Early Versus Late Initiation of Epidural Analgesia in Labor: Does It Increase the Risk of Cesarean Section? A Randomized Trial.
From: Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. gonen.ohel@b-zion.org.il
American journal of obstetrics and gynecology
- Publish Date: Mar 2006
- ISSN: 1097-6868
- Volume: 194
- Issue: 3
- Pages: 600-5
- Medium: Internet
- Language: English
- Citation (JAMA): Ohel Gonen, Gonen Roni, Vaida Sonia, et al. Early Versus Late Initiation of Epidural Analgesia in Labor: Does It Increase the Risk of Cesarean Section? A Randomized Trial.. Am. J. Obstet. Gynecol. Mar 2006;194:600-5
Abstract
OBJECTIVE: To determine whether early initiation of epidural analgesia in nulliparous women affects the rate of cesarean sections and other obstetric outcome measures. STUDY DESIGN: A randomized trial in which 449 at term nulliparous women in early labor, at less than 3 cm of cervical dilatation, were assigned to either immediate initiation of epidural analgesia at first request (221 women), or delay of epidural until the cervix dilated to at least 4 cm (228 women). RESULTS: At initiation of the epidural the mean cervical dilatation was 2.4 cm in the early epidural group and 4.6 cm in the late group (P < 0.0001). The rates of cesarean section were not significantly different between the groups — 13% and 11% in the early and late groups, respectively (P = 0.77). The mean duration from randomization to full dilatation was significantly shorter in the early compared to the late epidural group — 5.9 hours and 6.6 hours respectively (P = 0.04). When questioned after delivery regarding their next labor, the women indicated a preference for early epidural. CONCLUSION: Initiation of epidural analgesia in early labor, following the first request for epidural, did not result in increased cesarean deliveries, instrumental vaginal deliveries, and other adverse effects; furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.
Mesh Headings (Keywords): Analgesia, Epidural, Analgesia, Obstetrical, Cesarean Section, Female, Humans, Pregnancy, Risk Factors, Time Factors
Check for Full Text / PubMed Unique Identifier (PMID): 16522386
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