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Thomas P. Sculco - One of the best experts on this subject based on the ideXlab platform.

Jacques T Yadeau - One of the best experts on this subject based on the ideXlab platform.

Robert D Vincent - One of the best experts on this subject based on the ideXlab platform.

  • nulliparous active labor Epidural Analgesia and cesarean delivery for dystocia
    American Journal of Obstetrics and Gynecology, 1997
    Co-Authors: James A Bofill, Robert D Vincent, Elaine L Ross, Rick W Martin, Patricia F Norman, Carol F Werhan, John C Morrison
    Abstract:

    Abstract OBJECTIVE: Our purpose was to examine the effect of Epidural Analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women. STUDY DESIGN: Active labor was confirmed in nulliparous women by uterine contractions, cervical dilatation of 4 cm, effacement of 80%, and fetopelvic engagement. Patients were randomized to one of two groups: Epidural Analgesia or narcotics. A strict protocol for labor management was in place. Patients recorded the level of pain at randomization and at hourly intervals on a visual analog scale. Elective outlet operative vaginal delivery was permitted. RESULTS: One hundred women 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 first ( p = 0.54) or second ( p = 0.55) stages of labor or in any other time variable. Women with Epidural Analgesia underwent operative vaginal delivery more frequently ( p = 0.004). Pain scores were equivalent at randomization, but large differences existed at each hour thereafter. The number of patients randomized did not achieve prestudy estimates. A planned interim analysis of the results demonstrated that we were unlikely to find a statistically significant difference in cesarean delivery rates in a trial of reasonable duration. CONCLUSIONS: With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with Epidural Analgesia.(Am J Obstet Gynecol 1997;177:1465-70.)

  • does early administration of Epidural Analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin
    Anesthesiology, 1994
    Co-Authors: David H Chestnut, Robert D Vincent, Joan M Mcgrath, W W Choi, James N Bates
    Abstract:

    Background Some studies suggest that Epidural Analgesia prolongs labor and increases the incidence of cesarean section, especially if it is administered before 5 cm cervical dilation. The purpose of the current study was to determine whether early administration of Epidural Analgesia affects obstetric outcome in nulliparous women who are receiving intravenous oxytocin. Methods Informed consent was obtained from healthy nulliparous women with a singleton fetus in a vertex presentation, who requested Epidural Analgesia while receiving intravenous oxytocin at at least 36 weeks' gestation. Each patient was randomized to receive either early or late Epidural Analgesia. Randomization occurred only after the following conditions were met: (1) the patient requested pain relief at that moment, (2) a lumbar Epidural catheter had been placed, and (3) the cervix was at least 3 but less than 5 cm dilated. Patients in the early group immediately received Epidural bupivacaine Analgesia. Patients in the late group received 10 mg nalbuphine intravenously. Late-group patients did not receive Epidural Analgesia until they achieved a cervical dilation of at least 5 cm or until at least 1 h had elapsed after a second dose of nalbuphine. Results Early administration of Epidural Analgesia did not prolong the interval between randomization and the diagnosis of complete cervical dilation, and it did not increase the incidence of malposition of the vertex at delivery. Also, early administration of Epidural Analgesia did not result in an increased incidence of cesarean section or instrumental vaginal delivery. Thirteen (18%) of 74 women in the early group and 14 (19%) of 75 women in the late group underwent cesarean section (relative risk for the early group 0.94; 95% confidence interval 0.48-1.84). Patients in the early group had lower pain scores between 30 and 120 min after randomization, and were more likely to experience transient hypotension. Infants in the late group had lower umbilical arterial and venous blood pH and higher umbilical arterial and venous blood carbon dioxide tension measurements at delivery. Conclusions Early administration of Epidural Analgesia did not prolong labor or increase the incidence of operative delivery, when compared with intravenous nalbuphine followed by late administration of Epidural Analgesia, in nulliparous women who were receiving intravenous oxytocin.

