Epidural Analgesia and Cesarean Section for Dystocia

Risk Factors in Nulliparas

J. A. Thorp, L. O. Eckert, M. S. Ang, D. A. Johnston, A. M. Peaceman, V. M. Parisi

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (e 1 cm/hr, and < 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p >0.000001) in the epidural group (15.6%) than in the nonepidural group (2.4%). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (<1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6% versus 3.4%, relative risk of 6, p <0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p <0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.

Original languageEnglish (US)
Pages (from-to)402-410
Number of pages9
JournalAmerican Journal of Perinatology
Volume8
Issue number6
DOIs
StatePublished - Jan 1 1991

Fingerprint

Dystocia
Epidural Analgesia
Cesarean Section
Dilatation
Incidence
Labor Onset
Confounding Factors (Epidemiology)
Retrospective Studies
Head
Pregnancy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Thorp, J. A. ; Eckert, L. O. ; Ang, M. S. ; Johnston, D. A. ; Peaceman, A. M. ; Parisi, V. M. / Epidural Analgesia and Cesarean Section for Dystocia : Risk Factors in Nulliparas. In: American Journal of Perinatology. 1991 ; Vol. 8, No. 6. pp. 402-410.
@article{9432080318144b62a03dcf7faff79aa8,
title = "Epidural Analgesia and Cesarean Section for Dystocia: Risk Factors in Nulliparas",
abstract = "A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (e 1 cm/hr, and < 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p >0.000001) in the epidural group (15.6{\%}) than in the nonepidural group (2.4{\%}). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (<1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6{\%} versus 3.4{\%}, relative risk of 6, p <0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p <0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.",
author = "Thorp, {J. A.} and Eckert, {L. O.} and Ang, {M. S.} and Johnston, {D. A.} and Peaceman, {A. M.} and Parisi, {V. M.}",
year = "1991",
month = "1",
day = "1",
doi = "10.1055/s-2007-999426",
language = "English (US)",
volume = "8",
pages = "402--410",
journal = "American Journal of Perinatology",
issn = "0735-1631",
publisher = "Thieme Medical Publishers",
number = "6",

}

Epidural Analgesia and Cesarean Section for Dystocia : Risk Factors in Nulliparas. / Thorp, J. A.; Eckert, L. O.; Ang, M. S.; Johnston, D. A.; Peaceman, A. M.; Parisi, V. M.

In: American Journal of Perinatology, Vol. 8, No. 6, 01.01.1991, p. 402-410.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Epidural Analgesia and Cesarean Section for Dystocia

T2 - Risk Factors in Nulliparas

AU - Thorp, J. A.

AU - Eckert, L. O.

AU - Ang, M. S.

AU - Johnston, D. A.

AU - Peaceman, A. M.

AU - Parisi, V. M.

PY - 1991/1/1

Y1 - 1991/1/1

N2 - A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (e 1 cm/hr, and < 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p >0.000001) in the epidural group (15.6%) than in the nonepidural group (2.4%). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (<1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6% versus 3.4%, relative risk of 6, p <0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p <0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.

AB - A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (e 1 cm/hr, and < 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p >0.000001) in the epidural group (15.6%) than in the nonepidural group (2.4%). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (<1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6% versus 3.4%, relative risk of 6, p <0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p <0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.

UR - http://www.scopus.com/inward/record.url?scp=0025992168&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025992168&partnerID=8YFLogxK

U2 - 10.1055/s-2007-999426

DO - 10.1055/s-2007-999426

M3 - Article

VL - 8

SP - 402

EP - 410

JO - American Journal of Perinatology

JF - American Journal of Perinatology

SN - 0735-1631

IS - 6

ER -