ABSTRACT
Background: The pathways that are involved for the duration of pregnancy and type of parturition are extremely complex, involving maternal as well as fetal systems. The objective of this study was to determine the frequency of types of parturition and their relationship with maternal characteristics among pregnant female patients.Methods: A cross-sectional survey using a non-probability convenient sampling technique was conducted among 195 healthy pregnant females at Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, from 1st March 2019 to 31st August 2019. After taking written informed consent from the participants, the relevant data were gathered with the help of a structured questionnaire designed specifically for the study. Statistical package for social sciences was used for data entry while the chi-square test was applied for inferential analysis. The duration of the study was six months. Data were entered and analyzed using Statistical Package for Social Sciences version 20.0. Descriptive analysis was performed by generating means and standard deviations for continuous variables while frequencies and percentages for categorical variables. A Chi-square test was applied to perform the inferential analysis while the significance level was set at 0.05.Results: A total of 195 pregnant females were included in the study, whose mean age was 29.29±5.22 years. The study results showed that BMI before pregnancy (p=0.021), rest is taken during pregnancy (p=0.034) and gravida status (p=0.047) were all significantly associated with the type of parturition among the study participants, but spacing in pregnancies and parity were not.Conclusions: Maternal characteristics were found to be significantly associated with the type of parturition among pregnant females. For gynecologists the maternal characteristics identified in this study may serve as a useful indicator of the type of parturition expected in their patients.
ABSTRACT
Effective pain relief is one of the important components of management of normal labor. Adequate pain relief is associated with reduction in maternal sympathetic activity and considerably decreased maternal anxiety level. Epidural analgesia is being increasingly used for this purpose. Many local anesthetic drugs are being used for providing epidural analgesia. We conducted this study to compare Ropivacaine and Levobupivacaine in terms of onset and duration of analgesia, motor involvement, hemodynamic effects and neonatal outcome. Methods: This was a prospective comparative study in which 100 patients presenting in spontaneous labour were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups on the basis of drug used. Group A patients received Ropivacaine along with fentanyl whereas group B patients received Levobupivacaine along with fentanyl. VAS score, Sensory and motor block and vital parameters were recorded before giving epidural and 5,15, 30 and 60 minutes and thereafter every hourly till delivery took place. Sensory block was assessed by pin prick sensation whereas motor block was assessed by modified bromage scale. Statistical analysis was done using SSPS 21 software and p value less than 0.05 was taken as statistically significant. Results: Parameters such as height, weight, body mass index, ASA grades, gravidity and duration of labor were found to be comparable in both the groups with no statistically significant difference in between 2 groups (P>0.05). Mode of delivery and conversion to LSCS was also similar in both the groups. Mean time for onset of analgesia was comparable in both the groups. The mean VAS scores in group A were found to be less as compared to group B during initial 1 hour after the bolus dose and the difference was found to be statistically significant (P<0.0001). After 1 hour the VAS scores were found to be comparable in both the groups with no statistically significant difference in the mean VAS scores of patients in both the groups (P>0.05). The need for top-up analgesia was found to be statistically significantly higher in group B as compared to group A (P=0.0277). The motor sparing was better in group A as compared to group B and the difference was found to be statistically significant (P=0.0026). Hemodynamics and neonatal outcome were found to be comparable in both the groups (P>0.05). Conclusion: Ropivacaine is a better local anesthetic drug as compared to Bupivacaine for labor analgesia. Its use is associated with better analgesic effect, superior motor sparing and less need for top up analgesic doses.