NULLIPAROUS ACTIVE LABOR, EPIDURAL ANALGESIA, AND CESAREAN DELIVERY FOR DYSTOCIA

OBJECTIVE: Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparou s women. STUDY DESIGN: Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 8 0%, and fetopelvic engagement. Patients were randomized to one of two groups: epidural analgesia or narcotics. A strict protocol for labor m anagement was in place. Patients recorded the level of pain at randomi zation and at hourly intervals on a visual analog scale. Elective outl et operative vaginal delivery was permitted. RESULTS: One hundred wome n were randomized. No difference in the rate of cesarean delivery for dystocia was noted between the groups (epidural 8%, narcotic 6%; p = 0 .71). No significant differences were noted in the lengths of the firs t (p = 0.54) or second (p = 0.55) stages of labor or in any other time variable. Women with epidural analgesia underwent operative vaginal d elivery more frequently (p = 0.004). Pain scores were equivalent at ra ndomization, but large differences existed at each hour thereafter. Th e number of patients randomized did not achieve prestudy estimates. A planned interim analysis of the results demonstrated that we were unli kely to find a statistically significant difference in cesarean delive ry rates in a trial of reasonable duration. CONCLUSIONS: With strict c riteria for the diagnosis of labor and with use of a rigid protocol fo r labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.