Thorp J A, Meyer B A, Cohen G R, Yeast J D, Hu D
Department of Obstetrics and Gynecology, St. Luke's Perinatal Center, Kansas City, MO.
Obstet Gynecol Surv. 1994 May;49(5):362-9. doi: 10.1097/00006254-199405000-00027.
Published studies assessing the effect of epidural analgesia in nulliparous labor on the frequency of cesarean delivery for dystocia are reviewed. There are at least four retrospective studies and two prospective studies that suggest that epidural analgesia may increase the risk of cesarean delivery for dystocia in first labors. The potential for epidural to increase the frequency of cesarean delivery for dystocia is likely influenced by multiple variables including parity, cervical dilatation at epidural placement, technique of epidural placement, management of epidural during labor, and the obstetrical management of labor after placement of epidural analgesia. Two studies suggest that delaying placement of the epidural until 5 cm of cervical dilatation or greater may reduce the risk of cesarean birth. Epidural is safe and may be a superior labor analgesic when compared with narcotics. However, patients should be informed that epidural analgesia may increase the risk of cesarean birth in first labors.
本文综述了已发表的关于评估硬膜外镇痛对初产妇分娩时因难产而行剖宫产频率影响的研究。至少有四项回顾性研究和两项前瞻性研究表明，硬膜外镇痛可能会增加初产妇因难产而行剖宫产的风险。硬膜外镇痛增加因难产而行剖宫产频率的可能性可能受多种因素影响，包括产次、硬膜外穿刺时的宫颈扩张程度、硬膜外穿刺技术、分娩期间的硬膜外管理以及硬膜外镇痛实施后的产科分娩管理。两项研究表明，将硬膜外穿刺推迟至宫颈扩张5厘米或更大时，可能会降低剖宫产的风险。与麻醉剂相比，硬膜外镇痛是安全的，且可能是更好的分娩镇痛方法。然而，应告知患者，硬膜外镇痛可能会增加初产妇剖宫产的风险。
