title: Nulliparous active labor, epidural analgesia, and cesarean delivery for dystocia.
abstract: OBJECTIVE
  Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women.
  
  
  METHODS
  Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 80%, and fetopelvic engagement. Patients were randomized to one of two groups: epidural analgesia or narcotics. A strict protocol for labor management was in place. Patients recorded the level of pain at randomization and at hourly intervals on a visual analog scale. Elective outlet operative vaginal delivery was permitted.
  
  
  RESULTS
  One hundred women were randomized. No difference in the rate of cesarean delivery for dystocia was noted between the groups (epidural 8%, narcotic 6%; p = 0.71). No significant differences were noted in the lengths of the first (p = 0.54) or second (p = 0.55) stages of labor or in any other time variable. Women with epidural analgesia underwent operative vaginal delivery more frequently (p = 0.004). Pain scores were equivalent at randomization, but large differences existed at each hour thereafter. The number of patients randomized did not achieve prestudy estimates. A planned interim analysis of the results demonstrated that we were unlikely to find a statistically significant difference in cesarean delivery rates in a trial of reasonable duration.
  
  
  CONCLUSIONS
  With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.
authors.affiliation: Department of Obstetrics and Gynecology, Wright State University School of Medicine, Dayton, Ohio, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Bofill
authors.forename: R D
authors.initials: RD
authors.lastname: Vincent
authors.forename: E L
authors.initials: EL
authors.lastname: Ross
authors.forename: R W
authors.initials: RW
authors.lastname: Martin
authors.forename: P F
authors.initials: PF
authors.lastname: Norman
authors.forename: C F
authors.initials: CF
authors.lastname: Werhan
authors.forename: J C
authors.initials: JC
authors.lastname: Morrison
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D002585:Cesarean Section; D004420:Dystocia / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology; D009294:Narcotics / Q000627:therapeutic use; D010147:Pain Measurement; D010298:Parity; D011247:Pregnancy; D013997:Time Factors
chemical_list: D009294:Narcotics