Epidural Top-up in the Second Stage of Labor decreases Operative Deliveries

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Epidural Top-up in the Second Stage of Labor decreases Operative Deliveries

According to a recent study conducted by Allana Munro and colleagues, epidurals top-ups manifest significant efficacy among females with high assisted vaginal and cesarean deliveries or difficult labor issues. The observational and retrospective study was carried out to evaluate the relationship of top-ups epidural in the second stage of labor with neonatal and obstetrical problems. The study was based on a hypothesis that epidural top-up implementation helps to decrease operative deliveries by resolving ineffectual analgesia.

The data for the study was extracted by conducting a population-based cohort search by utilizing perinatal data from 1 Jan 2013 to 31 Dec 2014. The incidence of top-up cases was assessed by using information from the anesthesia database. The descriptive statistics were used to compare different delivery methods and neonatal features among women either with top-ups or without top-ups. Predictive factors of the delivery method were determined by using logistic regression.

A total of 1462 females at their second stage of labor received epidural analgesia for one hour. Out of this, only 7 % of women required a top-up approach. The females who obtained epidural top-ups showed 89% labor induction, 303 min longer second-stage, 41% assisted vaginal and 26% cesarean deliveries as compared to females without top-ups (76%, 171 min, 17% and 11% respectively). Women requiring top-ups had more predictors of harsh labor, high assisted vaginal and cesarean deliveries compared to the females without a top-up.  


Canadian Journal of Anesthesia         



The original title of article:

The impact of analgesic intervention during the second stage of labour: a retrospective cohort study


Allana Munro et al.

Therapeutic, Top-ups Epidurals, Retrospective Cohort Study, Efficacy
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