Authors

1Mª Teresa Ramírez López, 2Mª Dolores Sánchez Galán

Position

¹Especialista en Enfermería Obstétrico-ginecológica (matrona) del Servicio de Paritorio del Hospital Universitario de Getafe (Madrid).²Especialista en Enfermería Obstétrico-ginecológica (matrona) y profesora de la Unidad Docente de Matronas de Madrid. Servicio de Paritorio del Hospital de Getafe (Madrid).

Contact address

Hospital Universitario de Getafe. Ctra. de Toledo Km 12,500. 28905 Getafe (Madrid).

Contact email: maytematro@satse.es

Abstract

Objective: the objective of this literature review is to analyse the advantages and disadvantages of a strategy to delay the start of active pushing once women with epidural anaesthesia have reached the expulsion stage.

Methodology: a literature review has been carried out from the CINAHL and Medline databases.
Results: epidural analgesia is a very effective way to alleviate pain in labor, but its employment has been related to a higher incidence of forceps-assisted delivery. With the aim of decreasing these effects, several different alternatives have been proposed, such as the use of oxytocin during the expulsion stage, decreased concentration of epidural anaesthesia and delayed start of active pushing. This last strategy aims at favouring the descend and rotation of the foetus and has generated several studies with contradictory results in some cases
As part of the benefits offered by this technique, we could highlight a decrease in the number of difficult deliveries, such as forceps with rotation, decreased number of decelerations in the expulsion stage, and decreased maternal tiredness.
As regards the disadvantages, some would be an increased risk of altered foetal pH, with a normal index of neonatal morbidity, and increased risk of maternal fever.
Conclusion: there are contradictory results with regard to the advantages and disadvantages of the strategy to delay the start of acting pushing. Should this strategy be used it would seem appropriate to have adequate monitoring of the mother and foetus.

Keywords:

delivery; delayed pushing; late pushing; epidural anaesthesiaexpulsion stage

Versión en Español

Título:

Manejo del expulsivo en mujeres con analgesia epidural: pujos demorados frente a pujos inmediatos