title: Induction of labor with oxytocin increases cesarean section rate as compared with oxytocin for augmentation of spontaneous labor in nulliparous parturients controlled for lumbar epidural analgesia.
abstract: OBJECTIVE
  To study labor outcomes in parturients receiving oxytocin for augmentation or induction of labor, in the presence of labor epidural analgesia.
  
  
  METHODS
  Retrospective study of data from a continuous quality improvement database.
  
  
  METHODS
  Tertiary-care hospital with more than 8000 deliveries per annum.
  
  
  RESULTS
  Of the 1671 healthy nulliparous women with singleton pregnancies and who requested labor epidural analgesia at our institution, 675 patients received oxytocin during elective induction of labor, whereas 996 patients received oxytocin for augmentation of spontaneous labor. Measured variables were cervical dilatation at time of epidural analgesia request, epidural insertion to 10-cm time, duration of stage 2 of labor, normal spontaneous vaginal delivery rate, cesarean section rate, operative vaginal delivery rate, and baby weight. Women admitted for induction of labor requested epidural analgesia sooner than those who had their labor augmented (p < 0.001). The incidence of cesarean section was higher in the induced group (p = 0.008).
  
  
  CONCLUSIONS
  Patients who have their labor induced request analgesia sooner and are at a higher risk of cesarean section than are patients who go into labor spontaneously. Any study that purports to assess the effects of epidural analgesia in labor should distinguish between induced and augmented/spontaneous labor.
authors.affiliation: Department of Anesthesiology, Magee-Womens Hospital and the University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. kaulb@anes.upmc.edu
authors.forename: Bupesh
authors.initials: B
authors.lastname: Kaul
authors.forename: Manuel C
authors.initials: MC
authors.lastname: Vallejo
authors.forename: Sivam
authors.initials: S
authors.lastname: Ramanathan
authors.forename: Gordon
authors.initials: G
authors.lastname: Mandell
authors.forename: Amy L
authors.initials: AL
authors.lastname: Phelps
authors.forename: Ashi R
authors.initials: AR
authors.lastname: Daftary
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D007743:Labor, Obstetric / Q000187:drug effects*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D010121:Oxytocin / Q000008:administration & dosage / Q000009:adverse effects*; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010120:Oxytocics; D010121:Oxytocin