Effects of Combined Spinal-Epidural Analgesia during Labor on Postpartum Electrophysiological Function of Maternal Pelvic Floor Muscle: A Randomized Controlled Trial

Ji-Juan Xing, Xiu-Fen Liu, Xiao-Ming Xiong, Li Huang, Cheng-Yi Lao, Mei Yang, Shan Gao, Qiong-Yan Huang, Wei Yang, Yun-Feng Zhu, Di-Hua Zhang, Ji-Juan Xing, Xiu-Fen Liu, Xiao-Ming Xiong, Li Huang, Cheng-Yi Lao, Mei Yang, Shan Gao, Qiong-Yan Huang, Wei Yang, Yun-Feng Zhu, Di-Hua Zhang

Abstract

Objective: Combined spinal-epidural analgesia (CSEA) is sometimes used for difficult births, but whether it contributes to postpartum pelvic muscle disorder is unclear. This randomized controlled trial examined whether CSEA given during labor affects the electrophysiological index of postpartum pelvic floor muscle function.

Methods: A consecutive sample of primiparous women who delivered vaginally at term were randomly assigned to a CSEA group (n = 143) and control group (n = 142) between June 2013 and June 2014. All were assessed 6-8 weeks later for electrophysiological function of pelvic floor muscle.

Results: The two groups were similar in the degree of muscle strength, muscle fatigue, and pelvic dynamic pressure of pelvic floor muscle. The CSEA and control groups showed similar proportions of women with normal muscle strength (score ≥4) in type I pelvic fibers (23.1% vs. 14.1%, P = 0.051) and type II pelvic fibers (28.0% vs. 24.6%, P = 0.524). The groups also contained similar proportions of women who showed no fatigue in type I fibers (54.5% vs. 48.6%, P = 0.315) or type II fibers (88.8% vs. 87.3%, P = 0.699). Similarly low proportions of women in the CSEA group and control group showed normal pelvic dynamic pressure (11.2% vs. 7.7%, P = 0.321). However, women in the CSEA group spent significantly less time in labor than those in the control group (7.25 vs. 9.52 h, P <0.001).

Conclusions: CSEA did not affect the risk of postpartum pelvic muscle disorder in this cohort of primiparous women who gave birth vaginally. A significant shorter duration of labour was observed in the CSEA-group.

Trial registration: ClinicalTrials.gov NCT02334150.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. CONSORT flow diagram for randomized…
Fig 1. CONSORT flow diagram for randomized controlled study comparing postpartum electrophysiologic pelvic floor measurements after spontaneous vaginal delivery with combined spinal-epidural analgesia (CSEA) or no analgesia.

