Epidural analgesia and fetal head malposition at vaginal delivery.
OBJECTIVE
To determine if nulliparas who delivered with on-demand epidural analgesia are more likely to have malpositioning of the fetal vertex at delivery than women delivered during a period of restricted epidural use.


METHODS
A retrospective cohort of nulliparous women with spontaneous labor delivered during a 12-month period immediately before the availability of on-demand labor epidural analgesia was compared with a similar group of nulliparas delivered after labor epidural analgesia was available on request. The primary outcome variable was a non-occiput anterior position or malpositioned fetal head at vaginal delivery.


RESULTS
The frequency of epidural use increased from 0.9% before epidural analgesia became available on demand to 82.9% afterward. Fetal head malpositioning at vaginal delivery occurred in 26 of 434 (6.0%) women delivered in the before period compared with 29 of 511 (5.7%) in the after period (relative risk 0.95, 95% confidence interval 0.6, 1.6). No statistically significant difference in the incidence of fetal head malpositioning was present after patients were stratified by mode of delivery (Mantel-Haenszel weighted relative risk 0.94, 95% confidence interval 0.6, 1.4). The study sample size provided 85% power to detect a two-fold increase in the incidence of fetal malpositioning from a baseline rate of 6% associated with on-demand epidural use.


CONCLUSIONS
Providing on-request labor epidural analgesia to nulliparas in spontaneous labor did not result in a clinically significant increase in the frequency of fetal head malpositioning at vaginal delivery.
Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii, USA. michael.yancey@haw.tamc.amedd.army.mil
M K
MK
Yancey
J
J
Zhang
D L
DL
Schweitzer
J
J
Schwarz
M A
MA
Klebanoff
D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007746:Labor Presentation; D007744:Obstetric Labor Complications / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies