Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial.
OBJECTIVE
To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries.


METHODS
A randomised controlled trial.


METHODS
The delivery suite at Leeds General Infirmary.


METHODS
One hundred and thirty-five nulliparous women with an effective epidural in labour.


METHODS
The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner.


METHODS
Rate of instrumental vaginal delivery.


RESULTS
There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31, 95% CI 0.62-2.78). No adverse effects were noted.


CONCLUSIONS
Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.
Vause
S
S
Department of Obstetrics and Gynaecology, North Manchester General Hospital, UK.
Congdon
H M
HM
Thornton
J G
JG
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D036861:Delivery, Obstetric / Q000379:methods*; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007748:Labor Stage, Second / Q000502:physiology*; D010298:Parity; D011247:Pregnancy; D013997:Time Factors