title: Effect of epidural analgesia on labor times and mode of delivery: a prospective study.
abstract: OBJECTIVE
  To assess changes in labor times and delivery outcome in low-risk women requesting pain relief and undergoing epidural analgesia, according to the epidural analgesia schemes.
  
  
  METHODS
  Prospective observational study of 499 low-risk women with epidural analgesia. Speed of dilatation (SD) (centimeters of dilatation / hours), speed of lowering of the fetal head through maternal pelvis (SL) (centimeters in lowering / hours), time of active phase of labor (TA), cesarean section (CS), vacuum application (VA) were dependent variables in multivariable linear and logistic regressions.
  
  
  RESULTS
  Dilution of ropivacain, fentanyl amount, and volume of the first dose of epidural analgesia did not seem to affect labor times. Epidural analgesia with schemes used in this study favored both the dilatation and the fetal head lowering through maternal pelvis. Every five minutes from the first dose of epidural to the last top-up, SD decreased by about 13% (p=0.002), SL decreased by about 14% (p<0.001), and TA increased by about 40% (p<0.001). Additionally, every five minutes from the first dose of epidural to the last top-up, the odds of an operative vaginal birth (vacuum) increased by 0.7% (p<0.001). Increasing of number of top-ups independently caused a reduction in odds of undergoing CS (odds ratio 0.434; C.I. 95% 0.219-0.859, p=0.017), without influencing labor times.
  
  
  CONCLUSIONS
  Epidural analgesia in patients requesting pain relief favors normal course of labor if it is not discontinued or delayed.
authors.affiliation: Complex Operative Unit of Gynecology and Obstetrics, Hospital of Civitanova Marche-Area Vasta 3, Department of Woman's Health, Sapienza University, Rome, Italy. ugo.indraccolo@libero.it
authors.forename: U
authors.initials: U
authors.lastname: Indraccolo
authors.forename: A
authors.initials: A
authors.lastname: Ripanelli
authors.forename: R
authors.initials: R
authors.lastname: Di Iorio
authors.forename: S R
authors.initials: SR
authors.lastname: Indraccolo
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007743:Labor, Obstetric / Q000187:drug effects*; D011247:Pregnancy; D011446:Prospective Studies; D013997:Time Factors