A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate

OBJECTIVE: To estimate the effects of initiation of epidural analgesia on fetal heart rate (FHR) patterns compared with intravenous meperidine analgesia. METHODS: Fetal heart rate patterns in 200 nulliparous women with term pregnancies randomized to epidural analgesia with 0.25% bupivacaine were compared with those of 156 similar women given intravenous meperidine. Fetal heart rate patterns occurring within 40 minutes of initiation of labor analgesia were retrospectively read by three maternal-fetal medicine specialists who were blind to clinical events, including type of labor analgesia. RESULTS: Meperidine, compared with epidural analgesia, was associated with statistically significantly less beat-to-beat variability (absent or less than 5 beats per minute) of the FHR (30% versus 7% of fetuses, P <.001) in the first 40 minutes after initiation of analgesia, as well as with fewer FHR accelerations (88% versus 62% of fetuses, P <.001). Neither the incidence of FHR decelerations nor the type of deceleration were significantly different between methods of labor analgesia. Specifically, 41% of women given meperidine exhibited FHR decelerations within 40 minutes, compared with 34% given epidural analgesia (P =.353). CONCLUSION: Epidural analgesia does not have deleterious effects on FHR.     

Intrapartum epidural analgesia and maternal temperature regulation

OBJECTIVE: To examine maternal temperature changes after epidural analgesia. METHODS: A prospective cohort of nulliparas at term was monitored with hourly maternal tympanic temperatures after epidural analgesia (n=99). Temperature response after epidural analgesia was examined in the group as a whole. Subsequently, mean maternal temperature curves were compared between women who remained afebrile throughout labor (n=77) and women who developed intrapartum fever with body temperature greater than 100.4 degrees F (n=22). Baseline maternal characteristics were assessed. RESULTS: Women who later developed intrapartum fever had a higher mean temperature within 1 hour after epidural analgesia. In contrast, women who remained afebrile had no increase in core temperature. During the first 4 hours after epidural analgesia initiation, women who later develop intrapartum fever have an increase in mean tympanic temperature of 0.33 degrees F per hour. CONCLUSION: Epidural analgesia is not associated with increased temperature in the majority of women. Hyperthermia is an abnormal response confined to a minority subset, which occurs immediately after exposure. Our findings do not support a universal perturbation of maternal thermoregulation after epidural analgesia. LEVEL OF EVIDENCE: II.     

Association between epidural analgesia and intrapartum fever

The objective of this paper is to determine whether or not epidural analgesia is an independent risk factor for intrapartum fever. Maternal temperature was measured every 4 h during labor to 1004 consecutive women in term labor. Women with fever or on antibiotics were excluded. Epidural analgesia was administered upon patients' request. Of the 406 (40%) women who received epidural analgesia, 11.8% (n = 48) developed a fever > or = 37.8 degrees C during labor compared with only 0.2% (n = 1) of women not receiving epidural analgesia. Women who received epidural analgesia were more likely to have one or more risk factors for intrapartum infection. Their labor and ruptured membranes were longer, they were more likely to have internal monitoring and have more vaginal examinations. Compared with women who received epidural analgesia and did not develop intrapartum fever, women that did develop fever had longer epidurals and more risk factors for infection. However, in a logistic regression analysis with fever as dependent variable, only the duration of epidural was significantly associated with the occurrence of fever. The rate of fever increased with longer labors, from 5% with labor < 3 h to 28% with labor > 6 h. In 90% of women the fever resolved within a few hours after delivery. Sepsis evaluation was negative in all of the newborns to mother who had intrapartum fever. Our data support a noninfectious etiology for intrapartum fever in the vast majority of our patients. However, infection must be ruled out before a decision is made to withhold antibiotic therapy.     

The effect of delayed pushing in the second stage of labor with continuous lumbar epidural analgesia

We studied primigravid women in spontaneous labor at term and given epidural analgesia. Two hundred such women giving birth in 1983 were compared with similar groups who gave birth in 1985 and 1987 after the introduction of 'delayed pushing' into our labor ward protocol. Four hundred controls were obtained in 1983 and 1985 by selecting from the labor ward register the next normal primigravid woman in spontaneous labor without epidural analgesia. The assisted delivery rate was significantly higher in all three epidural groups than in the controls (p less than 0.001). Among epidural labors, there was no significant difference between 1983 and 1987 in the incidence of rotational or non-rotational forceps, or of cesarean section. In each epidural group, women who waited more than 60 min were less likely to experience a normal spontaneous delivery than were those who did not (p less than 0.001 in 1983; p = 0.006 in 1985 p = 0.035 in 1987). We conclude that to delay pushing beyond 60 min confers no benefit regarding mode of delivery.     

