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Re: OB: Clark et al From: Pat Sonnenstuhl (webmidwife1@home.com) Thu Dec 31 18:41:54 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Deborah J. Wage FNP, CNM: "Happy New Year" Previous message: John Robertson M.D.: "Re: RCT supports expectant management 42 wks" Maybe in reply to: Geffrey Klein: "OB: Clark et al" Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Does the article state when the epidural was given, especially to the nullips? That is the most significant factor IMHO. Occasionally, it's essential for the nullip who is having a difficult time. I like to wait until 3+ cms.... Geffrey Klein wrote: > > Reference: Clark et al. The influence of epidural analgesia on cesarean > delivery rates: A randomized, prospective clinical trial. Am J Obstet > Gynecol 1998;179:1527-33. > > This is a good article. It refutes any increased risk of cesarean from > epidural in nulliparous patients. > > Interesting facts from the study include: > > 1) total cesarean rate was very low for both epidural and meperidine > groups (intention to treat analysis). 9% epidural vs 13% demerol. > 2) active mgmt of labor protocol was used and pitocin was used often > (70% of cases) > 3) more than half of the women randomized to IV narcotic crossed over to > epidural. despite this, allocation compliant analysis showed cesarean > rates of 8% for epidural and 7% for IV narcotic. > 4) the patient population under the age of 18 was more than half of the > patients > 5) They had a significant number of babies with arterial cord pH under > 7.15. (allocation compliant analysis: 8% epidural arm vs 26% in opiod > group) > > I take away from this study that if nulliparous labor is aggressively > managed that cesarean rates are low and there is no added effect from > epidural to increase the cesarean rate. > > Any comments on this interesting study? > > 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 Next message: Deborah J. Wage FNP, CNM: "Happy New Year" Previous message: John Robertson M.D.: "Re: RCT supports expectant management 42 wks" Maybe in reply to: Geffrey Klein: "OB: Clark et al"

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