Epidural analgesia during labor is ...

Epidural analgesia during labor is an effective pain reliever that has become more commonly used. Despite wide acceptance of this use, the timing of epidural placement remains controversial, with conflicting reports forward the risk for subsequent cesarean deliveries and the amplification of the latent phase of labor. Because of these disturbs the American College of Obstetricians and Gynecologists (ACOG) attract favor toed using other forms of analgesia in nulliparous women until they reach dilatation of 4 to 5 cm However, a certain institutions did not follow these guidelines for all women in labor, with equal reason ACOG released a follow-up report recommending that maternal entreat is a sufficient indication for epidural analgesia during labor and that it should not be denied upon the basis of cervical dilatation. To exhibit better information about epidural analgesia, Vahratian and colleagues compared the event of early epidural analgesia with that of early intravenous analgesia upon labor progression.

In a retrospective analysis of obstetric data from common military medical center, including singleton, nulliparous denomination pregnancies with a spontaneous labor, the researchers analyzed pair groups of participants. The first clump included women who gave birth before a policy change that made epidural analgesia available upon demand. In this group, 1 percent had epidural analgesia, while 98 percent had intravenous analgesia. The next to the first group included women whose labor occurr after the policy change, of whom 92 percent received epidural analgesia and 8 percent received intravenous analgesia. Early analgesia was defined as that given while the patient was dilated to no more than 4 cm As a measure of labor progression, the median duration of labor by means of each centimeter of dilation was comput The investigation compared this and other factors in the one and the other groups.

There were 223 pregnancies in the first cluster and 278 pregnancies in the secondary group. When adjustments of confounder were made, the and nothing else period of labor that had a slower progression among women in the epidural assemblage compared with the intravenous dispose was from 4 to 5 cm (see accompanying table). The intravenous collection went from 4 to 5 cm in an average of 77 minutes, while the epidural group's time was 130 minutes. There were no significant differences in the remainder of the active phase of cervical dilatation between the couple groups.

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The proportion of cesarean deliveries remained the same (18 percent) in the two groups. In the epidural collection the use of outlet forceps or vacuum extraction increased from 10 to 14 percent and the use of mid to cheap forceps or vacuum extraction decreased from 14 to 10 percent

The authors gather that it is unnecessary to withhold epidural analgesia before 4 cm of cervical dilatation is achieved. In their contemplation the only difference in labor progression between epidural and intravenous analgesia was at 4 to 5 cm and not in the early phase of labor.

Vahratian A, et al. The power of early epidural versus early intravenous analgesia use upon labor progression: a natural experiment. Am J Obstet Gynecol July 2004;191:259-65

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