A comparison between the effectiveness of epidural analgesia and parenteral pethidine during labor

The study was aimed to define parturients' opinion on either epidural analgesia or intravenous pethidine, and to determine the effect of both analgesics after delivery. We interviewed and examined 401 consecutive parturients who requested analgesia during the beginning of their active stage of labor. Of those, 131 women requested and underwent epidural analgesia, and 270 received parenteral pethidine. The pain experienced before admission of any analgesia, was significantly higher in the epidural group than in the parental group (mean visual analog scale (VAS) score 8.9 and 8.4, respectively; P=0.004). However, after analgesics, women from the epidural analgesia experienced significantly less pain during labor as compared to those receiving pethidine (mean VAS scores 5.05 vs. 9.14, respectively; p<0.001). The pain scores 24 h after labor were significantly lower in patients who underwent epidural analgesia (1.69 vs. 2.13, respectively; p<0.001). We conclude that epidural analgesia is more effective than parenteral analgesia in pain and discomfort relief. This method is helpful also the day after delivery. Thus, epidural analgesia should be strongly recommended to all patients who do not have any medical contraindications to this method of treatment.     

Epidural analgesia lengthens the Friedman active phase of labor

OBJECTIVE: To estimate the effect of epidural analgesia on the Friedman labor curve. METHODS: This study was a secondary analysis of a previously reported randomized trial of the effects of patient-controlled epidural analgesia during labor compared with patient-controlled meperidine on cesarean delivery rate. All subjects had a singleton, cephalic, nonanomalous fetus at or beyond 37 weeks' gestation. This secondary analysis was limited to women who had cervical dilatation commencing of at least 3 cm (ie, active phase of labor). RESULTS: A total of 459 women were randomized. Twenty-five women were excluded for a cervix less than 3 cm dilated, leaving 220 women allocated to patient-controlled epidural analgesia and 214 to patient-controlled intravenous meperidine available for analysis. There were no significant demographic differences between the two groups, including age, race, gestational age, and cervix on admission. The active phase of labor was 1 hour longer in the epidural-treated group (6.0 +/- 3.2 hours versus 5.0 +/- 3.2 hours, P <.001). The rate of cervical dilation was significantly less with epidural analgesia (1.4 cm/h versus 1.6 cm/h, P <.002). The duration of the second stage tended to be longer in the epidural group (1.1 +/- 1.5 hours versus 0.9 +/- 1.0 hours, P =.079). CONCLUSION: Epidural analgesia prolonged the active phase of labor by 1 hour compared with Friedman's original criteria.     

Epidural analgesia and intrapartum fever: placental findings

OBJECTIVE: To assess whether epidural analgesia is associated with fever, independent of maternal infection, by evaluating the relationship between epidural analgesia and inflammation of the placenta. METHODS: Placentas collected prospectively from women with singleton gestations, who delivered 6 hours or more after membrane rupture, were evaluated systematically for histologic inflammation by an investigator blinded to all clinical information. Maternal and neonatal markers of infection were assessed in the cohorts who did and did not receive epidural analgesia. RESULTS: One hundred forty-nine consecutive placentas were analyzed, and 80 (54%) of these women received epidural analgesia. On univariate analysis, significant differences between epidural and no epidural groups were found with respect to maternal fever 38C or greater (46% versus 26%, P = .01), placenta inflammation (61% versus 36%, P = .002), and length of labor (11.8 hours versus 9.6 hours, P = .03). The combination of maternal fever plus placental inflammation was significantly more common in the epidural group (35% versus 17% P = .02). However, maternal fever in the absence of supporting evidence of infection, in the form of placental inflammation, was not increased after epidural analgesia (11% versus 9%, P = .61). CONCLUSION: Epidural analgesia is associated with intrapartum fever, but only in the presence of placental inflammation. This suggests that the fever reported with epidural analgesia is due to infection rather than the analgesia itself.     

Ophthalmic artery Doppler as a measure of severe pre-eclampsia

OBJECTIVE: To identify differences in orbital flow behavior in mild and severe pre-eclamptic women compared with healthy pregnant women, demonstrated by ophthalmic artery Doppler indexes. METHODS: Ophthalmic artery Doppler indexes of 20 mild and 20 severe pre-eclamptic women were compared with 51 healthy pregnant women. Right and left eye Doppler index means were evaluated and the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), end diastolic velocity (EDV), and peak ratio (PR) were calculated. RESULTS: Statistically significant differences were observed between PR, PSV, and EDV (P=0.0009, P=0.0020, P=0.0001) ophthalmic artery Doppler in a comparison of women with mild and severe pre-eclampsia. Statistically significant differences were seen between all Doppler indexes of the study group and healthy pregnant women. Ophthalmic PR, PSV, and EDV were significantly higher in severe pre-eclamptic cases but other index parameters did not show any difference. An elevation of diastolic and systolic flow occurred when pre-eclampsia became severe. CONCLUSION: Orbital vascular impedance reduction with orbital hyperperfusion was present in severe pre-eclamptic women compared with mild pre-eclamptic and healthy pregnant women. Ophthalmic Doppler is a novel parameter that may be useful in the diagnosis of severe pre-eclampsia.     

Neonatal Outcome after Trial of Labor Compared with Elective Repeat Cesarean Section

ABSTRACT: Background: Trial of labor after cesarean section has been an important strategy for lowering the rate of cesarean delivery in the United States, but concerns regarding its safety remain. The purpose of this study was to evaluate the outcome of newborns delivered by elective repeat cesarean section compared to delivery following a trial of labor after cesarean. Methods: All low‐risk mothers with 1 or 2 previous cesareans and no prior vaginal deliveries, who delivered at our institution from December 1994 through July 1995, were identified. Neonatal outcomes were compared between 136 women who delivered by elective repeat cesarean section and 313 women who delivered after a trial of labor. To investigate reasons for differences in outcome between these groups, neonatal outcomes within the trial of labor group were then compared between those mothers who had received epidural analgesia (n = 230) and those who did not (n = 83). Results: Infants delivered after a trial of labor had increased rates of sepsis evaluation (23.3% vs 12.5%, p = 0.008); antibiotic treatment (11.5% vs 4.4%, p = 0.02); intubation to evaluate for the presence of meconium below the cords (11.5% vs 1.5%, p < 0.001); and mild bruising (8.0% vs 1.5%, p = 0.008). Within the trial of labor group, infants of mothers who received epidural analgesia were more likely to have received diagnostic tests and therapeutic interventions including sepsis evaluation (29.6% vs 6.0%, p = 0.001) and antibiotic treatment (13.9% vs 4.8%, p = 0.03) than within the no‐epidural analgesia group. Conclusions: Infants born to mothers after a trial of labor are twice as likely to undergo diagnostic tests and therapeutic interventions than infants born after an elective repeat cesarean section, but the increase occurred only in the subgroup of infants whose mothers received epidural analgesia for pain relief during labor. The higher rate of intervention could relate to the well‐documented increase in intrapartum fever that occurs with epidural use. (BIRTH 30:2 June 2003)     

Ambulatory epidural anesthesia and the duration of labor.

OBJECTIVES: Ambulatory epidural analgesia has become a common option for women in labor in France. We tested the hypothesis that a method of epidural analgesia that allowed women to walk had specific advantages regarding mode of delivery, consumption of local anesthetic, oxytocin requirement, and labor duration. METHODS: Two hundred and twenty-one women with uncomplicated pregnancies who presented in spontaneous labor between 36 and 42 weeks of gestation or who were scheduled for induced labor were randomly divided into two groups, ambulatory and non-ambulatory. All were given intermittent epidural injections of 0.1% ropivacaine with 0.6 microg/ml sufentanil for analgesia during labor (P<0.05 was considered significant). None of the women had previous cesarean delivery. RESULTS: There were no significant differences between the two groups in mode of delivery, consumption of local anesthetic, or oxytocin requirement. However, a significant difference was noted in labor duration (173.4+/-109.9 min vs. 236.4+/-130.6 min; P=0.001). CONCLUSIONS: Walking with ambulatory labor analgesia shortens labor duration but has no other effect on the progress and outcome of labor.     

Epidural analgesia and the course of delivery in term primiparas

OBJECTIVES: Epidural analgesia provides the most effective pain control during labor. Of great concern is its influence on the course of delivery and perinatal complications. DESIGN: The aim of the study was to assess the effect of epidural analgesia on the course of delivery and perinatal outcome. MATERIALS AND METHODS: 609 deliveries among 1334 (323 women with epidural analgesia (53%) and 548 without epidural analgesia (47%)) met the following criteria: primipara, singleton, live pregnancy, > =37 weeks' gestation, cephalic presentation of a fetus, lack of contraindication for vaginal delivery. The incidence of instrumental deliveries and fetal distress, duration of the first, second and third stage of labor, perinatal outcome, perinatal complications and perinatal blood loss and were analyzed. RESULTS: The incidence of fetal distress during second stage of labor was significantly higher in the epidural group (12.69 vs. 6.99%, P=0.02). The incidence of fetal distress during first stage of labor did not differ in both groups (10.53% vs. 8.74%, NS). Cesarean sections rate was similar in epidural and non-epidural group (17.7 vs. 18.2%, NS). Among vaginal deliveries duration of the first and second stage of labor was longer in epidural group (6.5+/-2.4 vs. 5.4+/-2.5 godz., P=0,000003 and 47.3+/-34.8 vs. 29.1+/-25.8 min., P=0.000003) and this was independent of period of time between onset of first stage of labor and epidural analgesia. Oxitocin use was significantly more frequent in the epidural group (20.6 vs. 10.3%, P<0.004). There were no statistically significant differences in the rates of instrumental vaginal deliveries, 1 and 5-minute Apgar scores, length of third stage of labor and perinatal blood loss in patients with and without epidural analgesia. Perinatal outcome did not depend on previous use of epidural analgesia or mode of analgesia for the operation in cesarean section subgroup. CONCLUSION: Epidural labor analgesia is associated with slower progress of labor but has no adverse effect on perinatal outcome and perinatal complications.     

The effect of early epidural versus early intravenous analgesia use on labor progression: a natural experiment

OBJECTIVE: The purpose of this study was to compare the effect of early epidural with the use of early intravenous analgesia on labor progression. STUDY DESIGN: We systematically selected singleton, nulliparous term pregnancies with a spontaneous labor and analgesia placement 相似文献   

Inherited thrombophilias and pre-eclampsia in Brazilian women

OBJECTIVE: The aim of the present study was to compare the distribution of G1691A, G20210A and C677T mutations in pre-eclamptic Brazilian women and in matched control women with an uncomplicated normal pregnancy. STUDY DESIGN: these mutations were investigated by PCR-RFLP in 83 normal pregnancies (control group) and in 30 pre-eclamptic pregnant women (severe form). RESULTS: G1691A mutation was detected neither in the control group nor in pre-eclamsia women. G20210A mutation was detected in heterozygosis in 3 (3.61%) control subjects, but not in pre-eclampsia group. C677T mutation was detected in homozygosis in 6 (7.23%) control subjects and 2 (6.67%) pre-eclamptic women and in heterozygosis in 31 (37.3%) control subjects and 12 (40%) pre-eclamptic women. Differences in the mutation frequencies detected in the two groups were not statistically significant. CONCLUSION: No correlation was observed between pre-eclampsia and presence of G1691A, G20210A and C677T mutations in Brazilian women.     

Plasma anti-oxidant status and lipid profile in non-gravida women with a history of pre-eclampsia

Objective:  To investigate the total plasma anti-oxidant status, the plasma lipid profile and the uterine artery Doppler velocity waveform in formerly pre-eclamptic women.
Methods:  Thirty-two formerly pre-eclamptic, non-gravida women constituted the study group, while 28 age-matched non-gravida women who had never had pre-eclampsia served as control subjects. On days 17–19 of their menstrual cycle, fasting plasma samples were collected for total anti-oxidant status (TAS) and lipid profile evaluation, and uterine artery Doppler velocity waveform studies were performed. Results were analyzed with Mann–Whitney U -test and Pearson correlation analysis.
Results:  There was no significant difference between the groups in means of the uterine artery Doppler velocity waveforms and the plasma lipid levels, but body mass index values were significant ( P  < 0.005). The TAS value was subnormal in 72% of the formerly pre-eclamptic group and in 35% of the control group. The mean plasma TAS value was 1.20 ± 0.05 mmol/L and was significantly lower in the study group when compared with the control group ( P  < 0.05).
Conclusion:  The current study reveals significantly decreased TAS in women with a history of pre-eclampsia, which may have an important role in pathophysiology.     

Epidural analgesia and fetal head malposition at vaginal delivery

OBJECTIVE: To determine if nulliparas who delivered with on-demand epidural analgesia are more likely to have malpositioning of the fetal vertex at delivery than women delivered during a period of restricted epidural use. METHODS: A retrospective cohort of nulliparous women with spontaneous labor delivered during a 12-month period immediately before the availability of on-demand labor epidural analgesia was compared with a similar group of nulliparas delivered after labor epidural analgesia was available on request. The primary outcome variable was a non-occiput anterior position or malpositioned fetal head at vaginal delivery. RESULTS: The frequency of epidural use increased from 0.9% before epidural analgesia became available on demand to 82.9% afterward. Fetal head malpositioning at vaginal delivery occurred in 26 of 434 (6.0%) women delivered in the before period compared with 29 of 511 (5.7%) in the after period (relative risk 0.95, 95% confidence interval 0.6, 1.6). No statistically significant difference in the incidence of fetal head malpositioning was present after patients were stratified by mode of delivery (Mantel-Haenszel weighted relative risk 0.94, 95% confidence interval 0.6, 1.4). The study sample size provided 85% power to detect a two-fold increase in the incidence of fetal malpositioning from a baseline rate of 6% associated with on-demand epidural use. CONCLUSION: Providing on-request labor epidural analgesia to nulliparas in spontaneous labor did not result in a clinically significant increase in the frequency of fetal head malpositioning at vaginal delivery.     

Outcome of infants delivered between 24 and 28 weeks' gestation in women with severe pre-eclampsia.

OBJECTIVE: To determine whether there are differences in neonatal outcome between infants born to mothers with severe pre-eclampsia and those born to normotensive mothers with preterm labor and intact membranes between 24 and 28 weeks' gestation. MATERIALS AND METHODS: Over a 4-year period between 1991 and 1995, neonates of women with severe pre-eclampsia delivering between 24 and 28 weeks were matched for maternal age, antenatally assigned gestational age and mode of delivery to normotensive women delivering during the same period. RESULTS: Fifty-eight women with severe pre-eclampsia were matched to 58 normotensive controls who delivered as a result of preterm labor. Antenatal steroids were used more often in pre-eclamptic women (75% vs. 47%, p < 0.01). The mean birth weight of pre-eclamptic neonates was significantly lower than that of controls, 767 g vs. 989 g, respectively. Other neonatal complications were similar for both groups. Neonates of pre-eclamptics required longer ventilator support (21 vs. 16 median days, p = 0.03). Neonatal survival was similar for both groups (72% and 79% for pre-eclamptics and normotensives, respectively). CONCLUSIONS: Neonates born to patients with severe pre-eclampsia have similar survival but a lower birth weight and require longer ventilator support than neonates born to women with preterm labor.     

妊娠期糖代谢异常孕妇并发子痫前期的相关因素探讨

目的探讨妊娠期糖代谢异常孕妇子痫前期的发病情况,以及与发病相关的因素。方法回顾性分析1981至2003年23年间,在我院分娩的1202例妊娠期糖代谢异常孕妇的病例资料,其中151例(Ⅰ组)并发子痫前期,1051例(Ⅱ组)未并发子痫前期,分析与子痫前期发病相关的危险因素。结果(1)妊娠期糖代谢异常孕妇子痫前期的发生率为12.6%(151/1202)。其中糖尿病合并妊娠(DM)、妊娠期糖尿病(GDM)、妊娠期糖耐量降低(GIGT)患者中,子痫前期的发生率分别为34.8%(39/112)、11.8%(89/753)、6.8%(23/337),3者比较,差异有统计学意义(P<0.01)。(2)Ⅰ组孕妇分娩前体重指数(BMI)为(31±4)kg/m2,Ⅱ组为(29±4)kg/m2,两组比较,差异也有统计学意义(P=0.027);Ⅰ组孕期血糖升高出现的时间[(27±11)周]明显早于Ⅱ组[(30±7)周],平均产次也高于Ⅱ组。(3)有不良孕产史、合并慢性高血压者,子痫前期的发生率分别为18.5%(32/173)、41.9%(18/43),明显高于无不良孕产史及慢性高血压者(P=0.03、0.000)。(4)Ⅰ组孕妇的口服50g葡萄糖负荷试验(GCT)、口服75g葡萄糖耐量试验(OGTT,空腹、服糖后2、3h)及糖化血红蛋白(HbA1c)各值均明显高于Ⅱ组。(5)需要胰岛素治疗者,子痫前期的发生率为15.6%,高于饮食控制者(9.9%,P=0.009);血糖控制不满者子痫前期的发生率为17.0%,明显高于血糖控制满意者(10.0%,P=0.000)。(6)logistic回归分析显示,妊娠期糖代谢异常孕妇合并慢性高血压、HbA1c水平升高为子痫前期发病的独立危险因素。结论不同类型糖代谢异常者,并发子痫前期的发生率存在明显差异,GDM确诊时血糖水平、孕期血糖控制情况等与子痫前期发病存在明显相关性,慢性高血压与糖代谢异常并存,将明显增加子痫前期的发生率。     

