EARLY VERSUS LATE EPIDURAL ANALGESIA DURING LABOR: EFFECT ON LABOR PROGRESSION
Amal Hanafy, Ahmed M. Abdel Hak, Iman Zein El-Abedin, Dina Z. Mohamed*
Departments of Obstetrics and Gynecology and *Anesthesia, Faculty of Medicine, Cairo University
Objective: The study aims to evaluate the effect of early initiation of epidural analgesia during labor in nulliparous women in comparison to late administration.
Methods: This randomized trial involved 100 nulliparous women randomly assigned to either early initiation of epidural analgesia (Group 1, 44 women), or delay of epidural analgesia until the cervix is dilated to at least 4 cm (Group 2, 56 women). All women received epidural analgesia with bupivacaine and fentanyl. Pain was assessed with a 100-mm visual analog scale (VAS) ruler, and progress of labor was assessed every 2 hours. Cesarean delivery was performed for dystocia. The primary outcome was the duration of labor and quality of analgesia. Secondary outcomes were method of delivery and neonatal outcome.
Results: Duration of the first stage was significantly shorter in the late epidural group (p = 0.038). Analgesic effect and mode of delivery were comparable in the two groups. Adverse effects were not frequent in both groups with no significant differenced.
Conclusion: Early administration of epidural analgesia prolongs duration of first stage of labor, but did not increase the rate of cesarean delivery.