Effect of epidural anaesthesia on clinician-applied force during vaginal delivery.
OBJECTIVE
Epidural anesthesia (EA) is used in 80% of vaginal deliveries and is linked to neonatal and maternal trauma. Our objectives were to determine (1) whether EA affected clinician-applied force on the fetus and (2) whether this force influenced perineal trauma.


METHODS
After informed consent, multiparas with term, cephalic, singletons were delivered by 1 physician wearing a sensor-equipped glove to record force exerted on the fetal head. Those with EA were compared with those without for delivery force parameters. Regression analysis was used to identify predictors of vaginal laceration.


RESULTS
The force required for delivery was greater in patients with EA (n = 27) than without (n = 5) (P < .01). Clinical parameters, including birth weight (P = .31) were similar between the groups. Clinician force was similar in those with no versus first- versus second-degree laceration (P = .5). Only birth weight was predictive of laceration (P = .02).


CONCLUSIONS
Epidural use resulted in greater clinician force required for vaginal delivery of the fetus in multiparas, but this force was not associated with perineal trauma.
Georgetown University Hospital, Department of Obstetrics and Gynecology, Washington, DC 20007, USA. shp2@gunet.georgetown.edu
Sarah H
SH
Poggi
Robert H
RH
Allen
Chirag
C
Patel
Shad H
SH
Deering
John C
JC
Pezzullo
Young
Y
Shin
Catherine Y
CY
Spong
D000767:Anesthesia, Epidural / Q000009:adverse effects*; D001720:Birth Injuries / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000453:epidemiology; D011247:Pregnancy; D011312:Pressure; D012044:Regression Analysis; D014621:Vagina / Q000293:injuries