Citation
Thompson, Ted T.; Thorp, John M., Jr.; Mayer, David C.; Kuller, Jeffery A.; & Bowes, Watson A., Jr. (1998). Does Epidural Analgesia Cause Dystocia?. Journal of Clinical Anesthesia, 10(1), 58-65.Abstract
STUDY OBJECTIVE: To analyze the effects of epidural analgesia for labor when dystocia occurs.DESIGN: Retrospective cohort study.
SETTING: Academic health center.
PATIENTS: 641 low risk, nulliparous women in spontaneous labor.
INTERVENTIONS: 406 (63%) women received epidurals analgesia and 253 (37%) did not. Sixty women (9.4%) required an abdominal delivery for dystocia.
MEASUREMENTS AND MAIN RESULTS: Women receiving epidural analgesia were more likely to be white, receive care from an attending physician, need labor augmentation, and deliver a heavier infant. Multivariate analysis identified five variables predictive of dystocia and abdominal delivery: pitocin augmentation odds ratio (O.R.) = 3.9 (2.0 to 7.6), duration of labor more than 20 hours O.R. = 2.4 (1.3 to 4.4), high epidural dose O.R. = 2.2 (1.2 to 4.1), birthweight over 4,000 grams O.R. = 2.0 (1.0 to 4.2), and early placement of epidural O.R. = 1. 9 (1.0 to 3.5). Repeating the regression after excluding the 20 women who developed abnormal labor prior to epidural placement (18 of 20 women had protracted dilatation) demonstrated that pitocin augmentation O.R. = 4.0 (1.8 to 4.), high epidural dose O.R. = 3.0 (1.9 to 6.2), duration of labor greater than 20 hours O.R. = 2.7 (1.3 to 5.7), and birthweight over 4,000 grams O.R. = 2.1 (0. 9 to 4.8) were associated with dystocia.
CONCLUSION: Epidural analgesia appears to be a marker of abnormal labor rather than a cause of dystocia. High concentration anesthetics and epinephrine should be avoided, as they may influence labor. Randomized, controlled trials of this technique will be difficult to do; our work should reassure patients and their clinicians that epidural analgesia does not adversely affect labor.
URL
http://dx.doi.org/10.1016/s0952-8180(97)00222-5Reference Type
Journal ArticleYear Published
1998Journal Title
Journal of Clinical AnesthesiaAuthor(s)
Thompson, Ted T.Thorp, John M., Jr.
Mayer, David C.
Kuller, Jeffery A.
Bowes, Watson A., Jr.