Ambulation With Labor Epidural in Obese Women
Study Details
Study Description
Brief Summary
The purpose of this study is to determine if ambulation with a labor epidural in place is associated with decreased rate of cesarean delivery in obese patients.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Obese women are known to have increased risk of cesarean delivery and prolonged labors. Low concentration epidural analgesia can achieve pain relief and allow for ambulation. Prior investigations have not shown a benefit in cesarean delivery between those who ambulate with an epidural and those who do not. These studies were conducted in women with normal weights. It is unknown if ambulation with a labor epidural is beneficial in decreasing cesarean delivery among obese women.
Obese women at term with a singleton pregnancy will be enrolled in this pilot study. Patients will receive their epidural analgesia when they desire per standard protocol at our institution. Following epidural placement, a Modified Bromage Score and straight leg test will be performed. If the patient passes the straight leg test and has a modified Bromage score > 6, they will be allowed to ambulate. They will be encouraged to ambulate for 20 minutes per hour with another adult alongside them. Obstetric care will be standard of care.
On postpartum day one, the patient will be administered a Labor Agentry Scale. Chart review will then be conducted to review maternal and neonatal outcomes.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Ambulation Participants in this arm will be encouraged to ambulate with epidural in place. |
Behavioral: Ambulation
Patients will be encouraged to ambulate for 20 minutes of every hour.
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Outcome Measures
Primary Outcome Measures
- Cesarean Delivery Rate [At time of delivery]
Percent of cesarean delivery
Secondary Outcome Measures
- Labor Duration [From labor onset to time of delivery]
Duration (hrs)
- First Stage Duration [From onset of labor until complete dilation]
Duration (hrs)
- Second Stage Duration [From complete dilation until delivery]
Duration (hrs)
- Perceived Labor Control [Within 4 days postpartum]
Score on Labor Agentry Scale
Eligibility Criteria
Criteria
Inclusion Criteria:
Subjects capable of giving consent Singleton pregnancy Nulliparous (defined as no previous pregnancy beyond 20 weeks 0 days) Gestational age greater than or equal to 37 weeks BMI > = 35 at time of delivery admission Adult companion available Anticipated vaginal delivery
Exclusion Criteria:
Physical disability precluding ambulation Magnesium Administration Contraindications to neuraxial analgesia Cerclage in current pregnancy Active labor DPE Category III fetal heart tracing Fetal Demise In Utero
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | University of Chicago | Chicago | Illinois | United States | 60637 |
Sponsors and Collaborators
- University of Chicago
Investigators
- Principal Investigator: Maritza Gonzalez, Faculty
Study Documents (Full-Text)
None provided.More Information
Publications
- Collis RE, Harding SA, Morgan BM. Effect of maternal ambulation on labour with low-dose combined spinal-epidural analgesia. Anaesthesia. 1999 Jun;54(6):535-9.
- Karraz MA. Ambulatory epidural anesthesia and the duration of labor. Int J Gynaecol Obstet. 2003 Feb;80(2):117-22.
- Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol. 2004 Mar;103(3):452-6. Erratum in: Obstet Gynecol. 2004 May;103(5 Pt 1):1019.
- Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol. 2004 Nov;104(5 Pt 1):943-51.
- Vallejo MC, Firestone LL, Mandell GL, Jaime F, Makishima S, Ramanathan S. Effect of epidural analgesia with ambulation on labor duration. Anesthesiology. 2001 Oct;95(4):857-61.
- IRB19-1600