Department of Obstetrics and Gynaecology, "Santa Maria" Hospital, Bari, Italy.
Eur Rev Med Pharmacol Sci. 2010 Sep;14(9):799-806.
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.
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.
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%).
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.
评估小剂量舒芬太尼和罗哌卡因联合脊髓-硬膜外镇痛（CSE）分娩时枕后位的发生率。
本研究关注了 132 名女性，分为两组：自然分娩镇痛组和低剂量舒芬太尼和罗哌卡因 CSE 分娩镇痛组；所有女性均在分娩过程中进行数字化检查和超声检查。所有数据均由独立评审员收集和分析。
在第二产程中，79 名胎儿持续处于枕后位（POPP），36 名胎儿从前位转为后位（TAPP）。具体来说，25 名自然分娩的女性中有 17 名胎儿从前位转为后位，28 名 CSE 分娩镇痛的女性中有 19 名胎儿从前位转为后位，差异无统计学意义。POPP 组的不对称发生率（84%）高于 TAPP 组（75%），剖宫产率（67%比 52.7%）也更高。
小剂量罗哌卡因和舒芬太尼分娩不会增加胎儿下降过程中的枕后位，导致 POPP。最后，由于在枕前位分娩时镇痛会显著延长分娩时间，在枕后位时，分娩时间会显著延长，第二产程延长，胎头在产科骨盆下降时间缩短。