  • does early administration of Epidural Analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor
    Anesthesiology, 1994
    Co-Authors: David H Chestnut, Robert D Vincent, Joan M Mcgrath, W W Choi, James N Bates, Donald H Penning, Claude Mcfarlane
    Abstract:

    BACKGROUND Some studies suggest that Epidural Analgesia prolongs labor and increases the incidence of cesarean section, especially if it is administered before 5 cm cervical dilation. The purpose of the current study was to determine whether early administration of Epidural Analgesia affects obstetric outcome in nulliparous women who are in spontaneous labor. METHODS Informed consent was obtained from 344 healthy nulliparous women with a singleton fetus in a vertex presentation, who requested Epidural Analgesia during spontaneous labor at at least 36 weeks' gestation. Each patient was randomized to receive either early or late Epidural Analgesia. Randomization occurred only after the following conditions were met: (1) the patient requested pain relief at that moment, (2) a lumbar Epidural catheter had been placed, and (3) the cervix was at least 3 cm but less than 5 cm dilated. Patients in the early group immediately received Epidural bupivacaine Analgesia. Patients in the late group received 10 mg nalbuphine intravenously. Late-group patients did not receive Epidural Analgesia until they achieved a cervical dilation of at least 5 cm or until at least 1 h had elapsed after a second dose of nalbuphine. Ten of the 344 patients were excluded because of a protocol violation or voluntary withdrawal from the study. RESULTS Early administration of Epidural Analgesia did not increase the incidence of oxytocin augmentation, prolong the interval between randomization and the diagnosis of complete cervical dilation, or increase the incidence of malposition of the vertex at delivery. Also, early administration of Epidural Analgesia did not result in an increased incidence of cesarean section or instrumental vaginal delivery. Seventeen (10%) of 172 women in the early group and 13 (8%) of 162 women in the late group underwent cesarean section (relative risk for the early group 1.22; 95% confidence interval 0.62-2.40). Patients in the early group had lower pain scores between 30 and 150 min after randomization. Infants in the late group had lower umbilical arterial and venous blood pH and higher umbilical venous blood carbon dioxide tension measurements at delivery. CONCLUSIONS Early administration of Epidural Analgesia did not prolong labor, increase the incidence of oxytocin augmentation, or increase the incidence of operative delivery, when compared with intravenous nalbuphine followed by late administration of Epidural Analgesia, in nulliparous women who were in spontaneous labor at term.

James N Bates - One of the best experts on this subject based on the ideXlab platform.

  • does early administration of Epidural Analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin
    Anesthesiology, 1994
    Co-Authors: David H Chestnut, Robert D Vincent, Joan M Mcgrath, W W Choi, James N Bates
    Abstract:

    Background Some studies suggest that Epidural Analgesia prolongs labor and increases the incidence of cesarean section, especially if it is administered before 5 cm cervical dilation. The purpose of the current study was to determine whether early administration of Epidural Analgesia affects obstetric outcome in nulliparous women who are receiving intravenous oxytocin. Methods Informed consent was obtained from healthy nulliparous women with a singleton fetus in a vertex presentation, who requested Epidural Analgesia while receiving intravenous oxytocin at at least 36 weeks' gestation. Each patient was randomized to receive either early or late Epidural Analgesia. Randomization occurred only after the following conditions were met: (1) the patient requested pain relief at that moment, (2) a lumbar Epidural catheter had been placed, and (3) the cervix was at least 3 but less than 5 cm dilated. Patients in the early group immediately received Epidural bupivacaine Analgesia. Patients in the late group received 10 mg nalbuphine intravenously. Late-group patients did not receive Epidural Analgesia until they achieved a cervical dilation of at least 5 cm or until at least 1 h had elapsed after a second dose of nalbuphine. Results Early administration of Epidural Analgesia did not prolong the interval between randomization and the diagnosis of complete cervical dilation, and it did not increase the incidence of malposition of the vertex at delivery. Also, early administration of Epidural Analgesia did not result in an increased incidence of cesarean section or instrumental vaginal delivery. Thirteen (18%) of 74 women in the early group and 14 (19%) of 75 women in the late group underwent cesarean section (relative risk for the early group 0.94; 95% confidence interval 0.48-1.84). Patients in the early group had lower pain scores between 30 and 120 min after randomization, and were more likely to experience transient hypotension. Infants in the late group had lower umbilical arterial and venous blood pH and higher umbilical arterial and venous blood carbon dioxide tension measurements at delivery. Conclusions Early administration of Epidural Analgesia did not prolong labor or increase the incidence of operative delivery, when compared with intravenous nalbuphine followed by late administration of Epidural Analgesia, in nulliparous women who were receiving intravenous oxytocin.

