1 Stanford, CA, USA 2 Plymouth, UK
EditorVaginal examination policies to assess and monitor the progress of labour vary between maternity units in England. Thirty per cent of units have no vaginal examination policies, one third have a flexible policy, while 36% of units conduct vaginal examinations to assess cervical dilation at a fixed schedule, usually 4-hourly, but some at 2- or 3-hourly intervals.1
Epidural blocks are often requested and sited without knowing the result of a recent vaginal examination. We reviewed our obstetric anaesthesia database over the 2000/2001 period to determine the time interval between placement of the epidural and delivery.
We found 13.5% of epidurals were placed 30 min before delivery, and 22.5% of patients delivered within 60 min of the block placement. In addition, we estimate that 23% of epidurals were abandoned during placement because the patient wanted to bear down, and subsequent assessment revealed full cervical dilatation. The mean time interval between epidural placement and delivery was 5 h (SD 265 min); however, there was a large proportion of patients in whom the epidural placement to delivery interval did not allow adequate time to provide effective analgesia (Fig. 1).
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B. Carvalho1
J. Coghill2
1Stanford, CA, USA
2Plymouth, UK
References
1 Chalmers I, Garcia J, Post S. Care during labour: hospital policies for labour and delivery. In: Chalmers I, Enkin M, Keirse M, eds. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989; 81719