Several studies conducted at Parkland Hospital were designed to answer this and related questions. From 1995 to 2002, a total of 2703 nulliparas at term and in spontaneous labor were enrolled in ive trials to evaluate epidural analgesia techniques compared with methods of intravenous meperidine administration. he results from these are summarized in Figure 25-4 and show that epidural analgesia does not signiicantly raise cesarean delivery rates.
Timing of Epidural Placement
In several retrospective studies, epidural placement in early labor was linked to an increased risk of cesarean delivery
Ramin et ai, 1995
Sharma et ai, 1997 Gambling et ai, 1998
Lucas et ai, 2001
Sharma et ai, 2002
I OR (95% el) Force on Obstetrical Anesthesia (2016).I Epidural hematomas are rare, and inci 1.01 (0.79,e1.30) dence of nerve damage from a hematoma is estimated to be 1 in 150,000 (Grant, 2007). he American College of Obstetri 1.20 (0.73, 1.97) cians and Gynecologists (2016b) has conI cluded that selected women with platelet 0.77 (0.31e, 1.91e) counts of 80,000 to 100,000/LL may be
I candidates for regional analgesia. Caveats --: -1.13 (0.65, 1.97) include a stable platelet count, no acquired or congenital coagulopathy, normal plateI let function, no antiplatelet-specific drugs, 1.05 (0.68, 1.63) and anticoagulation parameters, describedI next, that are met. Counts between 50,000 0.81 (0.41e, 1.61e) and 80,000 require an individualizedI decision on risks and benefits (van Veen, 1.04 (0.81e,e1.34) 2010). Single-shot spinal anesthesia with a 25-gauge needle is less traumatic than epiI dural or combined spinal-epidural anesthe sia with a 17-or 18-gauge epidural needle 0.0 0.4 0.8 1.2 1.6 2.0 platelets in this range.
FIGURE 25-4 Results offive studies comparing the incidence of cesarean delivery in women given either epidural analgesia or intravenous meperidine. The individual
Anticoagulation. Women recelvmg odds ratios (ORs) with 95-percent confidence intervals (Cis) for each randomized study, coagulation therapy who are given regional as well as overall crude and adjusted ORs with 95-percent Cis, are shown. An OR <1o.0 analgesia are at increased risk for spinal cord favored epidural over meperidine analgesia. (Reproduced with permission from Sharma