  • does early administration of Epidural Analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor
    Anesthesiology, 1994
    Co-Authors: David H Chestnut, Robert D Vincent, Joan M Mcgrath, W W Choi, James N Bates, Donald H Penning, Claude Mcfarlane
    Abstract:

    BACKGROUND Some studies suggest that Epidural Analgesia prolongs labor and increases the incidence of cesarean section, especially if it is administered before 5 cm cervical dilation. The purpose of the current study was to determine whether early administration of Epidural Analgesia affects obstetric outcome in nulliparous women who are in spontaneous labor. METHODS Informed consent was obtained from 344 healthy nulliparous women with a singleton fetus in a vertex presentation, who requested Epidural Analgesia during spontaneous labor at at least 36 weeks' gestation. Each patient was randomized to receive either early or late Epidural Analgesia. Randomization occurred only after the following conditions were met: (1) the patient requested pain relief at that moment, (2) a lumbar Epidural catheter had been placed, and (3) the cervix was at least 3 cm but less than 5 cm dilated. Patients in the early group immediately received Epidural bupivacaine Analgesia. Patients in the late group received 10 mg nalbuphine intravenously. Late-group patients did not receive Epidural Analgesia until they achieved a cervical dilation of at least 5 cm or until at least 1 h had elapsed after a second dose of nalbuphine. Ten of the 344 patients were excluded because of a protocol violation or voluntary withdrawal from the study. RESULTS Early administration of Epidural Analgesia did not increase the incidence of oxytocin augmentation, prolong the interval between randomization and the diagnosis of complete cervical dilation, or increase the incidence of malposition of the vertex at delivery. Also, early administration of Epidural Analgesia did not result in an increased incidence of cesarean section or instrumental vaginal delivery. Seventeen (10%) of 172 women in the early group and 13 (8%) of 162 women in the late group underwent cesarean section (relative risk for the early group 1.22; 95% confidence interval 0.62-2.40). Patients in the early group had lower pain scores between 30 and 150 min after randomization. Infants in the late group had lower umbilical arterial and venous blood pH and higher umbilical venous blood carbon dioxide tension measurements at delivery. CONCLUSIONS Early administration of Epidural Analgesia did not prolong labor, increase the incidence of oxytocin augmentation, or increase the incidence of operative delivery, when compared with intravenous nalbuphine followed by late administration of Epidural Analgesia, in nulliparous women who were in spontaneous labor at term.

David H Chestnut - One of the best experts on this subject based on the ideXlab platform.

  • does early administration of Epidural Analgesia affect obstetric outcome in nulliparous women who are receiving intravenous oxytocin
    Anesthesiology, 1994
    Co-Authors: David H Chestnut, Robert D Vincent, Joan M Mcgrath, W W Choi, James N Bates
    Abstract:

