Does epidural analgesia influence the mode of delivery in primiparae managed actively? A preliminary study of 1250 women.
We studied 1250 primiparous women with a singleton pregnancy, gestational age at delivery of 37-42 weeks, with a single live fetus, vertex presentation whose first and second stages of labour were managed according to strict criteria for the active management of labour. 568 (45%) received epidural analgesia (bupivacaine 0.25%) during labour, and the other 682 (55%) received either Entonox, pethidine or no analgesia. The spontaneous vaginal delivery rate in the epidural group was 67% (95% confidence interval [CI] 63-71%), lower than that in the non-epidural group (87%, 95% CI 84-90%). All instrumental delivery rates were higher in the epidural group. However, the rotational forceps rate in the epidural group (2.5%, 95% CI 1.4-4.1%) was only marginally higher than in the non-epidural group (0.9%, 95% CI 0.3-1.9%). Women who were induced were more likely to request an epidural (56%: 95% CI 50-61%) than those with spontaneous onset of labour (41%: 95% CI 38-45%). Whether labour was spontaneous or induced, a higher proportion of women who received epidural required oxytocin augmentation. The effects of combinations of epidural analgesia, the need for oxytocin augmentation and induction of labour on mode of delivery were additive. This preliminary study suggests that a high rate of spontaneous vaginal delivery can be achieved with epidural analgesia when labour is actively managed.
Carli
F
F
Department of Anaesthesia, Northwick Park Hospital, MRC Clinical Research Centre, Harrow, Middlesex, UK.
Creagh-Barry
P
P
Gordon
H
H
Logue
M M
MM
Dore
C J
CJ