Document Detail

Is the management of epidural analgesia associated with an increased risk of cesarean delivery?
MedLine Citation:
PMID:  10819827     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The aim of this study was to quantify the association of cesarean delivery with epidural analgesia management, specifically with the timing of epidural catheter placement in relation to labor, the type of epidural analgesia, and the use of bolus dosing.
STUDY DESIGN: A retrospective cohort design was used to investigate 1561 consecutive nulliparous parturients whose labor occurred between November 1, 1996, and June 30, 1997, at Northwestern Memorial Hospital and who were delivered of term, singleton neonates in a cephalic presentation. The relationship between the management of epidural analgesia and the risk for cesarean delivery was determined with stepwise logistic regression to control for potential confounding variables.
RESULTS: There was a significantly increased risk of cesarean delivery associated with decrements in cervical effacement (P =.001), cervical dilatation (P =.001), and fetal station (P =.001) at the time of epidural catheter placement. An increasing number of epidural boluses during the first stage of labor was also associated with increased risk of cesarean delivery (P =.001). After we controlled for maternal age, maternal body mass index, gestational age, infant birth weight, induction of labor, use of magnesium sulfate, and presence of chorioamnionitis, the adjusted odds of cesarean delivery associated with fetal station (odds ratio, 1.45; 95% confidence interval, 1.2-1.7) and epidural boluses (odds ratio, 1.55; 95% confidence interval, 1.3-1.8) during the first stage of labor remained significant.
CONCLUSION: The management of epidural analgesia during labor was associated with the potential for increased risk of cesarean delivery. This risk increased with higher stations of the fetal head at the time of epidural catheter placement and with more frequent epidural boluses of local anesthetic during the first stage of labor.
J D Traynor; S L Dooley; S Seyb; C A Wong; A Shadron
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  182     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-06-15     Completed Date:  2000-06-15     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1058-62     Citation Subset:  AIM; IM    
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MeSH Terms
Analgesia, Epidural / adverse effects*,  methods*
Birth Weight
Body Mass Index
Cesarean Section*
Chorioamnionitis / complications
Cohort Studies
Gestational Age
Labor, Induced
Magnesium Sulfate / therapeutic use
Maternal Age
Odds Ratio
Retrospective Studies
Risk Factors
Reg. No./Substance:
7487-88-9/Magnesium Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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