title: Adverse effects of epidural analgesia in labor.
abstract: OBJECTIVE
  To examine the influence of epidural analgesia on labor and delivery in nulliparous and multiparous women.
  
  
  METHODS
  Data were collected on 847 consecutive parturients with singleton pregnancy and vertex presentation (384 nulliparous and 463 multiparous). The obstetrical and labor characteristics including maternal age, parity, gestational age, previous cesarean section, instrumental delivery, mode and timing of analgesia, mode of delivery, indications for cesarean section or instrumental delivery were analyzed comparing patients who received epidural analgesia with women who received systemic analgesia.
  
  
  RESULTS
  Epidural analgesia was administered in 233 nulliparous and 141 multiparous women. A stepwise logistic regression analysis revealed that epidural analgesia independently affected the rate of non-spontaneous delivery and the duration of the second stage of labor in nulliparous (P=0.0017 and P=0.0036, respectively) and multiparous (P=0.001 and P=0.0081, respectively) women. Epidural analgesia independently affected the duration of labor only in nulliparous women (P=0.0001).
  
  
  CONCLUSIONS
  Women should be informed that prolongation of labor and increase in nonspontaneous deliveries should be expected when choosing epidural analgesia in labor.
authors.affiliation: Department of Obstetrics and Gynecology, Rambam Medical Center, Technion-Faculty of Medicine, Haifa, Israel.
authors.forename: E Z
authors.initials: EZ
authors.lastname: Zimmer
authors.forename: P
authors.initials: P
authors.lastname: Jakobi
authors.forename: J
authors.initials: J
authors.lastname: Itskovitz-Eldor
authors.forename: B
authors.initials: B
authors.lastname: Weizman
authors.forename: I
authors.initials: I
authors.lastname: Solt
authors.forename: A
authors.initials: A
authors.lastname: Glik
authors.forename: Z
authors.initials: Z
authors.lastname: Weiner
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D011247:Pregnancy; D013997:Time Factors