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Rev Bras Ginecol Obstet. 2009;31(10):485-491
DOI 10.1590/S0100-72032009001000003
PURPOSE: to compare maternal and perinatal results, after the use of continuous peridural versus combined rachidian and peridural analgesia in primiparous parturients. METHODS: randomized clinical trial with 128 primiparous pregnant women in labor, divided into two groups: peridural analgesia (CPA) with 65 women, and combined continuous rachidian and peridural analgesia (CRPA) with 63, all of them admitted in the pre-labor period at two maternities in Jundiai, in the state of São Paulo. The variables studied were: latency of analgesia onset, pain intensity, total time until complete dilation, Apgar index at the first and fifth minutes, labor duration, degree of motor blockade, adverse effects such as vomiting, pruritus, arterial hypotension and degree of maternal fulfillment. Inclusion criteria were: primiparous, physical condition ASA 1 and 2, an only foetus, cephalic presentation, term delivery, 3 to 6 cm cervical dilation, and analgesia required by the obstetritian. Women with morbidity, membrane rupture, fetal abnormality and use of opioids up to four hours before were excluded. The Mann-Whitney test was used for the statistical analysis of non-parametric continuous variables, and Fisher's exact and Pearson's χ2 tests, for the categoric variables. RESULTS: there was no difference between the groups concerning the length of cervical dilation, labor duration, maternal hemodynamic parameters, newborn vitality, analgesic complementation during labor and type of delivery. Analgesia onset was quicker in the CRPA group, and the CPA group presented less motor blockade. Differences concerning adverse effects such as nausea, vomiting, pruritus and hypotension have not been observed, but hypotension was more frequent in the CPA group (6.3 versus 3.1%). CONCLUSIONS: both techniques have proved to be safe and efficient, but CRP has provided an earlier onset, with quicker pain relief. The lesser motor blockade in the CPA group has allowed the parturients more active movements in bed and more effective collaboration during the expulsion period. Most women were pleased with the analgesia they got. The doses of local anesthetics and opioids used in both analgesic techniques and the complementary doses, equal in both groups, neither had any significant adverse effect nor affected newborn vitality.
Summary
Rev Bras Ginecol Obstet. 2009;31(10):485-491
DOI 10.1590/S0100-72032009001000003
PURPOSE: to compare maternal and perinatal results, after the use of continuous peridural versus combined rachidian and peridural analgesia in primiparous parturients. METHODS: randomized clinical trial with 128 primiparous pregnant women in labor, divided into two groups: peridural analgesia (CPA) with 65 women, and combined continuous rachidian and peridural analgesia (CRPA) with 63, all of them admitted in the pre-labor period at two maternities in Jundiai, in the state of São Paulo. The variables studied were: latency of analgesia onset, pain intensity, total time until complete dilation, Apgar index at the first and fifth minutes, labor duration, degree of motor blockade, adverse effects such as vomiting, pruritus, arterial hypotension and degree of maternal fulfillment. Inclusion criteria were: primiparous, physical condition ASA 1 and 2, an only foetus, cephalic presentation, term delivery, 3 to 6 cm cervical dilation, and analgesia required by the obstetritian. Women with morbidity, membrane rupture, fetal abnormality and use of opioids up to four hours before were excluded. The Mann-Whitney test was used for the statistical analysis of non-parametric continuous variables, and Fisher's exact and Pearson's χ2 tests, for the categoric variables. RESULTS: there was no difference between the groups concerning the length of cervical dilation, labor duration, maternal hemodynamic parameters, newborn vitality, analgesic complementation during labor and type of delivery. Analgesia onset was quicker in the CRPA group, and the CPA group presented less motor blockade. Differences concerning adverse effects such as nausea, vomiting, pruritus and hypotension have not been observed, but hypotension was more frequent in the CPA group (6.3 versus 3.1%). CONCLUSIONS: both techniques have proved to be safe and efficient, but CRP has provided an earlier onset, with quicker pain relief. The lesser motor blockade in the CPA group has allowed the parturients more active movements in bed and more effective collaboration during the expulsion period. Most women were pleased with the analgesia they got. The doses of local anesthetics and opioids used in both analgesic techniques and the complementary doses, equal in both groups, neither had any significant adverse effect nor affected newborn vitality.
Summary
Rev Bras Ginecol Obstet. 1998;20(9):495-501
DOI 10.1590/S0100-72031998000900002
Objective: to compare the expectant versus active management with oxytocin in a Brazilian population of pregnant women with premature rupture of membranes (PROM) at term. Methods: a prospective, randomized and multicenter clinical trial was performed, evaluating variables concerning the time from PROM until the onset of labor and delivery, and maternal and neonatal hospitalization periods. Two hundred pregnant women with PROM at term were selected from four public hospitals in São Paulo state, from November 1995 to February 1997. They were randomly divided into two groups: active management, with oxytocin induction of labor until 6 h of PROM; and expectant management, waiting for the spontaneous onset of labor up to 24 h. The data were analyzed with the Epi-Info and SPSS-PC+ packages, using the statistical c², Student's t and log-rank tests. Results: the results indicate that the differences between the two managements concern to the longer time needed for the expectant management group until onset of labor and delivery, besides the higher number of women and neonates who remained in hospital for more than three days. Conclusions: the time between admission and onset of labor and delivery, and also the latent period were longer in the expectant management group.
Summary
Rev Bras Ginecol Obstet. 1998;20(9):495-501
DOI 10.1590/S0100-72031998000900002
Objective: to compare the expectant versus active management with oxytocin in a Brazilian population of pregnant women with premature rupture of membranes (PROM) at term. Methods: a prospective, randomized and multicenter clinical trial was performed, evaluating variables concerning the time from PROM until the onset of labor and delivery, and maternal and neonatal hospitalization periods. Two hundred pregnant women with PROM at term were selected from four public hospitals in São Paulo state, from November 1995 to February 1997. They were randomly divided into two groups: active management, with oxytocin induction of labor until 6 h of PROM; and expectant management, waiting for the spontaneous onset of labor up to 24 h. The data were analyzed with the Epi-Info and SPSS-PC+ packages, using the statistical c², Student's t and log-rank tests. Results: the results indicate that the differences between the two managements concern to the longer time needed for the expectant management group until onset of labor and delivery, besides the higher number of women and neonates who remained in hospital for more than three days. Conclusions: the time between admission and onset of labor and delivery, and also the latent period were longer in the expectant management group.
Summary
Rev Bras Ginecol Obstet. 2002;24(10):641-646
DOI 10.1590/S0100-72032002001000002
PURPOSE: to compare the effectiveness and safety of two different doses of misoprostol (12.5 mug and 25 mug) administered vaginally for cervical ripening and labor induction in term pregnancies with an indication for interruption. METHODS: this was a pilot randomized controlled single blinded trial, including 40 pregnant women treated with one of the two different doses of misoprostol. The independent variable was the dose of misoprostol and the main dependent variables were the mode of delivery, time between induction and delivery, perinatal complications and maternal side effects. The main control variables were maternal age, gestational age, literacy, parity, skin color and conditions of the cervix at the beginning of induction. For data analysis Student's t test, chi2, exact Fisher, Wilcoxon and Kolmogorov-Smirnof tests were used, besides survival analysis. RESULTS: the groups using 12.5 and 25 mug were similar and did not present any significant difference regarding time for onset of uterine contractions (20.9±20.4 and 16.6±9.8 h, respectively), time between onset of uterine contractions and delivery (7.8±3.4 and 6.9±5.0 h), vaginal delivery (65 and 80%) and maternal and perinatal side effects (similar Apgar scores and hyperstimulation syndrome in both groups). CONCLUSION: the higher percentage of vaginal births and the shorter time for delivery using 25 mug, although not significant, does not allow to recommend the dose of 12.5 mug as more advantageous for cervical ripening and labor induction in term pregnancies.
Summary
Rev Bras Ginecol Obstet. 2002;24(10):641-646
DOI 10.1590/S0100-72032002001000002
PURPOSE: to compare the effectiveness and safety of two different doses of misoprostol (12.5 mug and 25 mug) administered vaginally for cervical ripening and labor induction in term pregnancies with an indication for interruption. METHODS: this was a pilot randomized controlled single blinded trial, including 40 pregnant women treated with one of the two different doses of misoprostol. The independent variable was the dose of misoprostol and the main dependent variables were the mode of delivery, time between induction and delivery, perinatal complications and maternal side effects. The main control variables were maternal age, gestational age, literacy, parity, skin color and conditions of the cervix at the beginning of induction. For data analysis Student's t test, chi2, exact Fisher, Wilcoxon and Kolmogorov-Smirnof tests were used, besides survival analysis. RESULTS: the groups using 12.5 and 25 mug were similar and did not present any significant difference regarding time for onset of uterine contractions (20.9±20.4 and 16.6±9.8 h, respectively), time between onset of uterine contractions and delivery (7.8±3.4 and 6.9±5.0 h), vaginal delivery (65 and 80%) and maternal and perinatal side effects (similar Apgar scores and hyperstimulation syndrome in both groups). CONCLUSION: the higher percentage of vaginal births and the shorter time for delivery using 25 mug, although not significant, does not allow to recommend the dose of 12.5 mug as more advantageous for cervical ripening and labor induction in term pregnancies.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):791-798
DOI 10.1590/S0100-72032004001000006
PURPOSE: to find out the preference in regard to the way of delivery among primigravidae, as well as the reasons for their choice, in order to improve the quality of the doctor-patient relationship. METHODS: a qualitative-type study was conducted through analysis of the collective subject, including primigravidae attended from September to November 2003 at the emergency rooms of the hospital of the "Faculdade de Medicina de Jundiaí". A questionnaire, specially developed to accomplish the proposed objectives was applied. An informed and free consent, signed by the pregnant woman and one of the researchers in charge was obtained. This questionnaire was based on doubts of patients attended at this hospital some months before the trial. For the purpose of sample standardization, the patients' selection followed some inclusion criteria: age above 16, primigravidae that were receiving prenatal assistance and a post-informed and free consent. Mental disorders and clinical and/or obstetric pathologies that could interfere in the patient's choice were considered exclusion criteria. RESULTS: the studied population had as prevailing profile women in the third quarter of gestation, above 21 years of age, white, married and with completed school. Most of the women (90%) preferred vaginal delivery for the following main reasons: ease to be done (94%) and the fear of suffering and pain during the postpartum period caused by cesarean section. There was a relationship between older and married women and the preference for vaginal delivery, with no significant difference between races. CONCLUSION: these results show an enormous contrast between women's preference and the high cesarean section rates in Brazil. We conclude that there may be a lack of information and dialogue between the health professionals and patients about the possible difficulties, doubts and anxieties that involve the women's choice for a specific way of delivery. From an ethical point of view, we conclude that obstetricians should question every cesarean section indication and take into account the women's right to choose, without ignoring clinical criteria, when making the medical decision about the way of delivery.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):791-798
DOI 10.1590/S0100-72032004001000006
PURPOSE: to find out the preference in regard to the way of delivery among primigravidae, as well as the reasons for their choice, in order to improve the quality of the doctor-patient relationship. METHODS: a qualitative-type study was conducted through analysis of the collective subject, including primigravidae attended from September to November 2003 at the emergency rooms of the hospital of the "Faculdade de Medicina de Jundiaí". A questionnaire, specially developed to accomplish the proposed objectives was applied. An informed and free consent, signed by the pregnant woman and one of the researchers in charge was obtained. This questionnaire was based on doubts of patients attended at this hospital some months before the trial. For the purpose of sample standardization, the patients' selection followed some inclusion criteria: age above 16, primigravidae that were receiving prenatal assistance and a post-informed and free consent. Mental disorders and clinical and/or obstetric pathologies that could interfere in the patient's choice were considered exclusion criteria. RESULTS: the studied population had as prevailing profile women in the third quarter of gestation, above 21 years of age, white, married and with completed school. Most of the women (90%) preferred vaginal delivery for the following main reasons: ease to be done (94%) and the fear of suffering and pain during the postpartum period caused by cesarean section. There was a relationship between older and married women and the preference for vaginal delivery, with no significant difference between races. CONCLUSION: these results show an enormous contrast between women's preference and the high cesarean section rates in Brazil. We conclude that there may be a lack of information and dialogue between the health professionals and patients about the possible difficulties, doubts and anxieties that involve the women's choice for a specific way of delivery. From an ethical point of view, we conclude that obstetricians should question every cesarean section indication and take into account the women's right to choose, without ignoring clinical criteria, when making the medical decision about the way of delivery.
