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Reproduction and Women's Health Seminar 10th June The Comet Study: effect of low-dose mobile versus traditional epidural techniques on mode of delivery Dr Andrew Shennan - Senior Lecturer in Maternal Fetal Health and Obstetrics, Kings College, London ALL WELCOME - ROOM 1.68 FRANKLIN WILKINS BUILDING - WATERLOO CAMPUS http://www.kcl.ac.uk/maps/waterloo.html ABSTRACT Epidural analgesia is the most effective labour pain relief but is associated with increased rates of instrumental vaginal delivery and other effects. These may be related to the dense motor block with traditional epidural. Newer techniques that preserve motor function may reduce obstetric intervention. We performed a randomised controlled trial to compare combined spinal epidural (CSE) and low dose infusion (LDI) "mobile" techniques with traditional. 1054 primiparous women requesting epidural pain relief were randomised between Feb 1999 and April 2000: 353 to traditional, 351 to CSE and 350 to LDI. Primary outcome was mode of delivery and secondary outcomes were progress of labour, efficacy of procedure and neonatal effects. Data were collected during labour and women interviewed postnatally. A significant increase in spontaneous vaginal delivery (SVD) rate of 7.6% with CSE relative to traditional was found (p=0.044; OR 1.38, 95% CI 1.01 to 1.89) and 7.8% for LDI (p=0.037; OR= 1.39, 95% CI 1.01 to 1.90). Differences were accounted for by reduced instrumental delivery, not Caesarean section. Labour pain scores, assessed postnatally, were similar. Five minute Apgars of 7 or less were uncommon but greater for low dose techniques, although resuscitation and SCBU admission did not vary. Costs of techniques did not differ . Almost 1 in 4 operative vaginal deliveries could be avoided by using low dose epidural analgesia for labour. Pain relief and costs are not compromised and the reduced operative intervention for the neonate probably outweighs possible transient effects. Continued routine use of traditional epidural needs to be re-considered. Comet was performed by a multi-disciplinary team, including midwives, obstetric anaesthetists, obstetricans, health economists and epidemiologists. The study was based at Birmingham and Leiceister Universities and Andrew Shgennan was joint PI with Christine Macarther. he has an interest in research in obstetric anaesthesia, as well as pre-eclampsia and prematurity. Further queries: please contact Ann Pryor on 0207 848 3512 or [log in to unmask] ---------------------- Dr Jane Sandall Professor of Midwifery and Women's Health King's College 57 Waterloo Road London SE1 8WA Tel: 020 7848 3605 Fax: 020 7848 3506 email: [log in to unmask]