Does intrapartum epidural analgesia affect nulliparous labor and postpartum urinary incontinence?
BACKGROUND
The effect of epidural analgesia on nulliparous labor and delivery remains controversial. In addition, pregnancy and delivery have long been considered risk factors in the genesis of stress urinary incontinence (SUI). We sought to determine the effect of epidural analgesia and timing of administration on labor course and postpartum SUI.


METHODS
Five hundred and eighty three nulliparous women were admitted for vaginal delivery at > or = 36 gestational weeks. We compared various obstetric parameters and SUI, at puerperium and 3 months postpartum, among patients who had epidural and non-epidural analgesia, and among those who had early (cervical dilatation < 3 cm) and late (cervical dilatation > or = 3 cm) epidural analgesia.


RESULTS
When compared with the non-epidural analgesia group (n = 319), the group that received epidural analgesia (n = 264) had significant prolongation of the first and second stages of labor, and higher likelihood for instrumental and cesarean delivery but similar incidence of severe vaginal laceration and postpartum SUI. Except for the first stage of labor, early administration of epidural analgesia did not result in a significant influence on obstetric parameters or an increased incidence of postpartum SUI.


CONCLUSIONS
Our findings showed that epidural analgesia is associated with an increased risk of prolonged labor, and instrumental and cesarean delivery but is not related to increased postpartum SUI. Regarding the impact of the timing of epidural analgesia given in the labor course, the first stage of labor appeared to last longer when analgesia was administered early rather than late.
Liang
Ching-Chung
CC
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan, ROC.
Wong
Shu-Yam
SY
Chang
Yao-Lung
YL
Tsay
Pei-Kwei
PK
Chang
Shuenn-Dhy
SD
Lo
Liang-Ming
LM
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology*; D014550:Urinary Incontinence, Stress / Q000209:etiology*