Objective: The aim of this study was to assess whether the station of the fetal head at epidural placement is associated with the risk of malposition during labour.
Study Design: Retrospective study (covering a 3-month period) of patients in labour with singleton cephalic term fetuses and epidural placement before 5 cm of dilatation. We studied the following risk factors for malposition: station and cervical dilatation at epidural placement, induction of labour, parity and macrosomia. Malposition, defined as all occiput posterior and occiput transverse positions, was assessed at 5 cm of dilatation because of our policy of systematic manual rotation for malpositions.
Results: The study included 398 patients, 200 of whom had malpositions diagnosed at 5 cm of dilatation. In both the univariate and multivariate analyses, station at epidural placement was the only risk factor significantly associated with this malposition (adjusted OR: 2.49, 95% CI 1.47-4.24). None of the other factors studied was significantly associated with malposition: nulliparity (OR 1.45, 95% CI 0.96-2.20), macrosomia (OR 0.75, 95% CI 0.37-1.50), induction of labour (OR 0.84, 95% CI 0.49-1.45), or dilatation less than 3 cm at epidural administration (OR 1.16, 95% CI 0.59-2.30). Only three infants of the 365 delivered vaginally (0.8%) were born in occiput posterior positions.
Conclusion: Epidural placement when the fetal head is still "high" is associated with an increased rate of occiput posterior and transverse malpositions during labour.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.ejogrb.2005.02.009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks: A cadaveric observational study and a clinical randomized controlled trial.
J Clin Anesth
January 2025
Department of Anesthesiology, Sapporo Medical University School of Medicine, 291 South 1 West 16, Chuo-ku, Sapporo-shi, Hokkaido 060-8543, Japan.
Study Objective: We developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees.
Design: A cadaveric observational study and a clinical randomized controlled trial.
Setting: Sapporo Medical University Hospital.
A Novel Approach of Ultrasound-Guided Transforaminal Cervical Nerve Root Injection With Fluoroscopic Validation: A Case Report and Technical Illustration.
Cureus
December 2024
Pain and Rehabilitation, Regen Clinic, Taipei, TWN.
Article Synopsis
- Cervical radiculopathies are typically treated with nerve root injections, and this study introduces a new ultrasound-guided technique for better visualization and injection accuracy.
- A 56-year-old patient with chronic C6 radiculopathy received treatment using this method, combining 5% dextrose and vitamin B12, which significantly improved their symptoms.
- The new technique ensures precise needle placement and effective medication spread while minimizing risks and reducing the need for fluoroscopy, lowering radiation exposure and enhancing treatment outcomes.
Beyond Risk Factors: Spinal Epidural Abscess in a Young, Healthy Patient.
Cureus
November 2024
Anesthesiology, Unidade Local de Saúde do Alentejo Central, Évora, PRT.
Epidural abscess is a rare complication of neuraxial techniques, which, when left unnoticed, can lead to significant neurological deficits and poor outcomes. Identification of patients at high risk and the conduct of a strict aseptic technique are some of the measures that play an important role in epidural abscess prevention. Prompt recognition and treatment of epidural abscesses are essential.
View Article and Find Full Text PDFOptimizing Cervical Epidural Steroid Injections: A Case Report.
Orthop Rev (Pavia)
October 2024
Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston.
Cervical radiculopathy is characterized by pain, numbness, and weakness in the upper limbs. This is typically caused by nerve root compression. While conservative treatments like physical therapy and oral analgesics are often used, they may not be effective in more severe cases.
View Article and Find Full Text PDFRacial and Ethnic Disparities in Epidural Blood Patch Utilization Among Obstetric Patients in the United States: A Nationwide Analysis, 2016-2020.
Anesth Analg
December 2024
From the Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas.
Background: Racial and ethnic disparities in health care delivery can lead to inadequate peripartum pain management and associated adverse maternal outcomes. An epidural blood patch (EBP) is the definitive treatment for moderate to severe postdural puncture headache (PDPH), a potentially debilitating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!