EPIDURAL ANALGESIA AND CESAREAN-SECTION FOR DYSTOCIA - RISK-FACTORS IN NULLIPARAS

被引：89

作者：

THORP, JA

ECKERT, LO

ANG, MS

JOHNSTON, DA

PEACEMAN, AM

PARISI, VM

机构：

[1] Division of Maternal-Fetal Medicine, Departments of Obstetrics, Gynecology, and Reproductive Sciences, and of Pediatrics, University of Texas Medical School, The M.D. Anderson Cancer Center, Houston, Texas

来源：

AMERICAN JOURNAL OF PERINATOLOGY | 1991年 / 8卷 / 06期

关键词：

D O I：

10.1055/s-2007-999426

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

A retrospective study assessing the effect of epidural analgesia in labor on the incidence of cesarean section was performed. The first 500 consecutive nulliparas meeting the following criteria were included in this study: term (37 weeks or longer) and singleton gestation, cephalic presentation, spontaneous onset of labor, and 5 cm or less of cervical dilation on admission. Patients were grouped according to their rate of cervical dilation in early labor (greater-than-or-equal-to 1 cm/hr, and < 1 cm/hr) and the timing of epidural placement (none, early, or late). There was no effect of epidural analgesia on the incidence of cesarean section for fetal distress. The incidence of cesarean section for dystocia was significantly greater (p > 0.000001) in the epidural group (15.6%) than in the nonepidural group (2.4%). The greatest effect of epidural analgesia on the incidence of cesarean section for dystocia was observed in nulliparas who dilated at slower rates (< 1 cm/hr) in early labor and who had epidural analgesia placed at 5 cm or less of cervical dilation (20.6% versus 3.4%, relative risk of 6, p < 0.0005). The increase of cesarean section for dystocia associated with epidural analgesia could not be accounted for when other possibly confounding variables were studied. Both the dilation rate prior to epidural placement and the cervical dilation at epidural placement were significantly correlated to frequency of cesarean section for dystocia (p < 0.01). This study suggests that epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparas.

引用

页码：402 / 410

页数：9

共 15 条

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