From: YTDP43A@prodigy.com (MS GAIL M HART)
This came courtesy of Malcom Griffiths.
Lancet June 3, 1989,pp 1250-2. I scanned the summary and include it for anyone who can't access the original paper.
MATERNAL PYREXIA ASSOCIATED WITH USE OF EPIDURAL ANALGESIA IN LABOUR
Luca Fusi et al
Summary- To establish the effect of pain relief on maternal temperature during labour forty patients who went into spontaneous labour with a single fetus, had a normal temperature (<37-5'C), and had no clinical evidence of infection were investigated prospectively. They were divided into two comparable groups - one receiving pethidine and the other epidural analgesia. Both groups had much the same temperatures at the begining of labour and before any analgesic administration. The mean temparature in the pethidine group remained constant during labour, whereas in the epidural analgesia group it showed a significant rise after only 6 hours of labour. This rise was not related to any clinical evidence of infection. Patients receiving epidural analgesia during labour are at increased risk of developing pyrexia. This pyrexia may be the result of vascular and thermoregulatory modifications induced by epidural analgesia.
I can't tell where many of these originated --- some from/to personal posts, some from obs or midwives or others who responded to general information requests...
Peaceman AM,Lopez-Zeno JA,Minogue JP,Socol ML "Factors that influence route of delivery--active versus traditional labor management." Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, IL 60611. Am J Obstet Gynecol 1993 Oct;169(4):940-4
This study prospectively compared the results of 350 labouring patients in an "active management" group with 350 patients in a "traditional management" group (randomized) and concluded that there was a statisticaly significant correlation between epidural anaethesia and C- section.
And this via Michael Klein last year -- From M Klien <<<--The Trial itself: Frigoletto et al " A Clinical Trial of Active Management of Labor. NEJM vol 333 Sept 21, 1995. pgs 745-50.
Re the subanalysis of potential link of epidural to cxion, these low risk motivated women were 3.7x more likely to have a cxion if they chose epidural than other methods of pain relief. This is not yet reported in a full report but is as an abstract Am J Obs and Gyn 1995; 172 (1) 276 senior author is E. Lieberman.
The greatest risk was when the women had the epidural before 5 cms 5.1 times, but even when received later in the first stage was still 3.1x.<<<
ollis, RE; Davies, DWL, Aveling, W (1995) Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour. Lancet 345, 1413-1416.
1. Thorpe et al: "Epidural Analgesia, Labour, and C/S for Dystocia", American Journal of Obstetrics and Gynecology, 161:3, 670-675, 1989.
2. Thorpe et al, "The Effect of Intrapartum Epidural Analgesia on Nulliparous Labour: A Randomized, Controlled, Prospective Trial", American Journal of Obstetrics and Gynecology, 169;4, 851-858, 1993.
3. Chestnut, D.H. et al, "Does Early Administration of Epidural Analgesia Affect Obstetric Outcome in Nulliparous Women Who are Receiving Intravenous Oxytocin?" Anesthesiology, 80:1193-1200, 1994.
4. Chestnut, D.H. et al, "Does Early Administration of Epidural Analgesic Affect Obstetrical Outcome in Nulliparous Women Who Are in Spontaneous Labour?", Anesthesiology, 80:1201- 1208, 1994.
5. Iglesias et al, "Reducing the Cesarean Section Rate in a Rural Community Hospital", Canadian Medical Association Journal, 145: 1459-1464, 1991.
6. Iglesias et al, "Epidural Use and the Rate of Normal Vaginal Delivery in Nulliparous Women", Journal SOCG, 1045-1052, 1993.
7. Carli et al, "Does Epidural Analgesia Influence the Mode of Delivery in Primiparae Managed Actively? A Preliminary Study of 1250 Women," International Journal of Obstetric Anesthesia, 2: 15-20, 1993.
8. Collis, R.E. et al, "Combined Spinal Epidural (CSE) Analgesia: Technique, Management, and Outcome of 300 Mothers", International Journal of Obstetric Anesthesia, 3:75-81, 1994.
9. Iglesias, S. "Should Every Labouring Woman Be Offered an Epidural?" Paper presented at 12th Annual Obstetrics for Family Physicians, Vancouver, BC, November 1995 (Unpublished).
10. Iglesias, S. "Ambulatory Epidural Analgesia: A Proposal for Rural Canada", Canadian Journal of Rural Medicine (Forthcoming).
11. "Obstetrical Anesthesia in Alberta - A Survey" Ad Hoc Committee on Epidural Analgesia, Alberta Medical Association (Unpublished).