Epidural anesthesia during childbirth: benefit or harm?
DOI:
https://doi.org/10.37800/RM.4.2024.423Keywords:
эпидуральная анестезия, роды, обезболивание, польза, риски, роженица, новорожденный, родовая деятельность, безопасность, осложнения.Abstract
Relevance: The use of epidural anesthesia in our country has been steadily increasing over the past few years. However, despite its widespread use, there is much uncertainty about the optimal mode of epidural anesthesia. Different combinations and concentrations of drugs administered epidurally have different effects both during childbirth and in the postpartum period. With so many childbirth-related variables, it can be challenging to separate association from causation. Therefore, studies are needed to evaluate the results of childbirth using epidural anesthesia in order to increase its acceptability to the population in terms of better pain relief and maternal satisfaction.
The study aimed to analyze the existing data on the safety and effectiveness of epidural anesthesia and identify its possible advantages and disadvantages to determine the optimal anesthesia tactics during childbirth.
Methods: The search was conducted for publications available on the Internet on research for 2010-2023.
Results: Epidural anesthesia usually provides effective pain relief for childbirth, but it can also be associated with undesirable consequences for the mother and child. Maternal complications have been reported to include hypotension (decreased maternal blood pressure). Severe sudden hypotension (sometimes defined as a decrease in baseline blood pressure of more than 20%) can lead to a clinically significant decrease in uteroplacental blood flow, potentially affecting oxygen delivery to the baby. For this reason, before the introduction of epidurals, intravenous fluids (preloaded with liquid) can be administered to reduce the decrease in maternal blood pressure.
Conclusion: The use of epidural analgesia during childbirth can disrupt their natural rhythm, shortening the first stage and lengthening the second or both. This happens even if obstetric indications determine the choice of time for anesthesia and may lead to the need for medical intervention, such as a cesarean section. Epidural analgesia reduces pain during contractions but cannot eliminate it due to individual predisposition and circumstances.
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