The Outcome Analysis of Epidural Analgesia on Labor in Primigra vid Women: A Systematic Review and Meta-Analysis Focusing on Durati on of Labor

Abstract

Background: Epidural anesthesia is extensively used worldwide for pain relief in labor and more lately as an alternative and preferred form of anesthesia for caesarean sections; although its use is gaining universality, its outcome on the duration of labor is still debatable. Our meta-analysis aimed at analyzing the effects of epidural analgesia on duration of labor in primigravid women focusing on duration of labor. Methods: We conducted a systematical literature search in PubMed and Embase (from the inception to July 2016). We calculated weighted mean differences (WMD) between the groups for continuous data, and corresponding 95% confidence intervals (CIs) using the random-effects model. We also performed a subgroup analysis for the effects of different types of studies on duration of labor. Statistical heterogeneity amongst the included studies was tested by I2 indicator. Results: Twelve studies, recruiting 16200 mothers overall, were selected for this systematic review and metaanalysis. The duration of first stage of labor was significantly prolonged in the epidural group by a mean of 2.66 (0.89, 4.43, p<0.00001) and significantly shortened the second stage of labor by a mean of -12.79 (-21.13, -4.45, p<0.00001). Moreover, the overall subgroup analyses shown significantly prolongation of the first stage of labor by the same mean of 2.66 (0.89, 4.43, p<0.00001). Conclusion: The use of epidural analgesia for pain relief during labor is associated with prolongation of first stage of labor and does not prolong the second stage of labor.