Epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Delivery

Wang, Fuzhou; Shen, Xiaofeng; Guo, Xirong; Peng, Yongjun; Gu, Xiaohui

doi:10.1097/aln.0b013e3181b55e65

Cited by 128 publications

(99 citation statements)

References 33 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.…”

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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“…13 The efficacy of PCEA during labor is related to the local anesthetic dose used, 11 however, a higher administration of local anesthetics has been related to a prolonged second stage of labor. 9 Despite the multiple approaches and significant progress that has been achieved in labor PCEA research, to the best of our knowledge, no studies have tested the possible time-dependent cumulative effects resulting from the administration of analgesia throughout labor, even using low-dose regimens.…”

Section: 2mentioning

confidence: 99%

Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

Costa-Martins¹,

Dias

Pereira

et al. 2015

Acta Med Port

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(1):70-76 RESUMOIntrodução: A patient-controlled epidural analgesia com baixas concentrações de anestésicos é eficaz na redução da dor de parto. O objectivo deste estudo foi comparar dois regimes de doses ultrabaixas de ropivacaína e sufentanil (0,1% ropivacaína associada a 0,5 µg.ml -1 sufentanil vs. 0,06% ropivacaína associada a 0,5 µg.ml -1 sufentanil) nos intervalos entre bólus e na duração do trabalho de parto. Material e Métodos: Neste estudo prospectivo não-randomizado, realizado entre Janeiro e Julho de 2010, dois grupos de parturientes receberam patient-controlled epidural analgesia: o Grupo I (n = 58; 1 mg.ml -1 ropivacaína + 0,5 µg.ml -1 sufentanil) e o Grupo II (n = 57; 0,6 mg.ml -1 ropivacaína + 0,5 µg.ml -1 sufentanil). Quando necessário administraram-se doses de resgate de ropivacaína na concentração definida para cada grupo e sem sufentanil. Registaram-se a dor, os consumos de analgésicos, as características do bloqueio neuroaxial, do trabalho de parto, do recém-nascido, e a satisfação materna. Resultados: A dose de ropivacaína foi maior no Grupo I (9,5 [7,7-12,7] No Grupo I observouse um aumento do intervalo de tempo entre bólus (beta = 32,61 min, 95% CI [25,39; 39,82], p < 0,001), enquanto no Grupo II se observou uma diminuição dos intervalos (beta = -1,40 min, 95% CI [-2,44; -0,36], p = 0,009). A duração do segundo estadio do trabalho de parto foi significativamente maior no Grupo I do que no Grupo II (78 min vs. 65 min, p < 0,001). Conclusões: As parturientes que receberam ropivacaína a 0,06% exibiram uma menor evidência de efeitos cumulativos e um segundo estadio do trabalho de parto mais rápido do que as que receberam ropivacaína a 0,1%. Palavras-chave: Analgesia Controlada pelo Doente; Analgesia Obstétrica; Dor do Parto; Ropivacaína; Sufentanil. ABSTRACTBackground: Patient-controlled epidural analgesia with low concentrations of anesthetics is effective in reducing labor pain. The aim of this study was to assess and compare two ultra-low dose regimens of ropivacaine and sufentanil (0.1% ropivacaine plus 0.5 µg.ml-1 sufentanil vs. 0.06% ropivacaine plus 0.5 µg.ml -1 sufentanil) on the intervals between boluses and the duration of labor. Material and Methods: In this non-randomized prospective study, conducted between January and July 2010, two groups of parturients received patient-controlled epidural analgesia: Group I (n = 58; 1 mg.ml -1 ropivacaine + 0.5 µg.ml -1 sufentanil) and Group II (n = 57; 0.6 mg.ml -1 ropivacaine + 0.5 µg.ml -1 sufentanil). Rescue doses of ropivacaine at the concentration of the assigned group without sufentanil were administered as necessary. Pain, local anesthetic requirements, neuraxial blockade characteristics, labor and neonatal outcomes, and maternal satisfaction were recorded. Results: The ropivacaine dose was greater in ] mg.h -1 vs. 6.1 [5.1-9.8 mg.h -1 ], p < 0.001). A time increase between each bolus was observed in Group I (beta = 32.61 min, 95% CI [25.39; 39.82], p < 0.001), whereas a time decrease was observed in Group II (beta = -1.40 min, 95% CI ...

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“…In addition, Walsh (2009) has commented that the rise in epidural rates in the United Kingdom (which is also mirrored in Australia, see Lain et al, 2008) could be due less to an increased requirement for analgesia than to a fragmented maternity system that leaves women feeling unsupported. Given that epidural analgesia carries certain risks with use (Anim-Somuah, Smyth & Howell, 2005;Gaiser, 2005;Rahm, Hallgren, Hogberg, Hurtig, & Odlind, 2002;Jordan et al, 2009;Wang, Shen, Guo, Peng & Gu, 2009) and women are not always well-informed of these (Heinze & Sleigh, 2003), there is therefore a need for further investigation in this area, which our research aims to address.…”

Section: Ethnography In Midwiferymentioning

confidence: 99%

Access or Egress? Questioning the “Ethics” of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

Newnham

Pincombe

McKellar

2013

IJDS

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In this article, we discuss the principal difficulties in gaining ethics approval for an ethnographic midwifery doctoral research project in a hospital setting in South Australia. The research focus is on the various personal, social, institutional and cultural influences on women making a choice about whether or not to use epidural analgesia in labour. The obstacles encountered in gaining human research ethics committee (HREC) approval are discussed within the wider context of the benefits of ethnography as a research methodology, as well as the potential consequences to ethnography when assessed by quantitative research standards. By sharing our experience, we add to the current literature debating the "ethics" of ethics committee review in qualitative research approval. Engaging with the academic debate surrounding "ethics creep" -the increasing jurisdiction of ethics committees over research design -we consider the possibility of moving beyond principle-based ethics towards an ethical theory that more fully addresses the complexities of ethnographic research.

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Epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Delivery

Abstract: Epidural analgesia in the latent phase of labor at cervical dilation of 1.0 cm or more does not prolong the progression of labor and does not increase the rate of Cesarean in nulliparous women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more.

Cited by 128 publications

References 33 publications

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

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

Effects of Local Anesthetic on the Time Between Analgesic Boluses and the Duration of Labor in Patient-Controlled Epidural Analgesia: Prospective Study of Two Ultra-Low Dose Regimens of Ropivacaine and Sufentanil

Access or Egress? Questioning the “Ethics” of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

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