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Mobile epidurals boost vaginal births, cut instrument assists. (Little Change in Cesarean Rates).

HILTON HEAD ISLAND, S.C. -- Women who have low-dose mobile epidurals may itch a bit more, but they're also more likely to have spontaneous vaginal deliveries than are women who have traditional, high-dose neuraxial analgesia, Dr. Pamela Angle said.

The findings of her metaanalysis lend more weight to the notion that so-called mobile epidurals, which use low doses of analgesia to preserve motor function, reduce the odds of a woman requiring an instrumental delivery. Still, low-dose epidurals don't make much of a dent in cesarean section rates, Dr. Angle said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

After conducting a search of the literature published between 1980 and 2001, Dr. Angle of the Sunnybrook & Women's College, Toronto, and her colleagues identified four randomized, controlled trials comparing mobile and traditional epidurals and involving a total of nearly 2,100 patients.

All trials compared the modes of delivery from patients having low- and high-dose epidural using bupivacaine only.

The odds of having an instrumental delivery were lower in the low-dose group (28% vs. 36%); patients in the low-dose group were more likely to have a spontaneous vaginal delivery, compared with those in the high-dose group (49% vs. 43%).

The rates of cesarean section were not significantly different between the low-dose and high-dose groups (23% vs. 21%).

Still, patients in the low-dose group had a 10-fold higher risk of developing pruritus, which was typically described as mild and self-limiting. There were no other differences between the groups in terms of nausea, hypotension, or 5-minute Apgar scores of less than 7.

Patients in the low-dose group were maintained on a solution containing less than 0.125% bupivacaine; those in the high-dose group were maintained on solutions containing at least 0.125% bupivacaine.

The results reinforce findings from studies such as the Comparative Obstetric Mobile Epidural Trial.

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Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Dec 15, 2002
Previous Article:Mobile epidurals may help preserve bladder function. (Comet Study Analysis).
Next Article:Mobile epidural's effect on vaginal delivery may lie with pelvic muscles. (Actual Mobility May be Irrelevant).

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