POSTPARTUM COMPLICATIONS OF FORCEPS DELIVERY PERFORMED UNDER EPIDURAL AND PUDENDAL NERVE BLOCK

In a prospective study of 100 primigravidae, 50 women had a forceps delivery under epidural block and 50 women had a forceps delivery under pudendal nerve block with perineal infiltration. There was no significant difference in the incidence of postpartum headache, upsets of micturition and backache between the two groups. A survey was made of so-called minor complications amongst women who had recently been delivered under epidural analgesia, in an attempt to assess the influence of this technique on the incidence of head-ache, backache, and disturbances of micturition in the early puerperium. A second group of patients was also studied. These women had pudendal nerve blocks in the second stage of labour, and systemic analgesics (usually pethidine) in the first stage. Some also received nitrous oxide and oxygen (Entonox) analgesia. METHOD One hundred primigravid patients had a mid-cavity or low forceps delivery and a mediolateral episio-tomy. By studying only nulliparous women, the possible effect of past experiences of childbirth was eliminated. Lumbar epidural analgesia was given to 50 patients. A continuous technique was used in 44 of these women. In every case, the local anaesthetic drug was 0.5 % bupivacaine, without adrenaline. A 16 s.w.g. Tuohy needle was used, and a midline puncture was performed at the L3-4 or L2-3 inter-space. Bilateral pudendal nerve blocks were performed by the transvaginal route in the other 50 patients. A 1 % solution of prilocaine without adrenaline was used and the perineum was also infiltrated with this solution. Epidural analgesia is not used routinely in the Queen Mother's Hospital, but is reserved mainly for the more prolonged and painful labours, and for patients with hypertension (Moir, 1971). Conse-quently, there is a tendency for the more difficult forceps deliveries to be carried out under epidural block, and this is confirmed by the figures in table I, in which the types of forceps delivery are listed. The average duration of the first and second stages of labour was 14.7 hours in the patients who had epidural analgesia, and 9.2 hours in those who had TABLE I. Types of forceps delivery under epidural and pudendal block