title: [Delayed versus immediate pushing in the second stage of labor for nulliparous parturients with epidural analgesia: a meta-analysis of randomized trials].
abstract: OBJECTIVE
  The main object of this study was to evaluate the effect of delayed pushing on the second phase of delivery and the second one was to analyze the maternal and fetal consequences.
  
  
  METHODS
  This was a meta-analysis of randomized prospective studies. The inclusion criteria were nulliparous women with epidural analgesia, singleton cephalic presentation at term and a spontaneous or induced labor.
  
  
  RESULTS
  There was a significant increase in the number of spontaneous deliveries when pushing was delayed (p=0,019). On the other hand, no significant difference could be found in the incidence of perineal trauma (p=0,64). Post-partum hemorrhage and maternal fever could not be accurately evaluated because of insufficient data in the selected publications. Concerning the neonatal outcomes, the criteria for evaluation were too heterogeneous for analysis.
  
  
  CONCLUSIONS
  In nulliparous parturients under epidural analgesia the fetal descent must be respected, so long as the fetal heart rate is unremarkable, in order to increase the probability of a spontaneous delivery, without apparent adverse consequences for the mother or the neonate.
authors.affiliation: Service de Gynécologie-Obstétrique, Pavillon Mère et Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes Cedex 1.
authors.forename: C
authors.initials: C
authors.lastname: Menez-Orieux
authors.forename: T
authors.initials: T
authors.lastname: Linet
authors.forename: H-J
authors.initials: HJ
authors.lastname: Philippe
authors.forename: G
authors.initials: G
authors.lastname: Boog
mesh_terms: D015360:Analgesia, Epidural; D005260:Female; D006801:Humans; D007748:Labor Stage, Second / Q000502:physiology*; D010298:Parity; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors