Wpływ znieczulenia zewnątrzoponowego na przebieg porodu

*Magdalena Świątek-Zdzienicka¹, Elżbieta Nowacka^{1, 2}, Robert Jarzębski¹, Romana Krawczyńska-Wichrzycka¹

Summary
Mothers given epidural anaesthesia are usually satisfied with analgesia. It should not, however, affect the incidence of caesarean delivery, instrumented vaginal delivery, foetal oxygenation or 5-minute Apgar scores.
Early institution of epidural analgesia may be associated with longer first stage labour and increase incidence of caesarean section, especially when local anaesthetics (LA) are used. Epidural opioid administration seems more safe at this stage. Side effects are not severe and are usually related to the doses and concentrations of LA. Hypotonia may be prevented by volume preload, which is not required when low doses of LA are used. Active management of labour can shorten the first stage and improve condition of neonates. Epidural analgesia is associated with longer second-stage labour. Therefore, it should be stopped by 8-9 mm cervix dilatation. The incidence of caesarean delivery depends on proper cooperation between gynecologists and anaesthesiologists and it is not increased among experienced teams. There are, however, center-to-center individual variations.
Epidural analgesia may induce maternal fever and shivering; the exact mechanism of this phenomenon has not been fully understood. Among possible causes are: sympathetic autonomic blockade and vasodilatation, absence of muscle activity, decreased sweating, thermoregulation disturbances.
Uncomplicated epidural analgesia does not affect neonatal condition; sometimes, prolonged second stage may result in lower Apgar scores and need for neonatal resuscitation.

To jest tylko fragment artykułu. Aby przeczytać całość, przejdź do Czytelni medycznej.