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Is the management of epidural analgesia associated with an increased risk of cesarean delivery?
Journal article   Peer reviewed

Is the management of epidural analgesia associated with an increased risk of cesarean delivery?

Jeffrey D Traynor, Sharon L Dooley, Stacy Seyb, Cynthia A Wong and Amber Shadron
American journal of obstetrics and gynecology, Vol.182(5), pp.1058-1062
2000
DOI: 10.1067/mob.2000.105439
PMID: 10819827

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Abstract

Objective: The aim of this study was to quantify the association of cesarean delivery with epidural analgesia management, specifically with the timing of epidural catheter placement in relation to labor, the type of epidural analgesia, and the use of bolus dosing. Study Design: A retrospective cohort design was used to investigate 1561 consecutive nulliparous parturients whose labor occurred between November 1, 1996, and June 30, 1997, at Northwestern Memorial Hospital and who were delivered of term, singleton neonates in a cephalic presentation. The relationship between the management of epidural analgesia and the risk for cesarean delivery was determined with stepwise logistic regression to control for potential confounding variables. Results: There was a significantly increased risk of cesarean delivery associated with decrements in cervical effacement ( P = .001), cervical dilatation ( P = .001), and fetal station ( P = .001) at the time of epidural catheter placement. An increasing number of epidural boluses during the first stage of labor was also associated with increased risk of cesarean delivery ( P = .001). After we controlled for maternal age, maternal body mass index, gestational age, infant birth weight, induction of labor, use of magnesium sulfate, and presence of chorioamnionitis, the adjusted odds of cesarean delivery associated with fetal station (odds ratio, 1.45; 95% confidence interval, 1.2-1.7) and epidural boluses (odds ratio, 1.55; 95% confidence interval, 1.3-1.8) during the first stage of labor remained significant. Conclusion: The management of epidural analgesia during labor was associated with the potential for increased risk of cesarean delivery. This risk increased with higher stations of the fetal head at the time of epidural catheter placement and with more frequent epidural boluses of local anesthetic during the first stage of labor. (Am J Obstet Gynecol 2000;182:1058-62.)
 Bolus dosing epidural analgesia cesarean delivery fetal station

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