Cochrane review eyes epidural risks.(News)

The use of epidural anesthesia during labor significantly increases the risk of instrumented delivery but does not increase the risk of a cesarean birth, according to systematic review by the Cochrane Collaboration of 21 randomized clinical trials involving 6,664 women.

The study by Millicent Anim-Somuah, M.B., of Liverpool (England) Women's Hospital, and her colleagues included only randomized controlled trials comparing epidural anesthesia with other forms of pain relief or no pain relief in labor (Cochrane Database Syst. Rev. 2005;4:CD000331).

Epidural anesthesia was associated with a 38% increased risk of instrumental vaginal birth. Other statistically significant associations included a second stage of labor that was increased by 15.55 minutes, an 18% increase in the use of oxytocin, a 20-fold increase in the risk of maternal hypotension, and a 17-fold increase in the risk of urinary retention.

But the study uncovered no statistically significant associations with the risk of cesarean birth, maternal satisfaction with pain relief, long-term backache, or neonatal status as determined by Apgar scores. Other outcomes that showed no significant association with epidural anesthesia included length of the first stage of labor, maternal satisfaction with the childbirth experience, postnatal depression, nausea and vomiting, and drowsiness.

None of the clinical trials included in the review reported on rare but potentially serious adverse effects of epidural anesthesia, including thromboembolic events, respiratory failure, uterine rupture, birth trauma, or long-term neonatal morbidity.

"I think it's a valuable review because it involves so many women and so many studies," Rebecca D. Shaw, M.D., who was not involved with the review, said in an interview. Dr. Shaw is an obstetrician and gynecologist in ...