Delaying Epidural Not Necessary During Labor

Reuters Health

(Reuters Health) In comparison with early intravenous analgesia, use of early epidural analgesia does not lead to any important delay in labor progression, according to US researchers.

In the July issue of the American Journal of Obstetrics and Gynecology, Dr. John M. Thorp Jr. of the University of North Carolina School of Medicine, Chapel Hill and colleagues note that recent guidelines suggest that a request for pain relief should be sufficient grounds for epidural analgesia. The degree of cervical dilation alone should not be the determining factor.

Nevertheless, there have been many conflicting studies. A number suggest that epidural placement at or below 4 cm of cervical dilation may lead to greater risk of labor dysfunction and cesarean section.

To investigate further, the researchers examined data from an army medical center, at which over a one-year period there was a radical switch from predominant use of intravenous analgesia to that of epidural analgesia.

The researchers identified singleton, nulliparous term pregnancies with spontaneous labor and analgesia placement at or below 4 cm dilation. In total, 223 were from the period in which intravenous analgesia was used in 98% of women and 278 were from the period in which epidural analgesia was used in 92% of cases.

After adjustment, epidural analgesia was found to slow progression only from 4 to 5 cm. No significant difference was found between groups for the rest of the active labor phase.

The researchers thus concur with the guidelines, and conclude that "restraining use of epidural anesthesia at less than 4 cm of cervical dilation is unnecessary."

Am J Obstet Gynecol 2004;191:259-265.

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