Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

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

17.02.2005


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:
http://www.northwestern.edu

More articles from Health and Medicine:

nachricht The genes are not to blame
20.07.2018 | Technische Universität München

nachricht Targeting headaches and tumors with nano-submarines
20.07.2018 | Universitätsmedizin der Johannes Gutenberg-Universität Mainz

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: Future electronic components to be printed like newspapers

A new manufacturing technique uses a process similar to newspaper printing to form smoother and more flexible metals for making ultrafast electronic devices.

The low-cost process, developed by Purdue University researchers, combines tools already used in industry for manufacturing metals on a large scale, but uses...

Im Focus: First evidence on the source of extragalactic particles

For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.

To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...

Im Focus: Magnetic vortices: Two independent magnetic skyrmion phases discovered in a single material

For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.

Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...

Im Focus: Breaking the bond: To take part or not?

Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.

A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...

Im Focus: New 2D Spectroscopy Methods

Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.

"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

Leading experts in Diabetes, Metabolism and Biomedical Engineering discuss Precision Medicine

13.07.2018 | Event News

Conference on Laser Polishing – LaP: Fine Tuning for Surfaces

12.07.2018 | Event News

11th European Wood-based Panel Symposium 2018: Meeting point for the wood-based materials industry

03.07.2018 | Event News

 
Latest News

A smart safe rechargeable zinc ion battery based on sol-gel transition electrolytes

20.07.2018 | Power and Electrical Engineering

Reversing cause and effect is no trouble for quantum computers

20.07.2018 | Information Technology

Princeton-UPenn research team finds physics treasure hidden in a wallpaper pattern

20.07.2018 | Materials Sciences

VideoLinks
Science & Research
Overview of more VideoLinks >>>