RESUMO
Labour is an extremely painful process. Labour pain can have deleterious effects on the mother, on the foetus and on the labour outcome. Among the current methods of obstetric analgesia, regional analgesia (the most widespread technique being epidural analgesia) offers the best effectiveness/safety ratio. The increased availability of epidural analgesia and the favourable experiences of women who have had painless labour with epidural block have reshaped the expectations of pregnant women entering labour. Compared with other forms of pain relief, epidural analgesia is associated with the highest level of maternal satisfaction. Taking into consideration this aspect, a study was performed in a tertiary care center over a period of 18 months.METHODS160 patients fulfilling the inclusion criteria were divided into two groups namely Group A and Group B. Group A was administered epidural analgesia while Group B was offered other analgesic agents (inj. tramadol hydrochloride) after obtaining well informed consent. Pain compliance is marked over VAS at this point of time. Once the effect of epidural starts waning off, top up dosages are administered by anaesthesiologists. Increments or derangements in pain compliance are noted timely. Any maternal side effects such as headache, hypotension, motor paralysis etc. are noted. Duration of first and second stage of labour is noted with the help of partogram. In the end, mode of delivery, indication of instrumental delivery/caesarean section, neonatal outcome in terms of APGAR scores were noted.RESULTSProlongation of first and second stage of labour, increase in the rate of instrumental/caesarean delivery was not statistically significant between both the groups. (p>0.05). p Value calculated using unpaired t test (p= 0.5116). Maternal requests for caesarean section were significantly higher in control group compared to epidural group (p<0.05). This may be due to non/less efficacy of other analgesic drugs than epidural analgesics. The difference in VAS score between both the study groups was statistically significant (p<0.001) indicating that pain was significantly less in epidural group.CONCLUSIONSEpidural analgesia provides excellent labour analgesia compared to other agents with no significant prolongation of first and second stage of labour or mode of delivery. Study also shows that there is no significant rise in the number of instrumental or caesarean deliveries due to epidural analgesia. There are no serious maternal or foetal side effects of the epidural analgesia. Hence, it can be safely recommended in labour. The analgesic effect can be maintained as long as needed and even after delivery to relieve postoperative pain.
RESUMO
Vaginal leiomyomas are uncommon masses located on the anterior wall of vagina and rarely lateral wall and vulval region. Only 250 and 300 cases have been reported worldwide. These are benign smooth muscle lesions, usually single and mostly without symptoms. The cause is unknown. Histologically, they resemble leiomyoma elsewhere. They originate from smooth muscle cells of vagina, local arterial musculature, or bladder or urethra smooth muscles. These are oestrogen dependent lesions like uterine leiomyomas. They rarely become malignant. Pressure symptoms include discharge per vaginum or bleeding, dyspareunia, or retention of urine. Lesion has to be excised in the symptomatic patient. Recurrence is rare.