Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:


No increase in C-sections when epidural analgesia given early in labor


Injecting spinal-epidural analgesia in early labor does not increase cesarean delivery rates and provides better pain relief and a shorter duration of labor than systemic opioid analgesia, according to an article by Northwestern University researchers published in the Feb. 17 issue of The New England Journal of Medicine.
Epidural injections are administered into the space between the wall of the spinal canal and the sheath covering the spinal cord and anesthetize the abdominal, genital and pelvic areas. Spinal injections are administered into the fluid surrounding the spinal cord.

Previous research has suggested that epidural analgesia initiated early in labor – when the cervix is dilated less than 4 centimeters – is associated with an increased risk for cesarean delivery. Based on that research, the American College of Obstetricians and Gynecologists recommended that epidural analgesia be delayed in women who have not previously given birth until their cervix dilates to 4 to 5 centimeters and that other forms of analgesia, for example, systemic opioid analgesia, be used until that time.

However, it is unclear whether increased risk for cesarean delivery is due to neuraxial [spinal or epidural] analgesia or can be explained by other factors, said Cynthia A. Wong, M.D., associate professor of anesthesiology at Northwestern University Feinberg School of Medicine, who led the study. Wong also is an anesthesiologist at Northwestern Memorial Hospital. "Systemic opioid analgesia is often incomplete and has potential maternal and fetal side effects, including neonatal and maternal respiratory depression, especially when spinal or epidural opioids are administered concomitantly," Wong said.

The Northwestern study examined 750 full-term, nulliparous (no previous births) women in spontaneous labor, with cervical dilation less than 4 centimeters. Participants were randomized to receive spinal fentanyl or systemic hydromorphone (a morphine-like drug) at their first request for anesthesia. Epidural analgesia was administered in the spinal group at their second request for analgesia, and in the systemic group, when the cervix had dilated to 4 centimeters or greater, or at the third request for analgesia. Rate of cesarean delivery was the primary outcome. Wong and colleagues found that the rate of cesarean delivery was not significantly different between the groups – 18 percent in the spinal group versus 21 percent in the systemic group.

Moreover, the median time from initiation of analgesia to complete dilation was 295 minutes in the epidural group versus 385 minutes in the systemic group; vaginal delivery was significantly shorter (398 minutes versus 479 minutes) and self-reported pain scores were significantly lower after spinal-epidural analgesia. The lack of association between early labor neuraxial analgesia and an increased cesarean delivery rate suggests that request for analgesia, or greater analgesia use, may be markers for other risk factors for cesarean section, Wong said. Another clinically important finding of the Northwestern study was that duration of the first stage of labor following epidural administration of analgesia was shorter by approximately 80 minutes. Previous studies have found that epidural analgesia compared to systemic opioid analgesia was associated with a prolonged first stage of labor.

Wong’s co-authors on this study were Barbara M. Scavone, M.D.; Robert J. McCarthy, PharmD; John T. Sullivan, M.D.; Nathaniel T. Diaz, M.D.; Edward Yaghmour, M.D.; R-Jay L. Marcus, M.D.; Saadia S. Sherwani, M.D. Michelle T. Sproviero, M.D.; Roshani Patel; Carmen Robles; and Sharon Grouper, anesthesiology; and Alan M. Peaceman, M.D., obstetrics and gynecology.

Elizabeth Crown | EurekAlert!
Further information:

More articles from Health and Medicine:

nachricht NIH scientists describe potential antibody treatment for multidrug-resistant K. pneumoniae
14.03.2018 | NIH/National Institute of Allergy and Infectious Diseases

nachricht Researchers identify key step in viral replication
13.03.2018 | University of Pittsburgh Schools of the Health Sciences

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Mars' oceans formed early, possibly aided by massive volcanic eruptions

Oceans formed before Tharsis and evolved together, shaping climate history of Mars

A new scenario seeking to explain how Mars' putative oceans came and went over the last 4 billion years implies that the oceans formed several hundred million...

Im Focus: Tiny implants for cells are functional in vivo

For the first time, an interdisciplinary team from the University of Basel has succeeded in integrating artificial organelles into the cells of live zebrafish embryos. This innovative approach using artificial organelles as cellular implants offers new potential in treating a range of diseases, as the authors report in an article published in Nature Communications.

In the cells of higher organisms, organelles such as the nucleus or mitochondria perform a range of complex functions necessary for life. In the networks of...

Im Focus: Locomotion control with photopigments

Researchers from Göttingen University discover additional function of opsins

Animal photoreceptors capture light with photopigments. Researchers from the University of Göttingen have now discovered that these photopigments fulfill an...

Im Focus: Surveying the Arctic: Tracking down carbon particles

Researchers embark on aerial campaign over Northeast Greenland

On 15 March, the AWI research aeroplane Polar 5 will depart for Greenland. Concentrating on the furthest northeast region of the island, an international team...

Im Focus: Unique Insights into the Antarctic Ice Shelf System

Data collected on ocean-ice interactions in the little-researched regions of the far south

The world’s second-largest ice shelf was the destination for a Polarstern expedition that ended in Punta Arenas, Chile on 14th March 2018. Oceanographers from...

All Focus news of the innovation-report >>>



Industry & Economy
Event News

Virtual reality conference comes to Reutlingen

19.03.2018 | Event News

Ultrafast Wireless and Chip Design at the DATE Conference in Dresden

16.03.2018 | Event News

International Tinnitus Conference of the Tinnitus Research Initiative in Regensburg

13.03.2018 | Event News

Latest News

Physicists made crystal lattice from polaritons

20.03.2018 | Physics and Astronomy

Mars' oceans formed early, possibly aided by massive volcanic eruptions

20.03.2018 | Physics and Astronomy

Thawing permafrost produces more methane than expected

20.03.2018 | Earth Sciences

Science & Research
Overview of more VideoLinks >>>