Management of Incoordinate Uterine Action under Continuous Epidural Analgesia

Abstract

One hundred women with incoordinate uterine action had labour managed under continuous epidural analgesia, the average duration of the block being 10 hours. Most of the patients were primigravidae, many were of small stature, and many had large babies, commonly with the occiput in the posterior position. Graphic analysis of labour showed an increased rate of cervical dilatation after epidural block in over 70%. The caesarean section rate remained high (55%) in cases complicated by mechanical dystocia, but where this was not present the caesarean section rate was much lower (14%), while in those patients who had no cephalopelvic disproportion and who showed an increased rate of dilatation after epidural block the caesarean section rate was only 3.8%. With this management, caesarean section is rarely required purely for incoordinate uterine action or maternal distress. The perinatal mortality in the series was 2%, and there were no serious maternal complications. © 1967, British Medical Journal Publishing Group. All rights reserved.