The Effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, Controlled, Prospective Trial.
Thorp, James A.; Hu, Daniel H.; Albin, Rene M.; McNitt, Jay; Meyer, Bruce A.; Cohen, Gary R.; Yeast, John D.
[Abstract] American Journal of Obstetrics & Gynecology. 169(4):851-858, October 1993.

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OBJECTIVE: Our purpose was to determine the effect of epidural analgesia on nulliparous labor and delivery.

STUDY DESIGN: Normal term nulliparous women in early spontaneous labor were randomized to receive either narcotic or epidural analgesia.

RESULTS: When compared with the group receiving narcotic analgesia (n = 45), the group receiving epidural analgesia (n = 48) had a significant prolongation in the first and second stages of labor, an increased requirement for oxytocin augmentation, and a significant slowing in the rate of cervical dilatation. Epidural analgesia was associated with a significant increase in malposition (4.4% vs 18.8%, p < 0.05). Cesarean delivery occurred more frequently in the epidural group (2.2% vs 25%, p < 0.05), primarily related to an increase in cesarean section for dystocia (2.2% vs 16.7%, p < 0.05).

CONCLUSIONS: In a randomized, controlled, prospective trial epidural analgesia resulted in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery, primarily related to dystocia. (AM J OBSTET GYNECOL 1993;169:851-8.)

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