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Abstract(s)
Introdução: O trabalho de parto estå entre os tipos mais intensos de dor que uma
mulher experimenta, pelo que o seu alĂvio Ă© de extrema importĂąncia. EstĂŁo disponĂveis
variadas técnicas analgésicas para aliviar a dor do trabalho de parto, mas a anestesia
epidural é considerada o goldstandard devido à sua elevada eficåcia e segurança, sendo
recomendada pela Organização Mundial de SaĂșde. No entanto, continua a haver
controvérsia e não hå provas claras sobre os potenciais efeitos adversos da anestesia
epidural no desfecho de parto.
Objetivos: O propĂłsito foi analisar como a anestesia epidural influencia a forma como
o parto ocorre, analisando também variåveis adicionais que possam influenciar os
resultados, e, desta forma, dar orientação às gråvidas sobre os potenciais riscos,
permitindo que tenham uma decisĂŁo informada relativamente ao alĂvio da dor do parto.
Metodologia: Foi realizada uma vasta pesquisa bibliogrĂĄfica com recurso Ă plataforma
PubMed, atĂ© setembro de 2023, sendo incluĂdos artigos em portuguĂȘs e inglĂȘs, no
perĂodo de 2010 a 2023.
Resultados e DiscussĂŁo: A maioria dos estudos demonstraram que a incidĂȘncia de
parto vaginal instrumentado Ă© maior no grupo com anestesia epidural do que no grupo
sem, existindo, portanto, uma relação causal entre estas. De entre as causas desta
associação positiva encontram-se a diminuição do tónus uterino, o bloqueio motor e
mudanças no comportamento do médico. Relativamente à cesariana, vårios estudos
verificaram que a anestesia epidural nĂŁo tem impacto no risco de cesariana, nĂŁo
havendo, deste modo, uma relação causal entre as mesmas. à importante referir que o
Ten Group Classification System, inicialmente desenvolvido como uma ferramenta para
avaliar resultados perinatais focando nas taxas de cesariana, Ă© tambĂ©m Ăștil para avaliar
a taxa de parto vaginal instrumentado e a duração do trabalho de parto. Quanto Ă
duração do trabalho de parto, a maioria dos estudos demonstra uma maior duração da
segunda fase com a administração de anestesia epidural e, por conseguinte, hå a
diminuição da sensação de pressão pélvica, o que compromete a capacidade de a mulher
fazer força ativamente. No que diz respeito ao momento de administração da anestesia
epidural, nĂŁo hĂĄ evidĂȘncias consistentes de que a AE administrada precocemente
aumente as taxas de parto vaginal instrumentado, de cesariana ou mesmo a duração do
trabalho de parto. Relativamente ao uso de ocitocina, apenas foi evidente que a sua
utilização em casos de prolongamento da segunda fase do trabalho de parto aumentou a
probabilidade de parto eutĂłcico. Por fim, em relação Ă s nulĂparas, existem estudos que defendem uma maior taxa de parto vaginal instrumentado neste grupo, mas nĂŁo uma
maior taxa de cesariana. Para além disto, a maioria dos estudos sugerem um efeito mais
pronunciado do prolongamento do trabalho de parto em nulĂparas. Neste grupo, o
momento de administração da anestesia epidural não evidenciou diferenças. Contudo,
existem muitos estudos controversos, tendo sido verificado que vĂĄrias caracterĂsticas das
grĂĄvidas influenciam estes resultados.
ConclusĂŁo: A anestesia epidural aumenta a taxa de PVI, mas nĂŁo a taxa de cesariana. O
Ten Group Classification System pode ser uma ferramenta importante para analisar
associaçÔes entre a anestesia epidural e o desfecho do parto. A anestesia epidural
aumenta a duração da segunda fase do trabalho de parto, mas não a duração da primeira
fase. Não se observa uma correlação entre o momento da administração da anestesia
epidural e o desfecho do parto. A ocitocina pode influenciar o desfecho do parto em
mulheres com anestesia epidural. As nulĂparas tĂȘm particularidades importantes na
relação entre a anestesia epidural e o desfecho do parto. Por fim, defende-se que a AE
deva ser administrada a pedido da parturiente.
