Document Detail

Timing of initiating epidural analgesia and mode of delivery in nulliparas: a retrospective experience using ropivacaine.
MedLine Citation:
PMID:  18935798     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The timing of initiation of epidural analgesia and its causal relationship with mode of delivery is controversial. This retrospective investigation reviews and determines whether early initiation of epidural analgesia in nulliparous women influences the rate of cesarean sections as well as other obstetric outcome measures. METHODS: The nursing records of 1623 parturients who received epidural analgesia were retrospectively reviewed. Of these, 704 nulliparous parturients who presented in spontaneous labor or had spontaneous rupture of the membranes and received epidural analgesia with a regimen of ropivacaine and fentanyl were included in this study. All parturients received the epidural protocol following their first request. Parturients were divided into early (n = 457) and late (n = 247) groups according to cervical dilatation < 3 cm and > or = 3 cm, respectively, when epidural analgesia was initiated. The mean primary cesarean section rate during the research period was calculated from the monthly report of the department of obstetrics and gynecology. RESULTS: The mean primary cesarean section rate in the institution was 23.6% during the research period. The overall cesarean section rate was 13.4% (n = 704) in the studied groups. The early group required more top-up epidural anesthetic boluses, and had a higher cesarean section rate than the late group (16.4% vs. 7.7%, p = 0.002). However, the cesarean section rates of both groups were lower than the mean primary cesarean section rate. No difference was observed between groups in the percentage of arrested labor as the primary indication for cesarean section. Early epidural analgesia shortened the duration of the active phase of the first stage of vaginal delivery. No difference was observed between groups in the duration of the second stage or the instrumental vaginal delivery rate. CONCLUSIONS: The administration of epidural analgesia with a regimen of ropivacaine and fentanyl should not be delayed until cervical dilatation reaches 3 cm in nulliparas who are in spontaneous labor or have spontaneous rupture of the membranes. The timing of epidural analgesia should be determined on an individualized basis.
Hui-Ling Lee; Liang-Ming Lo; Chung-Chuan Chou; Tzu-Yi Chiang; Eng-Chye Chuah
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chang Gung medical journal     Volume:  31     ISSN:  2072-0939     ISO Abbreviation:  Chang Gung Med J     Publication Date:    2008 Jul-Aug
Date Detail:
Created Date:  2008-10-21     Completed Date:  2008-11-04     Revised Date:  2008-12-16    
Medline Journal Info:
Nlm Unique ID:  101088034     Medline TA:  Chang Gung Med J     Country:  China (Republic : 1949- )    
Other Details:
Languages:  eng     Pagination:  395-401     Citation Subset:  IM    
Department of Anesthesiology, Chang Gung Memorial Hospital, No. 199, Dunhua N. Rd., Songshan District, Taipei City 105, Taiwan (R.O.C.).
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MeSH Terms
Amides / administration & dosage*
Analgesia, Epidural*
Analgesia, Obstetrical*
Anesthetics, Local / administration & dosage*
Delivery, Obstetric*
Retrospective Studies
Time Factors
Reg. No./Substance:
0/Amides; 0/Anesthetics, Local; 84057-95-4/ropivacaine

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