Document Detail

The effect of early epidural versus early intravenous analgesia use on labor progression: a natural experiment.
MedLine Citation:
PMID:  15295376     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of this study was to compare the effect of early epidural with the use of early intravenous analgesia on labor progression. STUDY DESIGN: We systematically selected singleton, nulliparous term pregnancies with a spontaneous labor and analgesia placement <or=4 cm who were delivered at a hospital where the rate of epidural analgesia in labor increased from 1% (before) to 84% (after) in 1 year (a natural experiment). In the before period (n=223 pregnancies), 98% of women used intravenous analgesia, and 2% of women used epidural analgesia. In the after period (n=278 pregnancies), 92% of women used epidural analgesia, and 8% of women used intravenous analgesia. The median duration of labor by each centimeter of cervical dilation was computed and used as a measurement of labor progression. RESULTS: After adjustment had been made for confounders, women in the after period had a slower labor progression only from 4 to 5 cm, compared with those women in the before period. Interestingly, the process of labor admission and epidural analgesia placement, rather than analgesia use per se, appeared to explain most of the slowdown. No significant difference in the rest of the active phase was observed between the 2 groups. CONCLUSION: Our data support recent American College of Obstetricians and Gynecologists guidelines that the restraining use of epidural analgesia at <4 cm of cervical dilation is unnecessary.
Anjel Vahratian; Jun Zhang; Jill Hasling; James F Troendle; Mark A Klebanoff; John M Thorp
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  191     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-08-05     Completed Date:  2004-09-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  259-65     Citation Subset:  AIM; IM    
Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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MeSH Terms
Analgesia, Epidural*
Analgesia, Obstetrical* / methods
Analgesics / administration & dosage
Cesarean Section
Infusions, Intravenous
Labor Stage, First*
Obstetrical Forceps
Retrospective Studies
Time Factors
Reg. No./Substance:

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