title: Rebuilding the labor curve during neuraxial analgesia.
abstract: OBJECTIVE
  The aim of this study was to examine the pattern of labor progression among nulliparous women under neuraxial analgesia to obtain a new, specific reference labor curve and to compare the different effects of epidural and combined spinal epidural (CSE) analgesia on the progression of labor.
  
  
  METHODS
  This perspective cohort study was carried out in the Obstetrics and Gynecology tertiary care unit. Six hundred nulliparous parturients were enrolled. A total of 545 nulliparous women were assigned to receive either epidural (272) or CSE (273) analgesia during labor.
  
  
  RESULTS
  The mean duration of the first stage was 4 h and 30 min (SD 1.52 h) and the mean duration of the second stage was 1 h and 10 min (SD 0.43). In the second stage, the CSE analgesia labors showed an overall faster progression compared to the epidural labors but both lasted longer than the duration reported by Zhang (53 min) and Friedman (39 min). Both the first and the second-stage duration were significantly lower if neuraxial analgesia was performed as a CSE procedure with respect to the simple epidural procedure (first stage 4 h and 1 min vs. 4 h and 60 min, P = 0.043; second stage 1 h and 5 min vs 1 h and 15 min, P = 0.0356).
  
  
  CONCLUSIONS
  The pattern of labor progression in contemporary obstetrics differs significantly from the Friedman curve. Based on these observations, we can obtain a more comprehensive knowledge of the partogram's modifications due to the analgesia.
authors.affiliation: Intensive Care Unit and Anesthesiology, Fatebenefratelli Association for Research, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Frigo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Larciprete
authors.forename: Federica
authors.initials: F
authors.lastname: Rossi
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusco
authors.forename: Cristina
authors.initials: C
authors.lastname: Todde
authors.forename: Sheba
authors.initials: S
authors.lastname: Jarvis
authors.forename: Valentina
authors.initials: V
authors.lastname: Panetta
authors.forename: Danilo
authors.initials: D
authors.lastname: Celleno
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D016362:Analgesia, Obstetrical / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000188:drug therapy*; D007743:Labor, Obstetric; D011247:Pregnancy; D011446:Prospective Studies
chemical_list: D000700:Analgesics