Timing of epidural analgesia intervention for labor pain in nulliparous women in Taiwan: A retrospective study

Objective. The aim of this study was to assess and compare morning vs. midnight initiation of induction of labor (IOL) on time of birth and perinatal outcome.Study Design. A retrospective study performed at University Hospital Merkur, Zagreb, Croatia; in period between 2006 to 2017. The participants were low-risk nulliparous women with gestational age over 41 weeks who had labor induced by a prostaglandin E2 analogue dinoprostone applied intracervically. Two groups were compared; the first one had IOL initiated in the morning and the second one at midnight.Results. A total of 206 pregnant women were included in the study. Women with IOL starting at midnight (n=103) gave birth more often during daytime (7am-6.59pm) compared to women with IOL starting in the morning (n=103) (p<0.01). The midnight group also gave birth more often during regular hospital working hours (7.30am-3.30pm), but this result was not statistically significant (p=0.091). The rate of epidural analgesia was higher among women in the midnight group, while no other differences were observed in predefined perinatal outcome between the two groups.Conclusions. Initiation of IOL at midnight compared to morning results in giving birth more often during daytime. This presents a favourable option for reducing out of hours and night work.

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Cesarean Delivery

Anesthesiology ◽

10.1097/00000542-200203000-00007 ◽

2002 ◽

Vol 96 (3) ◽

pp. 546-551 ◽

Cited By ~ 101

Author(s):

Shiv K. Sharma ◽

James M. Alexander ◽

Gary Messick ◽

Steven L. Bloom ◽

Donald D. McIntire ◽

...

Keyword(s):

Confidence Interval ◽

Epidural Analgesia ◽

Labor Pain ◽

Cesarean Deliveries ◽

Nulliparous Women ◽

Lower Pain ◽

Intravenous Analgesia ◽

Obstetric Management ◽

Labor Epidural ◽

To Receive

Background Controversy concerning increased cesarean births as a result of epidural analgesia for relief of labor pain has been attributed, in large part, to difficulties interpreting published studies because of design flaws. In this study, the authors compared epidural analgesia to intravenous meperidine analgesia using patient-controlled devices during labor to evaluate the effects of labor epidural analgesia, primarily on the rate of cesarean deliveries while minimizing limitations attributable to study design. Methods Four hundred fifty-nine nulliparous women in spontaneous labor at term were randomly assigned to receive either epidural analgesia or intravenous meperidine analgesia. Epidural analgesia was initiated with 0.25% bupivacaine and was maintained with 0.0625% bupivacaine and fentanyl 2 microg/ml at 6 ml/h with 5-ml bolus doses every 15 min as needed using a patient-controlled pump. Women in the intravenous analgesia group received 50 mg meperidine with 25 mg promethazine hydrochloride as an initial bolus, followed by 15 mg meperidine every 10 min as needed, using a patient-controlled pump. A written procedural manual that prescribed the intrapartum obstetric management was followed for each woman randomized in the study. Results A total of 226 women were randomized to receive epidural analgesia, and 233 women were randomized to receive intravenous meperidine analgesia. Protocol violations occurred in 8% (38 of 459) of women. There was no difference in the rate of cesarean deliveries between the two analgesia groups (epidural analgesia, 7% [16 of 226; 95% confidence interval, 4-11%] vs. intravenous meperidine analgesia, 9% [20 of 233; 95% confidence interval, 5-13%]; P = 0.61). Significantly more women randomized to epidural analgesia had forceps deliveries compared with those randomized to meperidine analgesia (12% [26 of 226] vs. 3% [7 of 233]; P < 0.001). Women who received epidural analgesia reported lower pain scores during labor and delivery compared with women who received intravenous meperidine analgesia. Conclusions Epidural analgesia compared with intravenous meperidine analgesia during labor does not increase cesarean deliveries in nulliparous women.

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Comparison of the labor curves with and without combined spinal-epidural analgesia in nulliparous women- a retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03161-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hitomi Ando ◽

Shintaro Makino ◽

Jun Takeda ◽

Yojiro Maruyama ◽

Shuko Nojiri ◽

...

