title: Labor epidural analgesia and the incidence of instrumental assisted delivery.
abstract: OBJECTIVE
  To assess the influence of labor epidural analgesia on the course of labor and to determine its association with instrumental assisted delivery rate.
  
  
  METHODS
  A retrospective case-control study was performed during 2007-2011 aiming to identify the relation between epidural analgesia (EA) and instrumental assisted delivery (IAD) rate. All patients in whom instrumental assistance for delivery was applied were allocated into either case (parturients who received EA and had IAD) or control (parturients who did not receive EA but had IAD) groups. Maternal demographic data, pregnancy and delivery characteristics as well as neonatal short-term outcome were studied.
  
  
  RESULTS
  A total of 7675 vaginal deliveries occurred during the study period and 187 (2.43%) patients had IAD. Vacuum extraction was applied to 67 (2.16%) parturients who received EA, and to 120 (2.61%) who did not. The median duration of the first stage of labor was 510 min in the EA group as compared to 390 min in the control group (P=0.001). The median duration of the second stage of labor among cases and controls was 60 and 40 min, respectively (P<0.0005). Cases more often had their labor induced by oxytocin 80.3% as compared to 58.3% among controls (P=0.003). There was no significant association between the use of EA and increased IAD rate (OR=0.81; 95% CI, 0.60-1.09).
  
  
  CONCLUSIONS
  Labor EA did not increase the incidence of IAD and the risk of adverse neonatal outcomes, but was associated with prolonged first and second stages of labor.
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: kestutis.rimaitis@kaunoklinikos.lt.
authors.forename: Kęstutis
authors.initials: K
authors.lastname: Rimaitis
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Olga
authors.initials: O
authors.lastname: Klimenko
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Marius
authors.initials: M
authors.lastname: Rimaitis
authors.affiliation: Tauragė Hospital, Tauragė, Lithuania.
authors.forename: Asta
authors.initials: A
authors.lastname: Morkūnaitė
authors.affiliation: Department of Anesthesiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Andrius
authors.initials: A
authors.lastname: Macas
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D007743:Labor, Obstetric; D008097:Lithuania; D011247:Pregnancy; D012189:Retrospective Studies; D014620:Vacuum Extraction, Obstetrical / Q000295:instrumentation; D055815:Young Adult
keywords: Epidural analgesia; Instrumental assisted delivery; Vacuum extraction