Introduction: Labor is among the most intense types of pain that a woman can experience, making its relief extremely important. Various analgesic techniques are available to relieve labor pain, but epidural anesthesia is considered to be the gold standard due to its high efficacy and safety, being also recommended by the World Health Organization. However, controversy persists, and there is no clear evidence regarding the potential adverse effects of epidural anesthesia on labor outcomes. Objectives: The purpose of this research was to analyze how epidural anesthesia influences the course of labor and also examining additional variables that may influence the results. Thus, providing guidance to pregnant women about potential risks and enabling them to make an informed decision regarding labor pain relief. Methodology: A comprehensive literature search was conducted using the PubMed platform, up to September 2023, including articles in Portuguese and English from 2010 to 2023. Results and Discussion: Most studies have shown that the incidence of instrumental vaginal delivery is higher in the epidural anesthesia group than in the group without it, thus indicating a causal relationship between these. Among the causes of this positive association are decreased uterine tone, motor block, and changes in physician behavior. Regarding cesarean section, several studies have found that epidural anesthesia has no impact on the risk of this procedure, thus there is no causal relationship between them. It is important to note that the Ten Group Classification System, initially developed as a tool to assess perinatal outcomes focusing on cesarean rates, is also useful for evaluating the rate of instrumental vaginal delivery and the duration of labor. As for the duration of labor, most studies demonstrate a longer second stage duration with epidural anesthesia administration, mainly due to decreased sensation of pelvic pressure, compromising the woman's ability to actively push. Regarding the timing of epidural anesthesia administration, there is no consistent evidence that early administration increases the rates of instrumental vaginal delivery and cesarean section or labor duration. With reference to the use of oxytocin, it was only evident that its use in cases of prolonged second stage of labor increased the likelihood of eutocic delivery. Finally, concerning nulliparas, numerous studies advocate for a higher rate of instrumental vaginal delivery in this population, but not a higher rate of cesarean section. Furthermore, most studies suggest a more pronounced effect of prolonged labor in nulliparas, while the timing of epidural anesthesia administration showed no differences. However, there are many controversial studies, and it has been found that various characteristics of pregnant women influence these results. Conclusion: Epidural anesthesia increases the rate of instrumental vaginal delivery but not the rate of cesarean section. The Ten Group Classification System can be an important tool for analyzing associations between epidural anesthesia and labor outcome. Epidural anesthesia prolongs the duration of the second stage of labor, but has no effect on the duration of the first stage. There is no correlation between the timing of epidural anesthesia administration and labor outcome. Oxytocin may influence labor outcome in women with epidural anesthesia. Nulliparas have important particularities in the relationship between epidural anesthesia and labor outcome. Finally, it is advocated that epidural anesthesia should be administered at the request of the parturient.
Introduction: Labor is among the most intense types of pain that a woman can experience, making its relief extremely important. Various analgesic techniques are available to relieve labor pain, but epidural anesthesia is considered to be the gold standard due to its high efficacy and safety, being also recommended by the World Health Organization. However, controversy persists, and there is no clear evidence regarding the potential adverse effects of epidural anesthesia on labor outcomes. Objectives: The purpose of this research was to analyze how epidural anesthesia influences the course of labor and also examining additional variables that may influence the results. Thus, providing guidance to pregnant women about potential risks and enabling them to make an informed decision regarding labor pain relief. Methodology: A comprehensive literature search was conducted using the PubMed platform, up to September 2023, including articles in Portuguese and English from 2010 to 2023. Results and Discussion: Most studies have shown that the incidence of instrumental vaginal delivery is higher in the epidural anesthesia group than in the group without it, thus indicating a causal relationship between these. Among the causes of this positive association are decreased uterine tone, motor block, and changes in physician behavior. Regarding cesarean section, several studies have found that epidural anesthesia has no impact on the risk of this procedure, thus there is no causal relationship between them. It is important to note that the Ten Group Classification System, initially developed as a tool to assess perinatal outcomes focusing on cesarean rates, is also useful for evaluating the rate of instrumental vaginal delivery and the duration of labor. As for the duration of labor, most studies demonstrate a longer second stage duration with epidural anesthesia administration, mainly due to decreased sensation of pelvic pressure, compromising the woman's ability to actively push. Regarding the timing of epidural anesthesia administration, there is no consistent evidence that early administration increases the rates of instrumental vaginal delivery and cesarean section or labor duration. With reference to the use of oxytocin, it was only evident that its use in cases of prolonged second stage of labor increased the likelihood of eutocic delivery. Finally, concerning nulliparas, numerous studies advocate for a higher rate of instrumental vaginal delivery in this population, but not a higher rate of cesarean section. Furthermore, most studies suggest a more pronounced effect of prolonged labor in nulliparas, while the timing of epidural anesthesia administration showed no differences. However, there are many controversial studies, and it has been found that various characteristics of pregnant women influence these results. Conclusion: Epidural anesthesia increases the rate of instrumental vaginal delivery but not the rate of cesarean section. The Ten Group Classification System can be an important tool for analyzing associations between epidural anesthesia and labor outcome. Epidural anesthesia prolongs the duration of the second stage of labor, but has no effect on the duration of the first stage. There is no correlation between the timing of epidural anesthesia administration and labor outcome. Oxytocin may influence labor outcome in women with epidural anesthesia. Nulliparas have important particularities in the relationship between epidural anesthesia and labor outcome. Finally, it is advocated that epidural anesthesia should be administered at the request of the parturient.
Description
Keywords
Anestesia Anestesia Epidural Cesariana Parto Vaginal
Instrumentado Trabalho de Parto