Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia☆,☆☆,★,★★
Section snippets
Material and methods
Healthy nulliparous women at 36 to 42 weeks' gestation and in spontaneous active labor were candidates for this study. We chose to study only nulliparous patients because, as a group, they are more prone to dystocia and are more likely to require cesarean delivery than are women who have had a previous vaginal birth. Parturients with serious medical problems (e.g., insulin-dependent diabetes mellitus, chronic hypertension requiring medication, pregnancy-induced hypertension, etc.) or those with
Results
During a period of 15 months (August 1995 through October 1996) 100 patients were randomized in this trial: 49 in the epidural group and 51 in the narcotic group. Two women in the epidural group were delivered before obtaining regional analgesia and 12 women in the parenteral analgesia arm eventually received regional analgesia (“epidural rescue”). The “intent to treat” study design specified that these patients remain in their randomized group for all statistical considerations. Table I
Comment
There was no increase in dystocia-related cesarean delivery with epidural analgesia in this trial of spontaneously laboring nulliparous women. We attribute this to several factors. This study had rigid entry requirements that eliminated many of the pitfalls of earlier trials. Without a doubt the patients in this trial were in active labor. Criteria for entry stipulated that the cervix be dilated at least 4 cm, effaced at least 80%, the vertex engaged, and the patient having frequent uterine
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Cited by (133)
Does Labor Analgesia Affect Labor Outcome?
2022, Evidence-Based Practice of AnesthesiologyFetal descent in nulliparous women assessed by ultrasound: a longitudinal study
2021, American Journal of Obstetrics and GynecologyCitation Excerpt :Having a strict protocol of more frequent examinations would have given us more accurate knowledge of the clinical progression for each individual woman. Studies have shown conflicting results about the effects epidural analgesia has on the progression of labor.64–78 In our study group, 62% of the women were given epidural analgesia.
Factors that affect ultrasound-determined labor progress in women undergoing induction of labor
2019, American Journal of Obstetrics and GynecologyOxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 7: Epidural analgesia and use of oxytocin during spontaneous labor
2017, Journal of Gynecology Obstetrics and Human ReproductionAdjustment for compliance behavior in trials of epidural analgesia in labor using instrumental variable meta-analysis
2015, Journal of Clinical EpidemiologyCitation Excerpt :There were 888 women (23%) who were allocated to the epidural group who did not receive epidural analgesia (noncompliance) and 999 women (27%) allocated to the control group who ultimately received epidural analgesia in labor (contamination). Complete data on the number of cesarean sections in compliant and noncompliant groups were available in the published literature for eight studies [11,12,21,27,28,30,31,37] and were provided by the authors for two studies [18,36]. Thus, there were 10 RCTs with complete data available on the number of cesarean sections in compliant and noncompliant participants to conduct an IV analysis.
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From the Department of Obstetrics and Gynecology, Wright State University School of Medicine,a the Department of Anesthesiology, University of Alabama at Birmingham,b and the Departments of Obstetrics and Gynecologyc and Anesthesiology,d University of Mississippi Medical Center.
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Supported by the Vicksburg Hospital Medical Foundation.
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Reprints not available from the authors.
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