title: Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial.
abstract: OBJECTIVE
  To determine whether early initiation of epidural analgesia in nulliparous women affects the rate of cesarean sections and other obstetric outcome measures.
  
  
  METHODS
  A randomized trial in which 449 at term nulliparous women in early labor, at less than 3 cm of cervical dilatation, were assigned to either immediate initiation of epidural analgesia at first request (221 women), or delay of epidural until the cervix dilated to at least 4 cm (228 women).
  
  
  RESULTS
  At initiation of the epidural the mean cervical dilatation was 2.4 cm in the early epidural group and 4.6 cm in the late group (P < 0.0001). The rates of cesarean section were not significantly different between the groups--13% and 11% in the early and late groups, respectively (P = 0.77). The mean duration from randomization to full dilatation was significantly shorter in the early compared to the late epidural group--5.9 hours and 6.6 hours respectively (P = 0.04). When questioned after delivery regarding their next labor, the women indicated a preference for early epidural.
  
  
  CONCLUSIONS
  Initiation of epidural analgesia in early labor, following the first request for epidural, did not result in increased cesarean deliveries, instrumental vaginal deliveries, and other adverse effects; furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.
authors.affiliation: Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. gonen.ohel@b-zion.org.il
authors.forename: Gonen
authors.initials: G
authors.lastname: Ohel
authors.forename: Roni
authors.initials: R
authors.lastname: Gonen
authors.forename: Sonia
authors.initials: S
authors.lastname: Vaida
authors.forename: Shlomi
authors.initials: S
authors.lastname: Barak
authors.forename: Luis
authors.initials: L
authors.lastname: Gaitini
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors