Early Epidurals Don't Impact Operative Delivery


HOLLYWOOD, FLA. — Epidural analgesia given in early labor has been shown to have no significant effect on the risk of operative delivery in patients with spontaneous labor, and the same appears to hold true for patients with induced labor, according to data presented at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

In a series of 796 consecutive women with induced labor who requested early pain relief, the operative delivery rates were similar in those who did and did not receive early labor epidural analgesia (28% and 27%), Dr. Philip E. Hess reported.

Because labor induction is known to be associated with higher operative delivery rates, there was concern that the effects of epidural analgesia in induced labor might be different from its effects in spontaneous labor, Dr. Hess wrote in a poster.

The findings will hopefully put to rest the debate over whether there is a benefit with regard to operative delivery rates with delayed epidurals, Dr. Cynthia A. Wong said during a poster review session that she moderated. Dr. Wong of Northwestern University, Chicago, was lead author on a major study showing no benefit of delaying epidural analgesia in women with spontaneous labor (N. Engl. J. Med. 2005;352:655–65).

In the current study, patients undergoing labor induction who requested early pain relief (prior to 4-cm dilation) received parenteral opioid or labor epidural analgesia according to their obstetrician's protocol, reported Dr. Hess of Beth Israel Deaconess Medical Center in Boston.

A total of 350 women received epidural analgesia, and 446 received parenteral opioid. The groups were demographically similar, except the average body mass index was higher in the group that did not receive early epidural analgesia. The groups were also similar to a comparison group of 503 women with spontaneous labor who had a 21% operative delivery rate, significantly lower than the rates in the induced labor groups, he noted.

Next Article: