Cochrane CSEAvsEA4CS

Analysis 2.24. Comparison 2 Combined spinal-epidural versus low-dose epidural, Outcome 24 Apgar score < 7 at 5 minutes.

Review: Combined spinal-epidural versus epidural analgesia in labour

Comparison: 2 Combined spinal-epidural versus low-dose epidural

Outcome: 24 Apgar score < 7 at 5 minutes

Study or subgroup	CSE	Epidural	Risk Ratio	Risk Ratio
	n/N	n/N	M-H,Fixed,95% CI	M-H,Fixed,95% CI

1 Combined spinal-epidural versus low-dose epidural
COMET 2001a	7/351	10/350				0.70 [ 0.27, 1.81 ]
Hepner 2000	0/26	1/24				0.31 [ 0.01, 7.23 ]
Price 1998	0/45	1/48				0.36 [ 0.01, 8.50 ]
Van de Velde 1999	0/55	0/55				0.0 [ 0.0, 0.0 ]
Total (95% CI)	477	477				0.61 [ 0.26, 1.46 ]
Total events: 7 (CSE), 12 (Epidural)
Heterogeneity: Chi2 = 0.37, df = 2 (P = 0.83); I2 =0.0%
Test for overall effect: Z = 1.10 (P = 0.27)
		0.01	0.1	1	10	100
		Favours CSE			Favours epidural

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Analysis 2.25. Comparison 2 Combined spinal-epidural versus low-dose epidural, Outcome 25 Apgar score < 8 at 5 minutes.

Review: Combined spinal-epidural versus epidural analgesia in labour

Comparison: 2 Combined spinal-epidural versus low-dose epidural

Outcome: 25 Apgar score < 8 at 5 minutes

Study or subgroup	CSE	Epidural		Risk Ratio		Risk Ratio
	n/N	n/N	M-H,Fixed,95% CI			M-H,Fixed,95% CI
1 Combined spinal-epidural versus low-dose epidural
COMET 2001a	7/351	10/350				0.70 [ 0.27, 1.81 ]
Kartawiadi 1996	1/32	0/31				2.91 [ 0.12, 68.81 ]
Parry 1998	0/30	0/30				0.0 [ 0.0, 0.0 ]
Vernis 2004	0/54	0/59				0.0 [ 0.0, 0.0 ]
Subtotal (95% CI)	467	470				0.80 [ 0.33, 1.97 ]
Total events: 8 (CSE), 10 (Epidural)
Heterogeneity: Chi2 = 0.72, df = 1 (P = 0.40); I2 =0.0%
Test for overall effect: Z = 0.48 (P = 0.63)
3 Opioid combined spinal-epidural versus low-dose epidural
Abouleish 1991	1/20	0/22				3.29 [ 0.14, 76.33 ]
Subtotal (95% CI)	20	22				3.29 [ 0.14, 76.33 ]
Total events: 1 (CSE), 0 (Epidural)
Heterogeneity: not applicable
Test for overall effect: Z = 0.74 (P = 0.46)
Total (95% CI)	487	492				0.91 [ 0.39, 2.12 ]
Total events: 9 (CSE), 10 (Epidural)
Heterogeneity: Chi2 = 1.46, df = 2 (P = 0.48); I2 =0.0%
Test for overall effect: Z = 0.21 (P = 0.83)
		0.01	0.1	1	10	100
		Favours CSE			Favours epidural

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Analysis 2.26. Comparison 2 Combined spinal-epidural versus low-dose epidural, Outcome 26 Number admitted to neonatal unit.

Review: Combined spinal-epidural versus epidural analgesia in labour

Comparison: 2 Combined spinal-epidural versus low-dose epidural

Outcome: 26 Number admitted to neonatal unit

Study or subgroup	CSE	Epidural	Risk Ratio	Risk Ratio
	n/N	n/N	M-H,Fixed,95% CI	M-H,Fixed,95% CI

1 Combined spinal-epidural versus low-dose epidural
COMET 2001a	10/351	13/350						0.77 [ 0.34, 1.73 ]
Hepner 2000	0/26	0/24						0.0 [ 0.0, 0.0 ]
Zeidan 2004	0/50	0/51						0.0 [ 0.0, 0.0 ]
Total (95% CI)	427	425						0.77 [ 0.34, 1.73 ]
Total events: 10 (CSE), 13 (Epidural)
Heterogeneity: Chi2 = 0.0, df = 0 (P = 1.00); I2 =0.0%
Test for overall effect: Z = 0.64 (P = 0.52)
		0.1	0.2	0.5	1	2	5	10
			Favours CSE			Favours epidural

W H A T ’ S N E W

Last assessed as up-to-date: 21 May 2007.

1 September 2008 Amended Converted to new review format.

H I S T O R Y

Protocol first published: Issue 4, 2001

Review first published: Issue 4, 2003

22 May 2007 New citation required and conclusions have changed Comparisons were restructured to be more clinically relevant around combined spinal-epidural versus either traditional or low-dose epidural techniques. With this approach there appears to be little basis for recommending one technique over the other with there now being no difference in maternal satisfaction or other key outcomes.

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(Continued)
31 December 2006 New search has been performed	Search updated. An additional five studies were in-
	cluded (Medina 1994; Patel 2003a; Thomas 2005;
	Vernis 2004; Zeidan 2004).

C O N T R I B U T I O N S O F A U T H O R S

Planning of review: Allan Cyna.

Writing of draft protocol: Allan Cyna.

Revision of draft protocol: Allan Cyna, Scott Simmons.

Retrieving papers for review: Damien Hughes, Scott Simmons.

Extracting data from reviewed papers: Damien Hughes, Scott Simmons, Alicia Dennis.

Checking data prior to entry on Review Manager: Damien Hughes, Scott Simmons, Alicia Dennis.

Checking data entry on Review Manager: Damien Hughes, Scott Simmons, Alicia Dennis.

Writing of draft review: Damien Hughes, Scott Simmons, Allan Cyna.

D E C L A R A T I O N S O F I N T E R E S T

None known.

S O U R C E S O F S U P P O R T

Internal sources

• No sources of support supplied

External sources

• Department of Health and Ageing, Australia.

I N D E X T E R M S

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Medical Subject Headings (MeSH)

Analgesia, Epidural [adverse effects; methods]; Analgesia, Obstetrical [adverse effects; methods]; Anesthesia, Epidural [adverse effects; methods]; Anesthesia, Spinal [adverse effects; methods]; Randomized Controlled Trials as Topic

MeSH check words

Female; Humans; Pregnancy

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