Keyword(s):

Retrospective Study ◽

Epidural Analgesia ◽

Combined Spinal Epidural ◽

Nulliparous Women ◽

Spinal Epidural

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Association of Pain Catastrophizing and Depressive States with Multidimensional Early Labor Pain Assessment in Nulliparous Women Having Epidural Analgesia – A Secondary Analysis

Journal of Pain Research ◽

10.2147/jpr.s331703 ◽

2021 ◽

Vol Volume 14 ◽

pp. 3099-3107

Author(s):

Xiu Ling Jacqueline Sim ◽

Chin Wen Tan ◽

Cheng Teng Yeam ◽

Hon Sen Tan ◽

Rehena Sultana ◽

...

Keyword(s):

Epidural Analgesia ◽

Pain Assessment ◽

Pain Catastrophizing ◽

Secondary Analysis ◽

Labor Pain ◽

Nulliparous Women ◽

Depressive States

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Labor Pain at the Time of Epidural Analgesia and Mode of Delivery in Nulliparous Women Presenting for an Induction of Labor

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000386851.13525.9f ◽

2010 ◽

Vol 30 (3) ◽

pp. 184-185

Author(s):

Y. Beilin ◽

D. Mungall ◽

S. Hossain ◽

C.A. Bodian

Keyword(s):

Epidural Analgesia ◽

Mode Of Delivery ◽

Induction Of Labor ◽

Labor Pain ◽

Nulliparous Women

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Impact of Epidural Analgesia at Different Cervical Dilation on the Rate of Cesarean Delivery

Science Insights ◽

10.15354/si.14.or007 ◽

2014 ◽

Vol 7 (2) ◽

pp. 153-166

Author(s):

Xiaofeng Shen

Keyword(s):

Epidural Analgesia ◽

Cesarean Delivery ◽

Controlled Trial ◽

Labor Pain ◽

High Rate ◽

Care Hospital ◽

Cervical Dilation ◽

Maternal Characteristics ◽

Nulliparous Women ◽

Significant Difference

BACKGROUND: Epidural analgesia is the optimal means in controlling labor pain, whereas the correlation between epidural analgesia at different cervix dilation and corresponding risk of operative delivery remains unclear. OBJECTIVE: The aim of this study was to investigate the association between the epidural analgesia at different cervix and the rate of Cesarean in nulliparous women. METHODS: This is a perspective controlled trial conducted in a University affiliated tertiary women’s health care hospital. After approval by the Institutional Ethical Committee, 780 nulliparous women who underwent spontaneous vaginal delivery at term requesting labor analgesia were screened and 596 of them were assigned into interventions. Subjects were allocated into one of four groups received epidural analgesia initiated at different cervical dilation, i.e. from the onset of painful uterine contraction to the cervix 50.0 mm or greater. The primary outcome was the rate of Cesarean delivery. Others included maternal and neonatal outcomes due to epidural analgesia and drug delivery. RESULTS: Five hundred and thirty three subjects completed the study. Significant difference in the rate of Cesarean delivery was observed amongst the four groups (98.9% at cervix <= 10.0mm, 30.2% at cervix 11.0 – 30.0mm, 24.2% at cervix 31.0 – 50.0mm and 18.1% at cervix >= 51.0mm, P < 0.0001). The major reason led to high Cesarean rate at cervix <= 10.0 mm was poor labor progression (75.2%). No significant differences were expressed in variables of non-reassuring fetal status. CONCLUSIONS: Epidural analgesia should be avoided in controlling labor pain at the cervix below 10.0mm due to its influence on the progress of labor resulting in high rate of Cesarean. Maternal characteristics are additional aspects need to be concerned during epidural labor control in nulliparous women. TRIAL REGISTRATION: Epidural Analgesia in Different Cervix Diameter and the Rate of Cesarean Delivery (EACDRCD). ClinicalTrials.gov ID, NCT00677274. http://clinicaltrials.gov/ct2/show/NCT00677274.

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