Effects of Epidural Analgesia: Some Questions and Answers

Authors

  • James A. Thorp M.D.,

    Corresponding author
    1. James A. Thorp is Associate Director, Maternal-Fetal Medicine, St. Luke's Hospital, Kansas City, MO.
      Address correspondence to James Thorp, M.D., Perinatal Consultants, The Outpatient Center, 4400 Wornall Rd., Kansas City, MO 64111.
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  • Jay D. McNitt M.D.,

    1. Jay D. McNitt is Clinical Associate Professor, University of Missouri and Department of Anesthesia, St. Luke's Hospital, Kansas City, MO.
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  • Phyllis C. Leppert M.D., Ph.D., C.N.M.

    1. Phyllis C. Leppert is Chief and Associate Professor, Department of Obstetrics and Gynecology, Rochester General Hospital, Rochester, NY.
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Address correspondence to James Thorp, M.D., Perinatal Consultants, The Outpatient Center, 4400 Wornall Rd., Kansas City, MO 64111.

Abstract

ABSTRACT: The effects of epidural analgesia on first labors have been studied by Thorp and colleagues (1,2). One study has been published (3) and is the subject of a question-and-answer discussion, presented here. In this study 711 consecutive nulliparous women at term, with spontaneous onset of labor and cephalic presentation, were divided into one group (n = 447) who received epidural analgesia in labor and another group (n = 264) who received narcotics or no analgesia. The frequency of cesarean section for dystocia was significantly greater (p < 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%), even after selection bias was corrected and the variables of maternal age and race; gestational age; cervical dilatation on admission; use, duration, and maximum infusion rate of oxytocin; labor duration; presence of meconium; and birth weight were controlled. For both groups the frequency of cesarean section for fetal distress was similar (p < 0.20), and the frequency of low Apgar scores at 5 minutes and cord blood gas values showed no significant differences. The authors concluded that “epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women’(3).

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