Epidural placement before active delivery does not increase the likelihood of caesarean section delivery, according to research presented here at the 2018 Annual Meeting of the American College of Obstetricians and Gynecologists (ACOG).
“Placement of epidural prior to or after the onset of active labour did not differentiate mode of delivery or length of the second stage,” wrote Alexis Braverman, MD, University of Illinois, Chicago, Illinois, and colleagues in their presentation.
While previous studies have indicated that the timing of epidural placement does not affect the mode of delivery, the new definition of active labour (6 cm vs 4 cm) prompted the authors to revisit the issue.
The study included primiparous women delivering live-born, singleton, full-term infants between June 2015 and May 2016. Of the 433 participants, 284 (66%) received epidurals that were placed prior to 6 cm of cervical dilation and 149 (34%) had epidurals placed after 6 cm.
The results showed no significant differences in the rate of caesarean section between those who had epidurals placed prior to 6 cm (15.8%; n = 45) and after 6 cm (13.4%; n = 20).
Secondary outcomes showed no significant difference in the rate of operative vaginal delivery (4.2% vs 3.3%; P = .704), and little difference in the mean length of the second stage of labour (88 minutes vs 80 minutes; P = .336).
“With further study, providers may counsel patients to make decisions on timing of epidural based on maternal comfort without fear of increased risk of primary caesarean section,” the authors concluded.
[Presentation title: Association Between Timing of Epidural Placement and Obstetric Outcome With Reference to the Start of Active Labor. Abstract 35F]