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Systematic review and meta-analysis
No increased risk of caesarean or instrumental delivery for nulliparous women who have epidural analgesia early in (term) labour
  1. Siranda Torvaldsen1,
  2. Christine L Roberts2
  1. 1School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department of Obstetrics and Gynaecology, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Siranda Torvaldsen
    School of Public Health and Community Medicine, University of New South Wales, Level 3, Samuels Building, Sydney, NSW 2052, Australia siranda{at}unsw.edu.au

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Wassen and colleagues have published an article on a topic of great practical importance: Does epidural analgesia (EA) given early in labour (≤3 cm cervical dilatation) increase the risk of instrumental delivery, compared with EA administered later in labour? This is important because EA is the most effective labour analgesia, and, if the timing of its administration is not associated with any adverse consequences, then it should not be denied to women in early labour.

Women who have EA during their labour, compared with women who have other forms of analgesia, are at increased risk of instrumental delivery (RR 1.38, 95% CI 1.24 to 1.53).1 Instrumental deliveries are associated with increased risks to women of vaginal/perineal trauma and anal sphincter damage, which may in turn lead to urinary incontinence, bowel and sexual problems. …

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