    Background Some studies suggest that Epidural Analgesia prolongs labor and increases the incidence of cesarean section, especially if it is administered before 5 cm cervical dilation. The purpose of the current study was to determine whether early administration of Epidural Analgesia affects obstetric outcome in nulliparous women who are receiving intravenous oxytocin. Methods Informed consent was obtained from healthy nulliparous women with a singleton fetus in a vertex presentation, who requested Epidural Analgesia while receiving intravenous oxytocin at at least 36 weeks' gestation. Each patient was randomized to receive either early or late Epidural Analgesia. Randomization occurred only after the following conditions were met: (1) the patient requested pain relief at that moment, (2) a lumbar Epidural catheter had been placed, and (3) the cervix was at least 3 but less than 5 cm dilated. Patients in the early group immediately received Epidural bupivacaine Analgesia. Patients in the late group received 10 mg nalbuphine intravenously. Late-group patients did not receive Epidural Analgesia until they achieved a cervical dilation of at least 5 cm or until at least 1 h had elapsed after a second dose of nalbuphine. Results Early administration of Epidural Analgesia did not prolong the interval between randomization and the diagnosis of complete cervical dilation, and it did not increase the incidence of malposition of the vertex at delivery. Also, early administration of Epidural Analgesia did not result in an increased incidence of cesarean section or instrumental vaginal delivery. Thirteen (18%) of 74 women in the early group and 14 (19%) of 75 women in the late group underwent cesarean section (relative risk for the early group 0.94; 95% confidence interval 0.48-1.84). Patients in the early group had lower pain scores between 30 and 120 min after randomization, and were more likely to experience transient hypotension. Infants in the late group had lower umbilical arterial and venous blood pH and higher umbilical arterial and venous blood carbon dioxide tension measurements at delivery. Conclusions Early administration of Epidural Analgesia did not prolong labor or increase the incidence of operative delivery, when compared with intravenous nalbuphine followed by late administration of Epidural Analgesia, in nulliparous women who were receiving intravenous oxytocin.

  • does early administration of Epidural Analgesia affect obstetric outcome in nulliparous women who are in spontaneous labor
    Anesthesiology, 1994
    Co-Authors: David H Chestnut, Robert D Vincent, Joan M Mcgrath, W W Choi, James N Bates, Donald H Penning, Claude Mcfarlane
    Abstract:

    BACKGROUND Some studies suggest that Epidural Analgesia prolongs labor and increases the incidence of cesarean section, especially if it is administered before 5 cm cervical dilation. The purpose of the current study was to determine whether early administration of Epidural Analgesia affects obstetric outcome in nulliparous women who are in spontaneous labor. METHODS Informed consent was obtained from 344 healthy nulliparous women with a singleton fetus in a vertex presentation, who requested Epidural Analgesia during spontaneous labor at at least 36 weeks' gestation. Each patient was randomized to receive either early or late Epidural Analgesia. Randomization occurred only after the following conditions were met: (1) the patient requested pain relief at that moment, (2) a lumbar Epidural catheter had been placed, and (3) the cervix was at least 3 cm but less than 5 cm dilated. Patients in the early group immediately received Epidural bupivacaine Analgesia. Patients in the late group received 10 mg nalbuphine intravenously. Late-group patients did not receive Epidural Analgesia until they achieved a cervical dilation of at least 5 cm or until at least 1 h had elapsed after a second dose of nalbuphine. Ten of the 344 patients were excluded because of a protocol violation or voluntary withdrawal from the study. RESULTS Early administration of Epidural Analgesia did not increase the incidence of oxytocin augmentation, prolong the interval between randomization and the diagnosis of complete cervical dilation, or increase the incidence of malposition of the vertex at delivery. Also, early administration of Epidural Analgesia did not result in an increased incidence of cesarean section or instrumental vaginal delivery. Seventeen (10%) of 172 women in the early group and 13 (8%) of 162 women in the late group underwent cesarean section (relative risk for the early group 1.22; 95% confidence interval 0.62-2.40). Patients in the early group had lower pain scores between 30 and 150 min after randomization. Infants in the late group had lower umbilical arterial and venous blood pH and higher umbilical venous blood carbon dioxide tension measurements at delivery. CONCLUSIONS Early administration of Epidural Analgesia did not prolong labor, increase the incidence of oxytocin augmentation, or increase the incidence of operative delivery, when compared with intravenous nalbuphine followed by late administration of Epidural Analgesia, in nulliparous women who were in spontaneous labor at term.