| Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. | |
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MedLine Citation:
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PMID: 9392696 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Among nulliparous women, there appears to be an association between the use of epidural analgesia during labor and an increased risk of dystocia. We tested the hypothesis that combined spinal-epidural analgesia, which permits ambulation during labor, is associated with a lower incidence of dystocia than continuous lumbar epidural analgesia. METHODS: Between July 1995 and September 1996, we randomly assigned 761 nulliparous women in spontaneous labor at term who requested epidural analgesia to receive either continuous lumbar epidural analgesia or a combination of spinal and epidural analgesia. Among the women who received combined spinal-epidural analgesia, some were discouraged from walking and others were encouraged to walk. Maternal and neonatal outcomes, the incidence of dystocia necessitating cesarean section, and measures of patients' satisfaction were compared in the two groups. RESULTS: There were no significant differences in the overall rate of cesarean section, the incidence of dystocia, the frequency of maternal or fetal complications, the patients' or nursing staff's assessment of the adequacy of analgesia, or the degree of overall satisfaction between the two groups. Significantly more women receiving combined spinal-epidural analgesia had pruritus (P<0.001) and requested additional epidural bolus doses of local anesthetic (P=0.01). For all the women, dystocia necessitating cesarean section was significantly more likely when analgesia was administered with the fetal vertex at a negative station (odds ratio, 2.5; P<0.001) or at less than 4 cm of cervical dilatation (odds ratio, 2.2; P<0.001). CONCLUSIONS: As compared with continuous lumbar epidural analgesia, the combination of spinal and epidural analgesia is not associated with an overall decrease in the incidence of cesarean delivery. |
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Authors:
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M P Nageotte; D Larson; P J Rumney; M Sidhu; K Hollenbach |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The New England journal of medicine Volume: 337 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1997 Dec |
Date Detail:
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Created Date: 1997-12-11 Completed Date: 1997-12-11 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1715-9 Citation Subset: AIM; IM |
Affiliation:
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Women's Hospital, Long Beach, CA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analgesia, Epidural* / adverse effects Analgesia, Obstetrical* / adverse effects Analgesics, Opioid Anesthesia, Spinal* / adverse effects Anesthetics, Local Bupivacaine Cesarean Section Dystocia / etiology, prevention & control, surgery Female Fentanyl Humans Labor, Obstetric* / drug effects Parity Pregnancy Prospective Studies Risk Factors Time Factors Walking |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Opioid; 0/Anesthetics, Local; 2180-92-9/Bupivacaine; 437-38-7/Fentanyl |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1997 Dec 11;337(24):1764-6
[PMID:
9392705
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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