A
forceps delivery may be indicated when a fetus fails to progress to delivery, or when delivery needs to be expedited in the second stage of labour. Effective
analgesia is required to ensure that the woman is comfortable throughout the delivery, to allow the obstetrician to safely perform the procedure. It is currently unclear what the most effective and safe agent or method is to provide
pain relief during
forceps delivery.
OBJECTIVES: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), reviewed published guidelines and searched the reference lists of review articles.
SELECTION CRITERIA: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies.
MAIN RESULTS: We included four trials involving 388 women that were judged to be at an unclear to high risk of bias overall. A variety of different agents for providing
analgesia were assessed in the trials, and a number of different methods to measure
pain relief were used, and thus results could not be combined in meta-analysis. Three trials compared
diazepam with an alternative agent (
ketamine; vinydan-
ether; "other" anaesthesic agent) for the provision of general anaesthesia, and one trial compared spinal
analgesia to pudendal nerve block (in both groups
lignocaine was administered).With regard to the primary outcomes, women receiving
diazepam for
forceps delivery in one small trial were more likely to judge their
pain relief as effective compared with women receiving vinydan-
ether (risk ratio (RR) 1.13; 95% confidence interval (CI) 1.02 to 1.25; 101 women). In a further small trial, no significant difference was seen in the number of women judging their
pain relief as effective when
diazepam was compared with
ketamine (RR 1.42; 95% CI 0.98 to 2.07; 26 women). In the trial that compared spinal
analgesia to pudendal nerve block, women receiving spinal
analgesia were significantly more likely to regard their
analgesia as adequate (RR 3.36; 95% CI 2.46 to 4.60; 183 women) and were less likely to report severe
pain during
forceps delivery (RR 0.02; 95% CI 0.00 to 0.27; 183 women). No trials reported on the review's other two primary outcomes of serious maternal adverse effects or complications, and neonatal mortality or serious morbidity.In terms of secondary outcomes, women receiving
diazepam compared with vinydan-
ether, were significantly less likely to experience
vomiting (RR 0.04; 95% CI 0.00 to 0.62; 101 women). No significant differences were seen for the few neonatal outcomes that were reported across any of the comparisons (including Agpar score of less than seven at five minutes and
acidosis as defined by cord blood arterial pH less than 7.2).
AUTHORS' CONCLUSIONS: