Date of Award
8-1996
Document Type
Thesis
Degree Name
Master of Science (MS)
Department
Nursing
Abstract
Epidural analgesia for the parturient is a safe and effective method of pain relief during labor. This method of pain management permits the pregnant woman to have a virtually pain-free labor while remaining alert and able to participate in the delivery. However, the effect of epidural analgesia on nulliparous labor, and ultimately on the mode of delivery, vaginal or cesarean, remains controversial. Cesarean delivery is associated with greater maternal morbidity and mortality, as well as increased financial cost for the health care system. Therefore, the purpose of this study was to determine the incidence of and circumstances related to cesarean delivery for dystocia in nulliparas who receive intrapartal epidural analgesia.
A retrospective medical record review of the first 60 consecutive patients beginning January 1, 1994 through November 30, 1995 meeting the following criteria was performed: (a) nulliparas 18-40 years of age, (b) 37-40 wecks gestation, (c) spontaneous onset of labor, (d) singleton pregnancy in a vertex presentation, and (e) intrapartal epidural analgesia. Selected patients were placed into two equal groups based upon the early (< 5 cm dilatation) or late (≥ 5 cm dilatation) initiation of epidural analgesia. The physiologic data collected included cervical dilatation, neonatal weight and neonatal length. Maternal age, gestation, oxytocin use, and delivery method were also recorded.
Data were analyzed using the Statistical Package for the Social Sciences -- Revised (SPSS-X). Significance was determined at the .05 level. A two-tailed t-test was done to determine if differences in the cesarean rates between the early and late groups were significant. Results were significant and showed that 46.67% (n = 30) of those patients who received an epidural in early labor had a cesarean delivery as compared to a 20% (n = 30) cesarean delivery rate for those patients who received their epidurals in late labor (t = 2.25, df = 58, p = . 029). Pearson's correlation was performed to determine the significance of relationships among variables. The significant findings showed positive correlation's between neonatal weight/length and gestation, as well as neonatal weight and cesarean delivery. A significant negative correlation was noted between cervical dilatation and cesarean delivery. Finally, analysis of variance (ANOVA) was used to ascertain the probability of cesarean delivery as a function of time of epidural placement and oxytocin with gestation, maternal age, and neonatal weight/length. ANOVA showed significance for time of epidural placement, oxytocin use, and neonatal weight.
Recommended Citation
Sandelin, Wendy H., "Incidence of Cesarean delivery in nulliparous patients based upon timing of epidural analgesia initiation" (1996). Theses and Dissertations. 11076.
https://commons.und.edu/theses/11076