Does Epidural Labor Analgesia Increase the Rate of Cesarean Section? A Retrospective Study
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Published
Dec 22, 2016
Abstract
OBJECTIVE: The aim of this study was to investigate the impact of epidural analgesia on the rate of Cesarean section in nulliparous women.
METHODS: Retrospectively a total of 200 nulliparous women who underwent spontaneous vaginal delivery at term with or without requesting labor analgesia were reviewed and screened. The primary outcome is the rate of Cesarean section at different cervix diameter. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery.
RESULTS: The data from a total of 139 subjects were eventually included into the analysis. Significant difference in the rate of Cesarean delivery was observed amongst the two groups (7.3% in patients with epidural analgesia versus 63.4% in patients without epidural analgesia, P < 0.0001). The pain rating, oxytocin use, and patient’s satisfaction were also superior in those underwent epidural analgesia than those without analgesia. No significant differences were expressed in variables of non-reassuring fetal status.
CONCLUSIONS: Epidural analgesia does not increase the rate of Cesarean section, on the contrary, it is a reliable way to reduce the rate compared with the patients who do not received the analgesia in nulliparous women.
METHODS: Retrospectively a total of 200 nulliparous women who underwent spontaneous vaginal delivery at term with or without requesting labor analgesia were reviewed and screened. The primary outcome is the rate of Cesarean section at different cervix diameter. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery.
RESULTS: The data from a total of 139 subjects were eventually included into the analysis. Significant difference in the rate of Cesarean delivery was observed amongst the two groups (7.3% in patients with epidural analgesia versus 63.4% in patients without epidural analgesia, P < 0.0001). The pain rating, oxytocin use, and patient’s satisfaction were also superior in those underwent epidural analgesia than those without analgesia. No significant differences were expressed in variables of non-reassuring fetal status.
CONCLUSIONS: Epidural analgesia does not increase the rate of Cesarean section, on the contrary, it is a reliable way to reduce the rate compared with the patients who do not received the analgesia in nulliparous women.
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Keywords
Epidural Analgesia, Labor Pain, Cesarean Section, Cervix, Nullipara
References
1. Liu EHC, Sia ATH. Rates of Cesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: Systematic review. BMJ 2004; 328:1410-1420.
2. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labor. Cochrane Database Syst Rev 2005; 4:CD000331.
3. Marucci M, Cinnella G, Perchiazzi G, Brienza N, Fiore T. Patient-requested neuraxial analgesia for labor: Impact on rates of Cesarean and instrumental vaginal delivery. Anesthesiology 2007; 106:1035-1045.
4. Seyb ST, Berka RJ, Socol ML, Dooley SL. Risk of Cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol 1999; 94:600-607.
5. Luthy DA, Malmgren JA, Zingheim RW. Cesarean delivery after elective induction in nulliparous women: the physician effect. Am J Obstet Gynecol 2004; 191:1511-1515.
6. Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ. Bishop score and risk of Cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 2005; 105:690-697.
7. Clark SL, Belfort MA, Hankins GDV, Meyers JA, Houser FM. Variation in the rates of operative delivery in the United States. Am J Obstet Gynecol 2007; 196:526.e1-526.e5.
8. Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT, Yaghmour E, Marcus RJ, Sherwa-ni SS, Sproviero MT, Yilmaz M, Patel R, Robles C, Grouper S. The risk of Cesarean delivery with neuraxial anal-gesia given early versus late in labor. N Engl J Med 2005; 352:655-665.
9. Gambling DR, Sharma SK, Ramin SM, Lucas MJ, Leveno KJ, Wiley J, Sidawi JE. A randomized study of combined spinal-epidural analgesia versus intra-venous meperidine during labor: im-pact on Cesarean delivery rate. Anesthesiology 1998; 89:1336-1344.
10. Kotaska AJ, Klein MC, Liston RM. Epidural analgesia associated with low-dose oxytocin augmentation in-creases Cesarean births: A critical look at the external validity of randomized trials. Am J Obstet Gynecol 2006; 194:809-814.
2. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labor. Cochrane Database Syst Rev 2005; 4:CD000331.
3. Marucci M, Cinnella G, Perchiazzi G, Brienza N, Fiore T. Patient-requested neuraxial analgesia for labor: Impact on rates of Cesarean and instrumental vaginal delivery. Anesthesiology 2007; 106:1035-1045.
4. Seyb ST, Berka RJ, Socol ML, Dooley SL. Risk of Cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol 1999; 94:600-607.
5. Luthy DA, Malmgren JA, Zingheim RW. Cesarean delivery after elective induction in nulliparous women: the physician effect. Am J Obstet Gynecol 2004; 191:1511-1515.
6. Vrouenraets FP, Roumen FJ, Dehing CJ, van den Akker ES, Aarts MJ, Scheve EJ. Bishop score and risk of Cesarean delivery after induction of labor in nulliparous women. Obstet Gynecol 2005; 105:690-697.
7. Clark SL, Belfort MA, Hankins GDV, Meyers JA, Houser FM. Variation in the rates of operative delivery in the United States. Am J Obstet Gynecol 2007; 196:526.e1-526.e5.
8. Wong CA, Scavone BM, Peaceman AM, McCarthy RJ, Sullivan JT, Diaz NT, Yaghmour E, Marcus RJ, Sherwa-ni SS, Sproviero MT, Yilmaz M, Patel R, Robles C, Grouper S. The risk of Cesarean delivery with neuraxial anal-gesia given early versus late in labor. N Engl J Med 2005; 352:655-665.
9. Gambling DR, Sharma SK, Ramin SM, Lucas MJ, Leveno KJ, Wiley J, Sidawi JE. A randomized study of combined spinal-epidural analgesia versus intra-venous meperidine during labor: im-pact on Cesarean delivery rate. Anesthesiology 1998; 89:1336-1344.
10. Kotaska AJ, Klein MC, Liston RM. Epidural analgesia associated with low-dose oxytocin augmentation in-creases Cesarean births: A critical look at the external validity of randomized trials. Am J Obstet Gynecol 2006; 194:809-814.
How to Cite
Shen, X. (2016). Does Epidural Labor Analgesia Increase the Rate of Cesarean Section? A Retrospective Study. Science Insights, 2016(19), 1–6. https://doi.org/10.15354/si.16.ar390
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