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Objective: To create a Proportional Hazards Model of prospective factors associated with time-to-vaginal-delivery (TTVD). Methods: We analyzed a group of 144 women undergoing childbirth who received one out of two possible axial analgesia techniques, to find-out factors associated with TTVD. The patients were randomly assigned to receive either a levobupivacaine labor epidural (bolus concentration 0.25 % or less; infusion concentration 0.125 % or less) or a combined spinal-epidural procedure (morphine 0.20 mg, fentanyl 25 µg and hyperbaric bupivacaine 2.5 mg as spinal components) for labor analgesia. The factors initially chosen were: mother age, height and weight, parity, gestational age, newborn weight, type of labor, analgesic procedure, levobupivacaine and fentanyl doses, Bromage scale, pain Numeric Rating Scale, and a satisfaction interview. Cesarean section was the censored variable in our model. A systematic multivariate Cox regression was performed. Results: Our Final Model stated that nulliparous women had 2.5 times more chances of having longer TTVD than primiparous ( p < 0.001, CI 1.76-3.8), and 3.4 times more ( p = 0.015, CI 1.27-9.25) than multiparous. Women with oxytocin-augmented labor had 2.05 times more chances ( p = 0.001, CI 1.31-3.22) of having longer TTVD than patients without oxytocin. An induced partum had 3.8 times more chances ( p < 0.001, CI 2.09-6.8) of having longer TTVD compared to a spontaneous partum. Conclusion: Parity, labor augmentation, induction of labor and fetal weight determine TTVD; axial analgesia-related factors do not contribute to the model. [ABSTRACT FROM AUTHOR]

Objective: To determine whether combined spinal-epidural analgesia (CSEA) can decrease the known epidural effect of lengthening delivery.Methods: Between April and May 2010, 144 women undergoing childbirth in hospital with epidural pain relief were randomized to receive either low-dose epidural analgesia (LEA) or CSEA. The spinal component included 2.5mg of bupivacaine, 25 μg of fentanyl, and 200 μg of morphine. The epidural component of the CSEA procedure was started once pain returned. The primary outcome was total labor duration measured from the time of initiation of labor analgesia to delivery.Results: The difference in duration between LEA (n=72) and CSEA (n=72) was 5 minutes for labor (P=0.82), 2 minutes for delivery (P=0.60), and 7 minutes for total labor duration (P=0.75). The combined group used less levobupivacaine (P<0.001) and had lower sensory blockade at the dermatomal level (P=0.037). Women in the CSEA group had a higher incidence of pruritus (P=0.002) and lightheadedness (P=0.02) during labor; and a higher incidence of pruritus (P=0.002), nausea-vomiting (P=0.026), and drowsiness (P=0.003) in the postpartum period.Conclusion: As compared with LEA, CSEA did not shorten the duration of labor length; however, it did reduce levobupivacaine consumption and motor weakness. [ABSTRACT FROM AUTHOR]