Early versus late initiation of epidural analgesia in labor: Does it increase the risk of cesarean section? A randomized trial

Gonen Ohel, Roni Gonen, Sonia Vaida, Shlomi Barak, Luis Gaitini

Research output: Contribution to journalArticle

97 Scopus citations

Abstract

Objective: To determine whether early initiation of epidural analgesia in nulliparous women affects the rate of cesarean sections and other obstetric outcome measures. Study design: A randomized trial in which 449 at term nulliparous women in early labor, at less than 3 cm of cervical dilatation, were assigned to either immediate initiation of epidural analgesia at first request (221 women), or delay of epidural until the cervix dilated to at least 4 cm (228 women). Results: At initiation of the epidural the mean cervical dilatation was 2.4 cm in the early epidural group and 4.6 cm in the late group (P < 0.0001). The rates of cesarean section were not significantly different between the groups - 13% and 11% in the early and late groups, respectively (P = 0.77). The mean duration from randomization to full dilatation was significantly shorter in the early compared to the late epidural group - 5.9 hours and 6.6 hours respectively (P = 0.04). When questioned after delivery regarding their next labor, the women indicated a preference for early epidural. Conclusion: Initiation of epidural analgesia in early labor, following the first request for epidural, did not result in increased cesarean deliveries, instrumental vaginal deliveries, and other adverse effects; furthermore, it was associated with shorter duration of the first stage of labor and was clearly preferred by the women.

Original languageEnglish (US)
Pages (from-to)600-605
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume194
Issue number3
DOIs
StatePublished - Jan 1 2006

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology

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