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Created on : 15 Jul 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. British Medical Journal 2004;328:1410.

Author(s) :

Liu EHC, Sia ATH.

Year of publication :

2004

URL(s) :

http://bmj.bmjjournals.com/cgi/content/full/bmj;32…

Résumé (français)  :

Abstract (English)  :

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.

Sumário (português)  :

Resumen (español)  :

Comments :

Article en accès libre

Argument (français) :

La péridurale faiblement dosée en bipuvacaïne n’augmente pas le risque de césarienne, augmente le risque d’extraction iinstrumentale, rallonge la durée du 2sd stade.

Argument (English):

Argumento (português):

Argumento (español):

Keywords :

➡ c-section/caesarean ; instrumental delivery ; pain medication ; epidural ; pain

Author of this record :

Cécile Loup — 15 Jul 2004