Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 07 Jan 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Does epidural analgesia cause dystocia? J Clin Anesth. 1998 Feb;10(1):58-65.

Author(s) :

Thompson TT, Thorp JM Jr, Mayer D, Kuller JA, Bowes WA Jr.

Year of publication :

1998

URL(s) :

http://www.sciencedirect.com/science?_ob=ArticleUR…

Résumé (français)  :

Abstract (English)  :

STUDY OBJECTIVE: To analyze the effects of epidural analgesia for labor when dystocia occurs.

DESIGN: Retrospective cohort study.

SETTING: Academic health center.

PATIENTS: 641 low risk, nulliparous women in spontaneous labor.
I
NTERVENTIONS: 406 (63%) women received epidurals analgesia and 253 (37%) did not. Sixty women (9.4%) required an abdominal delivery for dystocia.

MEASUREMENTS AND MAIN RESULTS: Women receiving epidural analgesia were more likely to be white, receive care from an attending physician, need labor augmentation, and deliver a heavier infant. Multivariate analysis identified five variables predictive of dystocia and abdominal delivery: pitocin augmentation odds ratio (O.R.) = 3.9 (2.0 to 7.6), duration of labor more than 20 hours O.R. = 2.4 (1.3 to 4.4), high epidural dose O.R. = 2.2 (1.2 to 4.1), birthweight over 4,000 grams O.R. = 2.0 (1.0 to 4.2), and early placement of epidural O.R. = 1. 9 (1.0 to 3.5). Repeating the regression after excluding the 20 women who developed abnormal labor prior to epidural placement (18 of 20 women had protracted dilatation) demonstrated that pitocin augmentation O.R. = 4.0 (1.8 to 4.), high epidural dose O.R. = 3.0 (1.9 to 6.2), duration of labor greater than 20 hours O.R. = 2.7 (1.3 to 5.7), and birthweight over 4,000 grams O.R. = 2.1 (0. 9 to 4.8) were associated with dystocia.

CONCLUSION: Epidural analgesia appears to be a marker of abnormal labor rather than a cause of dystocia. High concentration anesthetics and epinephrine should be avoided, as they may influence labor. Randomized, controlled trials of this technique will be difficult to do; our work should reassure patients and their clinicians that epidural analgesia does not adversely affect labor.

Sumário (português)  :

Comments :

Argument (français) :

Argument (English):

Argumento (português):

Keywords :

➡ c-section/caesarean ; evidence-based medicine/midwifery ; duration of labour ; dystocy ; epidural ; active management of labor

Author of this record :

Cécile Loup — 07 Jan 2004