SynthesisBMJ (Clinical research ed.)2004
Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review.
Synthesis in BMJ (Clinical research ed.), 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 43 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pain Management During Labor: Use of Intermittent Drug Delivery Devices for Obstetric and Neonatal Outcome Improvement and Health-care Burden Reduction
Evaluation of the Effectiveness of Transcutaneous Electrical Nerve Stimulation During Labor. A Triple Blind Randomized Clinical Trial
Programmed Intermittent Epidural Bolus Versus Continuous Infusion When Added to Patient-controlled Epidural Analgesia on Bupivacaine Consumption in Labour Analgesia: a Randomized Controlled Trial
Who cites it
43 citing papers in PubMed, 5 syntheses or guidelines pooled it, 170 citations in OpenAlex.
- Early versus late initiation of epidural analgesia for labour.The Cochrane database of systematic reviews · 2014Pooled it
- Oxytocin augmentation of labour in women with epidural analgesia for reducing operative deliveries.The Cochrane database of systematic reviews · 2013Pooled it
- Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births.The Cochrane database of systematic reviews · 2012Pooled it
- Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event.BMC medical research methodology · 2012Pooled it
- Pain management for women in labour: an overview of systematic reviews.The Cochrane database of systematic reviews · 2012Pooled it
- Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial.BMJ (Clinical research ed.) · 2017Trial
- Assisting informed decision making for labour analgesia: a randomised controlled trial of a decision aid for labour analgesia versus a pamphlet.BMC pregnancy and childbirth · 2010Trial
- Do audio-guided decision aids improve outcomes? A randomized controlled trial of an audio-guided decision aid compared with a booklet decision aid for Australian women considering labour analgesia.Health expectations : an international journal of public participation in health care and health policy · 2009Trial
- Preanesthetic withdrawal improves the conversion efficacy of prolonged epidural labor analgesia to epidural surgical anesthesia: a prospective cohort study combined with MRI mechanistic exploration.BMC pregnancy and childbirth · 2026Article
- Article
- Effect of epidural analgesia on cervical ripening using dinoprostone vaginal inserts.Journal of anesthesia · 2024Article
- Comparative effects of epidural analgesia and intramuscular morphine on maternal and neonatal outcomes: a retrospective cohort study.AJOG global reports · 2024Article
- Knowledge and Attitudes towards Epidural Analgesia among Women of Childbearing Age in Jazan, Saudi Arabia: A Community-Based Cross-Sectional Study to Identify Predictors through Multivariate Modeling.Healthcare (Basel, Switzerland) · 2023Article
- Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland.Evolution, medicine, and public health · 2023Article
- Pain management during labor: use of intermittent drug delivery devices for improvement of obstetric and neonatal outcome and reduction of healthcare burden: A large non-inferiority randomized clinical trial.Journal of anesthesia, analgesia and critical care · 2021Article
- Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review.Research and practice in thrombosis and haemostasis · 2021Article
- Understanding Factors Leading to Primary Cesarean Section and Vaginal Birth After Cesarean Delivery in the Friuli-Venezia Giulia Region (North-Eastern Italy), 2005-2015.Scientific reports · 2020Article
- Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity.International journal of women's health · 2020Article
- A Systematic Evaluation of Hospital Performance of Childbirth Delivery Modes and Associated Factors in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015.Scientific reports · 2019Article
- Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study.European journal of anaesthesiology · 2019Article
Corrections and comments
- Commented on by
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo compare the effects of low concentration epidural infusions of bupivacaine with parenteral opioid analgesia on rates of caesarean section and instrumental vaginal delivery in nulliparous women. DATA SOURCES: Medline, Embase, the Cochrane controlled trials register, and handsearching of the International Journal of Obstetric Anesthesia. STUDY SELECTION: Randomised controlled trials comparing low concentration epidural infusions with parenteral opioids. DATA SYNTHESIS: Seven trials fulfilled the inclusion criteria for meta-analysis. Epidural analgesia does not seem to be associated with an increased risk of caesarean section (odds ratio 1.03, 95% confidence interval 0.71 to 1.48) but may be associated with an increased risk of instrumental vaginal delivery (2.11, 0.95 to 4.65). Epidural analgesia was associated with a longer second stage of labour (weighted mean difference 15.2 minutes, 2.1 to 28.2 minutes). More women randomised to receive epidural analgesia had adequate pain relief, with fewer changing to parenteral opioids than vice versa (odds ratio 0.1, 0.05 to 0.22).
conclusionsEpidural analgesia using low concentration infusions of bupivacaine is unlikely to increase the risk of caesarean section but may increase the risk of instrumental vaginal delivery. Although women receiving epidural analgesia had a longer second stage of labour, they had better pain relief.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.