Early versus late initiation of epidural analgesia in labor: Does it increase the risk of cesarean section? A randomized trial

Ohel, Gonen; Gonen, Roni; Vaida, Sonia; Barak, Shlomi; Gaitini, Luis

doi:10.1016/j.ajog.2005.10.821

Cited by 140 publications

(110 citation statements)

References 15 publications

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“…Of the selected studies, five concerned nulliparous women only. 7,[16][17][18][19] The retrospective cohort study of Ohel and Harats 20 presented results for both nulliparous and multiparous women. Only nulliparity-related results were included in this review, however.…”

Section: Description Of Studies and Characteristicsmentioning

confidence: 99%

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Early versus late epidural analgesia and risk on instrumental delivery in nulliparous women: a systematic review

Wassen

Zuijlen

Roumen

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Background The optimal timing of epidural analgesia during labour and delivery has been a controversial issue.Objective Review of the literature regarding the relation between the timing of epidural analgesia and the rate of caesarean or instrumental vaginal deliveries.Search strategy Pubmed, Embase and the Cochrane Library were searched for articles published until 31 July 2010.Selection criteria Studies were selected in which the effects of early latent phase (defined as a cervical dilatation of 3 cm or less) epidural analgesia (including combined-spinal epidural) and late active phase epidural analgesia on the mode of delivery in nulliparous women at 36 weeks of gestation or more were evaluated.Data collection and analysis Data extraction was completed by using a data-extraction form. Risk ratio and its 95% confidence intervals were calculated for caesarean delivery and instrumental vaginal delivery. Pooled data were calculated.Main results The search retrieved 20 relevant articles, of which six fulfilled the selection criteria of inclusion. These six studies reported on 15 399 nulliparous women in spontaneous or induced labour with a request for analgesia. Risk of caesarean delivery (pooled risk ratio 1.02, 95% CI 0.96-1.08) or instrumental vaginal delivery (pooled risk ratio 0.96, 95% CI 0.89-1.05) was not significantly different between groups.Authors' conclusions This systematic review showed no increased risk of caesarean delivery or instrumental vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 cm or less in comparison with late epidural analgesia.

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Section: Description Of Studies and Characteristicsmentioning

confidence: 99%

“…Three RCTs included women in spontaneous labour, 7,16,19 one RCT included women with induced labour, 18 and one included both spontaneous and induced labour. 17 The retrospective cohort study of Ohel did not report the start of labour. 20 In the study of Luxman et al 16 early and late EA were compared.…”

Section: Description Of Studies and Characteristicsmentioning

confidence: 99%

Early versus late epidural analgesia and risk on instrumental delivery in nulliparous women: a systematic review

Wassen

Zuijlen

Roumen

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…A meta-analysis suggested that EDA prolongs the first stage of labour by approximately 42 min [35]. However, other studies showed that EDA use during early-stage labour shortens the first stage of labour compared with opioid pain relief [32] or compared with EDA use later in labour [36].…”

Section: Discussionmentioning

confidence: 99%

Impact of Epidural Analgesia in Labour on Neonatal and Maternal Outcomes

Söderholm¹,

Türkmen²

2018

OJOG

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Aim: To evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. Methods: A retrospective cohort study of nulliparous parturients who gave birth in Västernorrland County, Sweden, over a 2-year period between 2015 and 2016. Neonatal outcomes (Apgar score at 5 min and umbilical cord arterial blood gases), maternal outcomes (perineal injury, total bleeding volume and maternal satisfaction with birth) and labour parameters (mode of delivery and the durations of labour and postpartum hospital stay) were evaluated. Results: The study cohort consisted of 1449 women with singleton pregnancies. Patients were divided into two groups according to whether during labour they were administered epidural analgesia using bupivacaine and sufentanil (EDA group, n = 615) or not (non-EDA group, n = 834). The rate of assisted vaginal delivery was significantly higher in the EDA group than in the non-EDA group (15.6% and 11.3%, respectively, p < 0.05), whereas the rates of caesarean section were similar. The duration of the active phase of labour was significantly longer in the EDA group than in the non-EDA group (489 ± 217 min versus 371 ± 210 min, respectively, p < 0.001). The Apgar score at 5 min and umbilical cord blood pH were lower and the base deficit greater in the EDA group (p < 0.001, p < 0.001 and p < 0.01, respectively). Bleeding volume was similar between the groups after adjusting for gestational age. Women in the EDA group were more satisfied with their labour experience, as measured by the visual analogue scale (p < 0.05). Conclusion: The results of this study suggest that EDA affects delivery and neonatal-maternal outcomes negatively, but increases the mother's satisfaction with labour.

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“…Metaanalysen randomisiert-kontrollierter Studien zeigen unklare Ergebnisse für spontane, instrumentelle Entbindungen und Sectiones beim Vergleich von früh-zeitiger (Muttermund < 4-5 cm) und später (Muttermund > 4-5 cm) Anlage einer PDA [36][37][38][39][40]. Auch eine Studie, die sich mit dem Vergleich von früher und spä- [85][86][87][88][89][90].…”

Section: Optimaler Zeitpunkt Des Neuroaxialen Verfahrensunclassified