References

    1. Ding T, Wang DX, Qu Y, Chen Q, Zhu SN (2014) Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study. Anesth Analg 119: 383–392. 10.1213/ANE.0000000000000107
    1. Singh N, Natarajan P, Rao PB, George SK, Gnanasekar R (2014) Labor analgesia in Eisenmenger syndrome: peripartum concerns. Ann Card Anaesth 17: 176–177. 10.4103/0971-9784.129892
    1. Wisner KL, Stika CS, Clark CT (2014) Double duty: does epidural labor analgesia reduce both pain and postpartum depression? Anesth Analg 119: 219–221. 10.1213/ANE.0000000000000322
    1. Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM (2012) Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 10: CD003401 10.1002/14651858.CD003401.pub3
    1. Tsen LC, Thue B, Datta S, Segal S (1999) Is combined spinal-epidural analgesia associated with more rapid cervical dilation in nulliparous patients when compared with conventional epidural analgesia? Anesthesiology 91: 920–925.
    1. Ashton-Miller JA, Delancey JO (2009) On the biomechanics of vaginal birth and common sequelae. Annu Rev Biomed Eng 11: 163–176. 10.1146/annurev-bioeng-061008-124823
    1. Memon H, Handa VL (2012) Pelvic floor disorders following vaginal or cesarean delivery. Curr Opin Obstet Gynecol 24: 349–354. 10.1097/GCO.0b013e328357628b
    1. Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Munoz A (2011) Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol 118: 777–784. 10.1097/AOG.0b013e3182267f2f
    1. Shan XM, Lu Y, Su SP, Zhang D, Liao QP (2012) Clinical significance of pelvic floor muscle strength screening in postpartum women. Chin J Clin Obstet Gynecol 13: 92–95.
    1. Schulz KF, Altman DG, Moher D; CONSORT Group (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 340: c332 10.1136/bmj.c332
    1. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. (2006) Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 144:575–580.
    1. Gambling D, Berkowitz J, Farrell TR, Pue A, Shay D (2013) A randomized controlled comparison of epidural analgesia and combined spinal-epidural analgesia in a private practice setting: pain scores during first and second stages of labor and at delivery. Anesth Analg 116: 636–643. 10.1213/ANE.0b013e31827e4e29
    1. Long Y, Bian XM, Zhu L, Teng LR, Lei L, Lang JH (2007) [Effect of different delivery modes on the short-term function of the pelvic floor]. Chin J Obstet Gynecol 42:808–811.
    1. Wang SS, Hu MC (2014) [Effects of different delivery methods on the pelvic floor muscle dysfunction in 3057 early postpartum]. Contemporary Medicine 20:97–98.
    1. Bø K (1992) Pressure measurements during pelvic floor muscle contractions: the effect of different positions of the vaginal measuring device. Neurourol Urodyn 11:107–113.
    1. Bø K, Hagen RH, Kvarstein B, Larsen S (1990) Pelvic floor muscle exercise for the treatment of female stress urinary incontinence, II: validity of vaginal pressure measurements of pelvic muscle strength–the necessity of supplementary methods for control of correct contraction. Neurourol Urodyn 9:479–487.
    1. Bø K, Larsen S (1990) Classification and characterisation of responders to pelvic floor muscle exercise for female stress urinary incontinence. Neurourol Urodyn 9, 395–396.
    1. Lovett RW, Martin EG (1916) Certain aspects of infantile paralysis with a description of a method of muscle testing. JAMA 66:729–733.
    1. Frawley HC, Galea MP, Phillips BA, Sherburn M, Bø K (2006) Effect of test position on pelvic floor muscle assessment. Int Urogynecol J Pelvic Floor Dysfunct 17:365–371.
    1. Caroci Ade S, Riesco ML, Sousa Wda S, Cotrim AC, Sena EM, Rocha NL, et al. (2010) Analysis of pelvic floor musculature function during pregnancy and postpartum: a cohort study: (a prospective cohort study to assess the PFMS by perineometry and digital vaginal palpation during pregnancy and following vaginal or caesarean childbirth). J Clin Nurs 19:2424–2433. 10.1111/j.1365-2702.2010.03289.x
    1. Yao ZC, Sang WS, Yang SM, Li P, He XJ (2014) [Early postpartum pelvic floor muscle effect of comprehensive rehabilitation therapy on pelvic nerve electrophysiology]. Nurs Prac Res 11:6–8.
    1. Simmons SW, Cyna AM, Dennis AT, Hughes D (2007) Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev: CD003401
    1. Oliveira LS, Brito LG, Quintana SM, Duarte G, Marcolin AC (2014) Perineal trauma after vaginal delivery in healthy pregnant women. Sao Paulo Med J 132: 231–238.
    1. Panayi DC, Khullar V (2009) Urogynaecological problems in pregnancy and postpartum sequelae. Curr Opin Obstet Gynecol 21: 97–100. 10.1097/GCO.0b013e328321e44b
    1. Torrisi G, Minini G, Bernasconi F, Perrone A, Trezza G, Guardabassof V, et al. (2012) A prospective study of pelvic floor dysfunctions related to delivery. Eur J Obstet Gynecol Reprod Biol 160: 110–115. 10.1016/j.ejogrb.2011.10.010
    1. Gou WL, Wu LF. Delivery. 1st ed. Peking: People’s Medical Publishing House; 2003.
    1. Costantini S, Esposito F, Nadalini C, Lijoi D, Morano S, et al. (2006) Ultrasound imaging of the female perineum: the effect of vaginal delivery on pelvic floor dynamics. Ultrasound Obstet Gynecol 27: 183–187.
    1. Salvesen KA, Morkved S (2004) Randomised controlled trial of pelvic floor muscle training during pregnancy. BMJ 329: 378–380.
    1. Feng BB, Wang L, Zhai JJ (2013) Investigation on delivery analgesia effect of combined spinal epidural anesthesia plus Doula and safety of mother and baby. Clin Exp Obstet Gynecol 40: 574–578.
    1. Rofaeel A, Lilker S, Fallah S, Goldszmidt E, Carvalho J (2007) Intrathecal plain vs hyperbaric bupivacaine for labour analgesia: efficacy and side effects. Can J Anaesth 54: 15–20.
    1. Van de Velde M, Teunkens A, Hanssens M, Vandermeersch E, Verhaeghe J (2004) Intrathecal sufentanil and fetal heart rate abnormalities: a double-blind, double placebo-controlled trial comparing two forms of combined spinal epidural analgesia with epidural analgesia in labor. Anesth Analg 98: 1153–1159.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner