81 women with previous one caesarean section (CS) done for non-recurrent indications to confirm the efficacy and safety of trial of labour (TOL) and to examine the effect of various factors on the mode of delivery. Singleton term pregnancy, vertex presentation and adequate pelvic capacity were the pre-requisites for case selection. Careful monitoring was done during labour and effect of various factors on the outcome was analysed statistically. Success rate of TOL was 73%. A non-recurrent indication for previous CS, such as malpresentation and foetal distress is associated with higher success rate of vaginal birth after caesarean (VBAC) compared to recurrent indications, such as cephalopelvic disproportion (CPD) and failure to progress (FTP). Prior vaginal birth improves the success rate (87%) of VBAC. Factors like premature rupture of membranes, hypertensive disorders of pregnancy, and post-date pregnancy did not affect the outcome adversely. Rate of emergency CS was 44% in women with floating head foetus, 39% in induction/augmentation group and 43% when birth weight of the foetus was > 3000 g. No maternal/perinatal mortality observed. Maternal/perinatal morbidity was low in cases with successful TOL. Uterine rupture occurred in one woman. There are few absolute contra-indications to attempted VBAC. Though the success rate does vary with different pre-existing factors, the clinician may anticipate greater than 50% chance for success in any individual labour.