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Title: Early versus late initiation of epidural in labour: what is the impact on the delivery mode?
Author: Petrou, Paraskevi-Maria
Awarding Body: City University London
Current Institution: City, University of London
Date of Award: 2011
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Introduction: Epidural analgesia has been widely used in obstetrics as a method of pain relief for women in labour. However, there is a controversy on whether epidural has any influence on the delivery outcome. Aim: The main aim of this literature review is to assess whether the timing of initiation of epidural has a different impact on the mode of delivery in nulliparous women in labour. Methods: The Cochrane, Medline, Emhase, Wiley and The Maternity and Infant data bases were systematically searched for relevant literature until April 2011. We searched for RCTs and Cohort studies on epidural analgesia that was administered in nulliparous women at term pregnancies, that went into spontaneous labour or had induction of labour and we compared the delivery outcomes. Results: 4 RCTs, 3 retrospective cohort studies and 1 prospective cohort study were included in the final review. The relevant articles were critically appraised with the use of the CASP framework and then synthesised in order to compare the results. Most of the studies showed that there is no significant difference in the caesarean section and instrumental delivery rates between the early and late initiation of epidural group. Conclusion: Although most of the studies showed that there was no significant difference on the delivery mode between the 2 groups, there is still a controversy in the results. The sample size in many of the studies was not sufficient in order to provide strong evidence on the topic. Moreover, the differences in the management of labour and the variety of drugs that were used for the epidural and other pain relief options could possibly have had an impact on the results of the reviewed studies. From all the above we can conclude that more research needs to be done around the topic in order to provide the readers with more robust information
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Epidural. early, late, labour, initiation instrumental delivery,