Abstract
Objective: This study was undertaken to determine whether a policy of delayed pushing for nulliparous
women with continuous-infusion epidural analgesia reduces the risk of difficult delivery
(cesarean delivery, operative delivery from a midpelvic position, low-pelvic procedures
with rotation >45°). Study Design: In this multicenter, randomized, controlled trial women in the delayed pushing group
(n = 936) were advised to wait ≥2 hours after full dilatation before commencement
of pushing. Women in the early pushing group (n = 926) were advised to commence pushing
as soon as they had been randomly assigned. Results: Difficult delivery was reduced with delayed pushing (relative risk, 0.79; 95% confidence
interval, 0.66-0.95). The greatest effect was on midpelvic procedures (relative risk,
0.72; 95% confidence interval, 0.55-0.93). Although there was little evidence for
an effect on low-pelvic procedures, spontaneous delivery was more frequent among women
who practiced delayed pushing (relative risk, 1.09; 95% confidence interval, 1.00-1.18).
Abnormal umbilical cord blood pH (<7.15 venous value or <7.10 arterial value) was
more frequent in the delayed pushing group (relative risk, 2.45, 95% confidence interval,
1.35-4.43). However, scores for a summary indicator, the Neonatal Morbidity Index,
were similarly distributed in the 2 groups. Conclusion: Delayed pushing is an effective strategy to reduce difficult deliveries among nulliparous
women. (Am J Obstet Gynecol 2000;182:1165-72.)
Keywords
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Article Info
Publication History
Accepted:
December 16,
1999
Received in revised form:
September 9,
1999
Received:
April 30,
1999
Footnotes
☆Sponsored by the Medical Research Council of Canada (grant MT-12423). AstraZeneca R&D Montreal, Montreal, Quebec, Canada, provided medication and salary support for Michel Boulvain, MD, PhD, as a research fellow. William D. Fraser, MD, MSc, received salary support from the Medical Research Council of Canada. Sylvie Marcoux, MD, PhD, is a National Health Research Scholar of Health Canada.
☆☆Reprint requests: William D. Fraser, MD, CHUQ-PSFA, 10 Rue de l’Espinay, Local D1-724; Québec, Québec, Canada G1L 3L5.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
