Intrapartum sonography for occiput posterior detection in early low dose combined spinal epidural analgesia by sufentanil and ropivacaine

A. Malvasi 1, A. Tinelli 2, A. Brizzi 3, M. Guido 4, V. Martino 1, S. Casciaro 5, D. Celleno 6, M.G. Frigo 6, M. Stark 7, D. Benhamou 8

1 Department of Obstetrics and Gynaecology, “Santa Maria” Hospital, Bari (Italy), 2 Department of Obstetrics and Gynaecology, “Vito Fazzi” Hospital, Lecce (Italy), 3 Department of Anaesthesiology, “Santa Maria” Hospital, Bari (Italy), 4 Laboratory of Hygiene, Department of Biological and Environmental Sciences and Technologies, Di.S.Te.B.A., Faculty of Sciences, University of Salento, Lecce (Italy), 5 Biomedical Engineering Science and Technology Division, IFC-CNR, Institute of Clinical Physiology, National Council of Research (Italy), 6 Department of Anaesthesiology, Fatebenefratelli General Hospital, Isola Tiberina, Rome (Italy), 7 The New European Surgical Academy (NESA), Berlin (Germany), 8 AP-HP, Service d’Anesthésie-Réanimation, Hôpital Bicêtre,Le Kremlin-Bicêtre (France)

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• Obstetrics

Abstract. – Aim: To evaluate the incidence of occiput posterior position in labour with and without combined spinal epidural analgesia (CSE) by low dose of sufentanyl and ropivacaine.
Material and Methods: This study focused on 132 women subdivided in two groups, patients in spontaneous and in labour analgesia, administered by a low dose CSE by sufentanyl and ropivacaine; all women were evaluated by digital examinations and ultrasound till delivery. All data were collected and analyzed by an independent reviewer.
Results: In the second stage, 79 were persistent occiput posterior position (POPP) fetuses and 36 were translated from anterior to posterior position (TAPP) fetuses. Specifically, in spontaneous labour on 25 women in anterior position, there were 17 TAPP and in CSE analgesia on 28 women in anterior, there were 19 in TAPP, without significant differences. The number of asynclitisms was higher in the POPP group (84%) respect to the TAPP group (75%), so as the rate of caesarean section (67% versus 52.7%).
Conclusions: The labour with low dose of ropivacaine and sufentanyl does not increase the occiput posterior position during fetal descent, leading to a POPP. Finally, since in the occiput anterior presentation labour analgesia significantly lengthens time to delivery, in the occiput posterior position this is significantly increased, with a prolonged second stage of labour and reduced time of descent of fetal head in obstetric pelvis.

Corresponding Author: Antonio Malvasi, MD; e-mail: antoniomalvasi@gmail.com

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