[Primary management of labor using neuroleptic analgesia]

Abstract

Within the limits granted, neuroleptanalgesia constitutes a very interesting technique in the major part of management of labour. In particular it has the advantage of preserving maternal consciousness. On the other hand, it allows analgesia of rather long duration, which renders early management of labour possible while still respecting its physiology. The institution of this technique demands the presence at the parturients bedside, not only of the obstetrician and the medwife but also that of a qualified anesthetist. As in all cases of major management of labour it engages the responsability of the obstetrical team which undertakes it and this is even more so, the earlier it is started. To us its indications seem comparable with those of Gamma OH: the early management of labour however has the advantage over the latter of preserving maternal consciouness. Moreover it proved to be particularly interesting in the management of breech presentations. But if its properties are an advantage in the indications which we have just mentioned, they can constitute an invonvenience and restrain its use under different circumstances: its slowness of induction, the absence of narcosis which limits the effect on cervical resistance means that one prefers the Toulouse method using pentothal for the management of labour after 7 centimeters of dilatation. In conclusion, it seems important to us to state that neuroleptanalgesia is not the ideal method for management of labour any more than is thiopental or Gamma-OH. Other techniques merit being studied. Their study must obey strict rules in order to specify the risks and therefore the indications and limits. It should cover different fields which are, pharmacology, the objective assessment, by quantitative criteria, of the effects on uterine contraction, on the mother's clinical and biological state as well as that of the fetus in utero, then that of the child in the first hours of live and up to the first years of his development.