American Journal of Obstetrics and Gynecology
The influence of epidural analgesia on cesarean delivery rates: A randomized, prospective clinical trial☆,☆☆
Section snippets
Methods
Approval for the study protocol was granted by the Human Studies Review Committee of the University of Louisville. Spontaneously laboring nulliparous patients admitted to the labor and delivery unit at the University of Louisville Hospital were invited to participate in the study. A patient was considered eligible for enrollment if the following criteria were met: (1) patient was nulliparous, (2) gestational age was ≥36 weeks, (3) presentation was vertex, and (4) patient was in spontaneous
Results
From January 1, 1995, to May 25, 1996, a total of 328 patients gave consent to enroll in the study. Ten patients were excluded from the data analysis because of protocol violations, including patients admitted for labor induction, multiparous patients, and an estimated gestational age <36 weeks. Of the 318 remaining patients, 162 were randomly assigned to receive intravenous opioids and 156 were randomly assigned to receive epidural analgesia. As shown in Table I, the randomization resulted in
Comment
This study is the fifth randomized trial conducted in the United States to evaluate the effect of epidural analgesia on cesarean delivery rates. In contrast to the first 2 studies,6, 7 we found no increase in cesarean delivery rates, either overall or for dystocia, associated with the use of epidural analgesia. The first randomized trial comparing epidural analgesia with intravenous opioids was reported in 1993 by Thorp et al.6 In this trial of 93 nulliparous, spontaneously laboring women, the
References (25)
- et al.
The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women
Am J Obstet Gynecol
(1989) - et al.
The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled prospective trial
Am J Obstet Gynecol
(1993) - et al.
Randomized trial of epidural versus intravenous analgesia during labor
Obstet Gynecol
(1995) - et al.
Nulliparous active labor, epidural analgesia and cesarean delivery for dystocia
Am J Obstet Gynecol
(1997) - et al.
The cesarean birth epidemic: trends, causes, and solutions
Am J Obstet Gynecol
(1996) - et al.
Temporal variation in rates of cesarean section for dystocia: does “convenience” play a role?
Am J Obstet Gynecol
(1987) - et al.
Trends in cesarean section use in California, 1983 to 1990
Am J Obstet Gynecol
(1993) The myth of painless childbirth
Pain
(1984)- et al.
Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas
Am J Perinatol
(1991) - et al.
Cesarean birth for failed progress in labor
Obstet Gynecol
(1989)
Effect of epidural analgesia on the primary cesarean rate
Obstet Gynecol
Epidural analgesia need not influence the spontaneous vaginal delivery rate [abstract 240]
Am J Obstet Gynecol
Cited by (0)
- ☆
Reprint requests: Ann L. Clark, MD, Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, KY 40292.
- ☆☆
0002-9378/98 $5.00 + 06/1/91685