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Mobile epidurals may help preserve bladder function. (Comet Study Analysis).

HILTON HEAD ISLAND, S. C. -- Women who receive walking, or mobile, epidurals are more likely to void spontaneously during labor and are less dependent on urinary catheterization than women on traditional epidural regimens, Dr. Matt Wilson said at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Preserved bladder function may help explain why women given walking epidurals have higher rates of spontaneous vaginal births and lower rates of instrumental delivery compared with traditional epidural, said Dr. Wilson, who conducted the study at the University of Birmingham (England).

The effect of epidurals on bladder function is controversial. Some studies have shown that bladder function remains abnormal up to 8 hours after epidural use. During this period, the bladder is vulnerable to overdistension injury and it's not clear whether the injury has a long-term effect on urinary incontinence.

The current analysis was based on data from the Comparative Obstetric Mobile Epidural Trial (COMET). In that study, 1,054 nulliparous women were randomized to receive either traditional epidural analgesia or one of two mobile regimens: combined spinal epidural (CSE) or low-dose infusion (LDI).

Overall, the rates of women in all three groups requiring intermittent catheterization at some point during labor were similar: traditional (79%), CSE (68%), and LDI (62%). But even when a catheter was required during labor, women in the two mobile groups required it about threefold less often than did those in the traditional epidural group.

In addition, women in the mobile groups were more likely to void spontaneously at some point during labor: traditional (11%), CSE (31%), and LDI (32%). The mobile groups were also more likely to void spontaneously throughout their labor and, therefore, completely avoid catheterization: traditional (4%), CSE (13%), and LDI (14%).

These differences may reflect the preservation of peripheral motor and sensory function attained by the mobile epidural techniques. It might be that women who have mobile epidurals are more likely to be asked or encouraged to void spontaneously during labor. Then again, only about 35% of the mobile groups did indeed walk during labor, despite having the ability to do so.

As reported earlier, 35% of women in the traditional group had spontaneous vaginal births, compared with 43% of women in each of the mobile groups. Likewise, 37% of women in the traditional group had instrumental deliveries, compared with 29% of the CSE and 28% of the LDI groups. There was no significant difference in C-section rates, which hovered around 28% for all three groups (Lancet 358[9275]:19-23, 2001).

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Author:DeMott, Kathryn
Publication:Family Practice News
Article Type:Brief Article
Geographic Code:1USA
Date:Dec 15, 2002
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