Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review
Abstract Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearc...
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| Veröffentlicht in: | BMJ 2004-06, Vol.328 (7453), p.1410-1412 |
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| description | Abstract Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief. |
| doi_str_mv | 10.1136/bmj.38097.590810.7C |
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| fullrecord | <record><control><sourceid>jstor_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_421779</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>41709791</jstor_id><sourcerecordid>41709791</sourcerecordid><originalsourceid>FETCH-LOGICAL-b616t-711bc0967e8309870080a0a95f3448689439da0c64bae2caf3de564321e7db213</originalsourceid><addsrcrecordid>eNqNkl2LEzEUhgdR3LLuLxAlKOpVazLJ5EPwQoqrsquCaC-8CaczmZo6ndRkprW_xz_q6U6pq6B4Fcj7vDkfebPsLqMTxrh8Ol8tJ1xToyaFoRpv1fRGNmJC6nGhOb-ZjagpzFgzrk-ys5SWlNKcK21kcTs7YQWTRgkxyn58gM4lEmpSgksQHbQkubLzoSXQVsS3qYv9yrUdNGQDC9_iWbnGb1zcoUravmn8GmLoE9kGBAnUnYukCVtShrZEZ4Sr59zaV31Eu2_rPuENlo0krH3wFdaCZuGSh2ck7VLnVugpSXQb77Z3sls1NMmdHc7T7NP5y4_T1-PL96_eTF9cjueSyW6sGJuX1EjlNKdGK0o1BQqmqLkQWmojuKmAllLMweUl1LxyhRQ8Z05V85zx0-z58O66n69cNbTe2HX0K4g7G8Db35XWf7GLsLEiZ0oZ9D85-GP41rvU2ZVPpWsaaB2uxyop8pxhK0g-_jeZU1YoUSD44A9wGfqIu0o2p4Iyrop93Yd_g7AvTaXWTCDFB6qMIaXo6uNgjNp9pixmyl5lyg6ZsmqKrvvXd_LLc0gQAo8OAKQSmjpCW_p0jdPCMKmQuzdwy9SFeNQFU1jQ7Jc_HnSPv__9qEP8atGtCvtuNrVmVry9-HxxbmfITwZ-3_X_TPITBD__uA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1778068814</pqid></control><display><type>article</type><title>Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review</title><source>MEDLINE</source><source>Applied Social Sciences Index & Abstracts (ASSIA)</source><source>JSTOR Archive Collection A-Z Listing</source><source>Alma/SFX Local Collection</source><creator>Liu, E H C ; Sia, A T H</creator><creatorcontrib>Liu, E H C ; Sia, A T H</creatorcontrib><description>Abstract Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.</description><edition>International edition</edition><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 0959-8146</identifier><identifier>EISSN: 1468-5833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.38097.590810.7C</identifier><identifier>PMID: 15169744</identifier><identifier>CODEN: BMJOAE</identifier><language>eng</language><publisher>London: British Medical Journal Publishing Group</publisher><subject>Analgesia ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesics, Opioid - administration & dosage ; Anesthesia ; Anesthetics, Local - administration & dosage ; Biological and medical sciences ; Births ; Bupivacaine - administration & dosage ; Cesarean section ; Cesarean Section - utilization ; Childbirth & labor ; Confidence intervals ; Delivery, Obstetric - instrumentation ; Delivery. Postpartum. Lactation ; Epidural analgesia ; Epidural anesthesia ; Experimentation ; Female ; Gender equality ; Gynecology. Andrology. Obstetrics ; Health risk assessment ; Humans ; Low concentrations ; Maternal, fetal and perinatal monitoring ; Medical sciences ; Meta-analysis ; Obstetric Labor Complications - therapy ; Obstetrical anesthesia ; Opioid analgesics ; Parity ; Pregnancy ; Randomized Controlled Trials as Topic ; Risk Factors ; Second stage of labor ; Studies ; Vacuum Extraction, Obstetrical ; Validity</subject><ispartof>BMJ, 2004-06, Vol.328 (7453), p.1410-1412</ispartof><rights>2004 BMJ Publishing Group Ltd.</rights><rights>BMJ Publishing Group Ltd 2004</rights><rights>2004 INIST-CNRS</rights><rights>Copyright: 2004 (c) 2004 BMJ Publishing Group Ltd.</rights><rights>Copyright BMJ Publishing Group Jun 12, 2004</rights><rights>Copyright © 2004, BMJ Publishing Group Ltd. 2004</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b616t-711bc0967e8309870080a0a95f3448689439da0c64bae2caf3de564321e7db213</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/41709791$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/41709791$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>230,314,780,784,803,885,27923,27924,30998,58016,58249</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15849167$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15169744$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, E H C</creatorcontrib><creatorcontrib>Sia, A T H</creatorcontrib><title>Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review</title><title>BMJ</title><addtitle>BMJ</addtitle><description>Abstract Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.</description><subject>Analgesia</subject><subject>Analgesia, Epidural</subject><subject>Analgesia, Obstetrical</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Anesthesia</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Biological and medical sciences</subject><subject>Births</subject><subject>Bupivacaine - administration & dosage</subject><subject>Cesarean section</subject><subject>Cesarean Section - utilization</subject><subject>Childbirth & labor</subject><subject>Confidence intervals</subject><subject>Delivery, Obstetric - instrumentation</subject><subject>Delivery. Postpartum. Lactation</subject><subject>Epidural analgesia</subject><subject>Epidural anesthesia</subject><subject>Experimentation</subject><subject>Female</subject><subject>Gender equality</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Low concentrations</subject><subject>Maternal, fetal and perinatal monitoring</subject><subject>Medical sciences</subject><subject>Meta-analysis</subject><subject>Obstetric