Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine.
OBJECTIVE
To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine.


METHODS
This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer.


RESULTS
In the second stage, 79 were persistent occiput posterior position (POPP) fetuses and 36 were translated from anterior to posterior position (TAPP) fetuses. Specifically, in spontaneous labour on 25 women in anterior position, there were 17 TAPP and in CSE analgesia on 28 women in anterior, there were 19 in TAPP, without significant differences. The number of asynclitisms was higher in the POPP group (84%) respect to the TAPP group (75%), so as the rate of caesarean section (67% versus 52.7%).


CONCLUSIONS
The labour with low dose of ropivacaine and sufentanyl does not increase the occiput posterior position during fetal descent, leading to a POPP. Finally, since in the occiput anterior presentation labour analgesia significantly lengthens time to delivery, in the occiput posterior position this is significantly increased, with a prolonged second stage of labour and reduced time of descent of fetal head in obstetric pelvis.
Department of Obstetrics and Gynaecology, "Santa Maria" Hospital, Bari, Italy. antoniomalvasi@gmail.com
A
A
Malvasi
A
A
Tinelli
A
A
Brizzi
M
M
Guido
V
V
Martino
S
S
Casciaro
D
D
Celleno
M G
MG
Frigo
M
M
Stark
D
D
Benhamou
D000328:Adult; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D015992:Body Mass Index; D002585:Cesarean Section; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D005323:Fetal Monitoring / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007746:Labor Presentation; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D011247:Pregnancy; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil