(536) Epidural placement early in cervical ripening: is there a negative impact?

Thursday, January 30, 2025

4:00 PM – 6:00 PM

Submitting Author and Presenting Author(s)

Katie Brow, MD, MPH (she/her/hers)

Resident physician
Washington University School of Medicine
St. Louis, Missouri, United States

Coauthor(s)

NR

Nandini Raghuraman, MD, MSCI

Assistant Professor of Ob&Gyn
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Alison G. Cahill, MD, MSCI

Associate Dean of Translational Research, Professor of Women's Health
The University of Texas at Austin
Austin, Texas, United States
CW

Candice Woolfolk, MPH, PhD

Research Statistician
Washington University School of Medicine in Saint Louis
St. Louis, Missouri, United States
Sydney M. Thayer, MD

Washington University in St. Louis
St. Louis, Missouri, United States
Jeannie C. Kelly, MD, MS (she/her/hers)

Associate Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Antonina I. Frolova, MD, PhD (she/her/hers)

Assistant Professor of Ob&Gyn
Washington University School of Medicine
St. Louis, Missouri, United States
Julia Burd, MD

Fellow
Washington University in St. Louis
St. Louis, Missouri, United States

Objective: National guidelines recommend epidural anesthesia be offered at any point in labor. At our institution, patients undergoing induction of labor (IOL) often request “early” epidurals during cervical ripening or prior to mechanical ripening. Our objective was to evaluate if early epidural placement during IOL impacts labor duration.

Study Design: This is a secondary analysis of a prospective cohort study of term patients from a single institution. We included all patients who presented for IOL and received either a prostaglandin or mechanical cervical ripening. Patients with history of cesarean and those without an epidural were excluded. Patients were divided into two groups based on the exam prior to epidural placement: early epidural (EE) if < 2 cm and late epidural (LE) if > 2 cm. Analysis was stratified by parity. The primary outcome was length of IOL, defined as interval between first cervical exam and delivery. Secondary outcomes were mode of delivery, intraamniotic infection, 3^rd/4^th degree lacerations, and neonatal outcomes. Time to event analysis was performed and the log-rank test was used to compare the primary outcome between groups. Cox proportional hazards modeling was used to adjust for potential confounders.

Results: 1704 patients were included with 816 (48%) in the EE group and 888 (52%) in the LE group. Median Bishop score on admission was 1 for both groups. IOL duration was significantly longer in patients with EE (22.7 hours vs 19.9 hours in nulliparous and 15.9 hours vs 14.8 hours in multiparous, both P< 0.001) (Figure). There was no difference in second stage duration between groups. After adjusting for confounders, there was no association between timing of epidural and rates of cesarean delivery, operative vaginal delivery, intraamniotic infection, 3^rd/4^th degree lacerations, or neonatal outcomes (Table).

Conclusion: Early epidural placement < 2 cm is associated with a statistically longer total duration of IOL with an absolute difference of no more than 2-3 hours. Early epidural is not associated with adverse maternal or neonatal outcomes or a longer second stage of labor.