Labor Complications - therapy</subject><subject>Obstetrical anesthesia</subject><subject>Opioid analgesics</subject><subject>Parity</subject><subject>Pregnancy</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Factors</subject><subject>Second stage of labor</subject><subject>Studies</subject><subject>Vacuum Extraction, Obstetrical</subject><subject>Validity</subject><issn>0959-8138</issn><issn>0959-8146</issn><issn>1468-5833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkl2LEzEUhgdR3LLuLxAlKOpVazLJ5EPwQoqrsquCaC-8CaczmZo6ndRkprW_xz_q6U6pq6B4Fcj7vDkfebPsLqMTxrh8Ol8tJ1xToyaFoRpv1fRGNmJC6nGhOb-ZjagpzFgzrk-ys5SWlNKcK21kcTs7YQWTRgkxyn58gM4lEmpSgksQHbQkubLzoSXQVsS3qYv9yrUdNGQDC9_iWbnGb1zcoUravmn8GmLoE9kGBAnUnYukCVtShrZEZ4Sr59zaV31Eu2_rPuENlo0krH3wFdaCZuGSh2ck7VLnVugpSXQb77Z3sls1NMmdHc7T7NP5y4_T1-PL96_eTF9cjueSyW6sGJuX1EjlNKdGK0o1BQqmqLkQWmojuKmAllLMweUl1LxyhRQ8Z05V85zx0-z58O66n69cNbTe2HX0K4g7G8Db35XWf7GLsLEiZ0oZ9D85-GP41rvU2ZVPpWsaaB2uxyop8pxhK0g-_jeZU1YoUSD44A9wGfqIu0o2p4Iyrop93Yd_g7AvTaXWTCDFB6qMIaXo6uNgjNp9pixmyl5lyg6ZsmqKrvvXd_LLc0gQAo8OAKQSmjpCW_p0jdPCMKmQuzdwy9SFeNQFU1jQ7Jc_HnSPv__9qEP8atGtCvtuNrVmVry9-HxxbmfITwZ-3_X_TPITBD__uA</recordid><startdate>20040612</startdate><enddate>20040612</enddate><creator>Liu, E H C</creator><creator>Sia, A T H</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group</general><general>British Medical Association</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7QJ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20040612</creationdate><title>Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review</title><author>Liu, E H C ; Sia, A T H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b616t-711bc0967e8309870080a0a95f3448689439da0c64bae2caf3de564321e7db213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Analgesia</topic><topic>Analgesia, Epidural</topic><topic>Analgesia, Obstetrical</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Anesthesia</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Biological and medical sciences</topic><topic>Births</topic><topic>Bupivacaine - administration & dosage</topic><topic>Cesarean section</topic><topic>Cesarean Section - utilization</topic><topic>Childbirth & labor</topic><topic>Confidence intervals</topic><topic>Delivery, Obstetric - instrumentation</topic><topic>Delivery. Postpartum. Lactation</topic><topic>Epidural analgesia</topic><topic>Epidural anesthesia</topic><topic>Experimentation</topic><topic>Female</topic><topic>Gender equality</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Low concentrations</topic><topic>Maternal, fetal and perinatal monitoring</topic><topic>Medical sciences</topic><topic>Meta-analysis</topic><topic>Obstetric Labor Complications - therapy</topic><topic>Obstetrical anesthesia</topic><topic>Opioid analgesics</topic><topic>Parity</topic><topic>Pregnancy</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Factors</topic><topic>Second stage of labor</topic><topic>Studies</topic><topic>Vacuum Extraction, Obstetrical</topic><topic>Validity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, E H C</creatorcontrib><creatorcontrib>Sia, A T H</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, E H C</au><au>Sia, A T H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review</atitle><jtitle>BMJ</jtitle><addtitle>BMJ</addtitle><date>2004-06-12</date><risdate>2004</risdate><volume>328</volume><issue>7453</issue><spage>1410</spage><epage>1412</epage><pages>1410-1412</pages><issn>0959-8138</issn><issn>0959-8146</issn><eissn>1468-5833</eissn><eissn>1756-1833</eissn><coden>BMJOAE</coden><abstract>Abstract Objective To compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. Data sources Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. Study selection Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. Data synthesis Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22). Conclusions Epidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.</abstract><cop>London</cop><pub>British Medical Journal Publishing Group</pub><pmid>15169744</pmid><doi>10.1136/bmj.38097.590810.7C</doi><tpages>3</tpages><edition>International edition</edition><oa>free_for_read</oa></addata></record> |
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| ispartof | BMJ, 2004-06, Vol.328 (7453), p.1410-1412 |
| issn | 0959-8138 0959-8146 1468-5833 1756-1833 |
| language | eng |
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| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); JSTOR Archive Collection A-Z Listing; Alma/SFX Local Collection |
| subjects | Analgesia Analgesia, Epidural Analgesia, Obstetrical Analgesics, Opioid - administration & dosage Anesthesia Anesthetics, Local - administration & dosage Biological and medical sciences Births Bupivacaine - administration & dosage Cesarean section Cesarean Section - utilization Childbirth & labor Confidence intervals Delivery, Obstetric - instrumentation Delivery. Postpartum. Lactation Epidural analgesia Epidural anesthesia Experimentation Female Gender equality Gynecology. Andrology. Obstetrics Health risk assessment Humans Low concentrations Maternal, fetal and perinatal monitoring Medical sciences Meta-analysis Obstetric Labor Complications - therapy Obstetrical anesthesia Opioid analgesics Parity Pregnancy Randomized Controlled Trials as Topic Risk Factors Second stage of labor Studies Vacuum Extraction, Obstetrical Validity |
| title | Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review |
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