TY - JOUR
T1 - Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery
AU - Lipschuetz, Michal
AU - Nir, Eshel A.
AU - Cohen, Sarah M.
AU - Guedalia, Joshua
AU - Hochler, Hila
AU - Amsalem, Hagai
AU - Karavani, Gilad
AU - Hochner-Celnikier, Drorith
AU - Unger, Ron
AU - Yagel, Simcha
N1 - Publisher Copyright:
© 2020 Nordic Federation of Societies of Obstetrics and Gynecology
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Introduction: Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. Material and methods: A retrospective electronic medical records-based study of 18 870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. Results: In primiparas, receiving EA correlated with longer medians of active first stage (+51 minutes; P <.001) and second stage (+55 minutes; P <.001). In multiparas, median increases in active first stage (+43 minutes; P <.001) and second stage (+8 minutes; P <.001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10 cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. Conclusions: Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.
AB - Introduction: Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. Material and methods: A retrospective electronic medical records-based study of 18 870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. Results: In primiparas, receiving EA correlated with longer medians of active first stage (+51 minutes; P <.001) and second stage (+55 minutes; P <.001). In multiparas, median increases in active first stage (+43 minutes; P <.001) and second stage (+8 minutes; P <.001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10 cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. Conclusions: Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.
KW - duration of labor
KW - epidural analgesia
KW - first stage of labor
KW - instrumental deliveries
KW - multiparas
KW - primiparas
KW - second stage of labor
UR - http://www.scopus.com/inward/record.url?scp=85088169974&partnerID=8YFLogxK
U2 - 10.1111/aogs.13822
DO - 10.1111/aogs.13822
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C2 - 32031682
AN - SCOPUS:85088169974
SN - 0001-6349
VL - 99
SP - 1039
EP - 1049
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
IS - 8
ER -