Re: OB: Epidurals Can Prolong Labor
From: art fougner, md (evsono@pipeline.com)
Thu Apr 23 07:37:33 1998
ever think that the controversy may be related to the department
authoring and interpreting the studies?
ya think?
art
At Tue, 14 Apr 1998, Geffrey Klein wrote:
>
>Lots of conflicting data in this area.. Now some more ammunition for
>the anti-epidural side..
>
>--
>_______________
>
>Tuesday April 14 12:42 PM EDT
>
>Epidurals Can Prolong Labor
>
>NEW YORK (Reuters) -- Epidural analgesia to ease the pain of labor
>affects uterine performance and may increase the length of labor, Texas
>researchers report.
>
>In an epidural, anesthetic is injected into the lower spine to block
>pain sensations from the lower body. Compared with women who received an
>intravenous drug to control labor pain, those who elected to receive an
>epidural were in labor longer and needed more medication to speed up
>their contractions, according to the article published in the March
>issue of the American Journal of Obstetrics and Gynecology.
>
>Researchers led by Dr. James M. Alexander of the University of Texas
>Southwestern Medical Center in Dallas, studied 199 women with normal
>pregnancies who were admitted to the hospital with labor contractions.
>For all of the women, it was their first experience of labor. The women
>were offered a choice between an epidural injection for pain or
>intravenous Demerol. Women who elected to receive Demerol were given the
>additional option of switching to an epidural if pain relief was
>inadequate.
>
>Women in both groups entered labor spontaneously, had similar degrees of
>cervical dilatation when pain medication was given and received equal
>dosages of oxytocin -- a drug given during labor to stimulate uterine
>contractions. However, the active first phase of labor, the duration of
>the second stage of labor (which includes delivery), and the time from
>admission to delivery were all significantly longer among women who
>received an epidural, the researchers report. A prolonged second stage
>of labor can weaken the muscles in the uterus necessary to push the
>infant out during delivery.
>
>Of the 126 women who received an epidural, length of labor averaged
>nearly 8 hours, compared with approximately 6.5 hours among the 73 women
>who chose Demerol. The rate of fetal descent, which is the rate at which
>the fetus progresses to delivery, was also significantly prolonged (4.2
>centimeters per hour with an epidural versus 7.9 centimeters per hour
>with Demerol).
>
>But the study also showed that an epidural did not affect the health of
>the newborn. Mean birth weights of infants in both groups were almost
>identical, as was the health of the newborns and the rate of admission
>to intensive care.
>
>This study adds to previous research suggesting that epidurals are
>associated with higher rates of cesarean section because prolonged labor
>can lead to fetal distress. The researchers recommend that women should
>be informed before they elect an epidural that it may significantly
>prolong their labor. And physicians may need to modify guidelines
>regarding the management of labor to recognize that an epidural can
>prolong labor. "Such modifications of labor expectations may serve to
>diminish the excess cesarean deliveries associated with epidural
>analgesia," they conclude. SOURCE: American Journal of Obstetrics and
>Gynecology (1998;178:516-520)
>
>Geffrey H Klein, MD
>Dept OB-GYN
>MacGregor Medical Association
>2200 Nasa Road 1 Suite 200
>Houston, Texas 77058
>(713) 741-2273 ext. 2628
>geffrey.klein@obgyn.net
>
--
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
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