BMJ  2004;329:293 (31 July), doi:10.1136/bmj.329.7460.293

Letter

Good news is often ignored

The first 150 words of the full text of this article appear below.

EDITOR—In their systematic review Liu et al show that epidural analgesia does not increase the caesarean section rate, which is welcome.1 Unlike previous meta-analyses, this one included only studies of nulliparous women receiving low concentration epidural infusions, in order to re-examine their effect on instrumental vaginal delivery, in the belief that low concentration infusions of local anaesthetic are associated with fewer abnormal deliveries than higher concentrations.

Credit: BSP LAURENT/SPL

They cite the COMET trial, which could compare only low and high dose bolus administration.2 There have been at least five other randomised comparisons of low and high dose boluses, three showing no significant difference in delivery outcome, but aggregation of all the data shows a significant effect.3 By contrast none out of six comparisons of low (usually 0.0625% bupivacaine) and high concentration infusions showed a difference in delivery type, despite randomising over 800 women.3 Had any randomised trials . . . [Full text of this article]

Felicity Reynolds, emeritus professor of obstetric anaesthesia

St Thomas' Hospital, London SE1 7EH felicity.reynolds@btinternet.com


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Relevant Article

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review
E H C Liu and A T H Sia
BMJ 2004 328: 1410. [Abstract] [Full Text] [PDF]

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