{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:17Z","timestamp":1787013857912,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,2,21]],"date-time":"2020-02-21T00:00:00Z","timestamp":1582243200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta\u2010analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis\u2010\u00e0\u2010vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>A retrospective electronic medical records\u2010based study of 18\u00a0870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half\u2010hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and\/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1\u2010cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In primiparas, receiving EA correlated with longer medians of active first stage (+51\u00a0minutes;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and second stage (+55\u00a0minutes;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). In multiparas, median increases in active first stage (+43\u00a0minutes;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and second stage (+8\u00a0minutes;\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) were noted. The timing of EA, vis\u2010\u00e0\u2010vis cervical dilation (1\u201010\u00a0cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi\u2010 and multiparas. Importantly, the timing of EA, vis\u2010\u00e0\u2010vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.13822","type":"journal-article","created":{"date-parts":[[2020,2,7]],"date-time":"2020-02-07T10:08:46Z","timestamp":1581070126000},"page":"1039-1049","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7370-0417","authenticated-orcid":false,"given":"Michal","family":"Lipschuetz","sequence":"first","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"},{"name":"The Mina and Everard Goodman Faculty of Life Sciences Bar\u2010Ilan University Ramat\u2010Gan Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshel A.","family":"Nir","sequence":"additional","affiliation":[{"name":"Division of Anesthesiology &amp; Critical Care Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"},{"name":"Department of Anesthesiology, Perioperative Medicine, and Pain Treatment Shaare Zedek Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Guedalia","sequence":"additional","affiliation":[{"name":"The Mina and Everard Goodman Faculty of Life Sciences Bar\u2010Ilan University Ramat\u2010Gan Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9500-5135","authenticated-orcid":false,"given":"Hila","family":"Hochler","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagai","family":"Amsalem","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1848-4560","authenticated-orcid":false,"given":"Gilad","family":"Karavani","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7930-4573","authenticated-orcid":false,"given":"Drorith","family":"Hochner\u2010Celnikier","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Unger","sequence":"additional","affiliation":[{"name":"The Mina and Everard Goodman Faculty of Life Sciences Bar\u2010Ilan University Ramat\u2010Gan Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simcha","family":"Yagel","sequence":"additional","affiliation":[{"name":"Division of Obstetrics &amp; Gynecology Hadassah\u2010Hebrew University Medical Center Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,2,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002018"},{"key":"e_1_2_9_3_1","first-page":"CD000331","article-title":"Epidural versus non\u2010epidural or no analgesia for pain management in labour","volume":"5","author":"Anim\u2010Somuah M","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"100","key":"e_1_2_9_4_1","first-page":"177","article-title":"ACOG Practice Bulletin. 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