title: Patient-requested neuraxial analgesia for labor: impact on rates of cesarean and instrumental vaginal delivery.
abstract: A systematic review, including a meta-analysis, on the timing effects of neuraxial analgesia (NA) on cesarean and instrumental vaginal deliveries in nulliparous women was conducted. Of 20 articles identified, 9 met the inclusion quality criteria (3,320 participants). Cesarean delivery (odds ratio, 1.00; 95% confidence interval, 0.82-1.23) and instrumental vaginal delivery (odds ratio, 1.00; 95% confidence interval, 0.83-1.21) rates were similar in the early NA and control groups. Neonates of women with early NA had a higher umbilical artery pH and received less naloxone. In the early NA group, fewer women were not compliant with assigned treatment and crossed over to the control group. Women receiving early NA for pain relief are not at increased risk of operative delivery, whereas those receiving early parenteral opioid and late epidural analgesia present a higher risk of instrumental vaginal delivery for nonreassuring fetal status, worse indices of neonatal wellness, and a lower quality of maternal analgesia.
authors: Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. massimo.marucci@tin.it
authors: Massimo
authors: M
authors: Marucci
authors: Gilda
authors: G
authors: Cinnella
authors: Gaetano
authors: G
authors: Perchiazzi
authors: Nicola
authors: N
authors: Brienza
authors: Tommaso
authors: T
authors: Fiore
mesh_terms: D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005113:Extraction, Obstetrical / Q000592:standards*; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D017060:Patient Satisfaction; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic