American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 2006
ReviewEpidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials.
Randomized controlled trials suggest epidural analgesia (EA) does not increase the frequency of cesarean births compared with opioid analgesia. We analyzed trials comparing EA with opioid analgesia to determine their external validity in contemporary North American practice. ⋯ Randomized trials showing no effect of EA on cesarean section (CS) rate lack external validity in much of North American practice. The limited data available suggest EA and low-dose oxytocin used together increase the CS rate. Early detection of dystocia and high-dose oxytocin augmentation should be considered for women receiving EA; those delivering in low-dose oxytocin settings should be advised of a probable increase in the likelihood of CS.