Nulliparas' Preferences for Epidural Analgesia: Their Effects on Actual Use in Labor

Background: Few studies have directly examined the reasons for choices of pain relief during labor. The purpose of this study was to investigate if women's preferences for epidural analgesia in labor have an impact on the use of intrapartum epidural analgesia. Methods: Nulliparous women attending childbirth classes completed questionnaires about their antenatal preferences for the use of intrapartum epidural analgesia. Data on actual use of analgesia was obtained by chart review. The analysis included 303 women with either spontaneous or induced labor at term. Results: The 185 women who planned to receive epidural analgesia had a markedly higher rate of epidural use (91%) than the 110 women who hoped to avoid it (57%) ( p= 0.001). Of 237 epidurals administered, 169 (71%) were planned during the antenatal period. Among women receiving epidural analgesia, those planning to receive it tended to have more frequent early administration (≤ 3 cm cervical dilation) than women who unsuccessfully tried to avoid epidural use (54% vs. 24%, p= 0.003). Conclusion: In our population of nulliparas, a woman's antenatal plan to receive epidural analgesia is strongly associated with her likelihood of receiving it. Women who plan to receive epidural analgesia have earlier administration.     

Periodontal disease as a risk factor for pre-eclampsia: a case control study

OBJECTIVE: To investigate the association between periodontal disease and pre-eclampsia, while controlling known risk factors for pre-eclampsia. METHODS: A matched case-control study was carried out on 41 pre-eclamptic women and 41 normotensive, healthy, pregnant, control women. The pre-eclamptic women and controls were individually matched for age, gravidity, parity, smoking and prenatal care. The number of teeth and the number of restorations and decay on all tooth surfaces, and clinical periodontal parameters, excluding third molars were determined within 48 h before delivery. The relation of independent variables to pre-eclampsia was assessed using conditional multiple logistic regression analysis on subject-based data. RESULTS: There were no statistically significant differences in mean percentages of sites with plaque between groups. The mean probing depth (PD) and mean clinical attachment level (CAL) for pre-eclamptic patients were significantly greater compared to those of normotensive patients (P < 0.01). The percentage of sites exhibiting bleeding on probing (BOP) (P < 0.05), the number of sites with PD >/= 4 mm and with CAL >/= 3 mm was significantly higher among pre-eclamptic patients than those with normotensive patients (P < 0.01). Conditional multiple logistic regression analysis indicated that periodontal disease and triglycerides level were significantly associated with pre-eclampsia. Other independent variables (maternal body weight and serum total cholesterol level) did not appear to be associated with pre-eclampsia. Conditional multiple logistic regression results showed that pre-eclamptic patients were 3.47 (95% CI = 1.07-11.95) times more likely to have periodontal disease than normotensive patients. CONCLUSION: The present study shows that maternal periodontal disease during pregnancy is associated with an increased risk for the development of pre-eclampsia. The higher incidence of periodontal disease parameters in pre-eclamptic group would suggest a possible role for periodontal disease in the development of pre-eclampsia. The nature both of periodontitis and pre-eclampsia is multifactorial, and caution should be exercised when implicating periodontal disease in causation of pre-eclampsia.     

Effects of Epidural Analgesia: Some Questions and Answers

ABSTRACT: The effects of epidural analgesia on first labors have been studied by Thorp and colleagues (1,2). One study has been published (3) and is the subject of a question-and-answer discussion, presented here. In this study 711 consecutive nulliparous women at term, with spontaneous onset of labor and cephalic presentation, were divided into one group (n = 447) who received epidural analgesia in labor and another group (n = 264) who received narcotics or no analgesia. The frequency of cesarean section for dystocia was significantly greater (p < 0.005) in the epidural group (10.3%) than in the nonepidural group (3.8%), even after selection bias was corrected and the variables of maternal age and race; gestational age; cervical dilatation on admission; use, duration, and maximum infusion rate of oxytocin; labor duration; presence of meconium; and birth weight were controlled. For both groups the frequency of cesarean section for fetal distress was similar (p < 0.20), and the frequency of low Apgar scores at 5 minutes and cord blood gas values showed no significant differences. The authors concluded that “epidural analgesia in labor may increase the incidence of cesarean section for dystocia in nulliparous women’(3).