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. 2013 Oct 9;2013(10):CD003934. doi: 10.1002/14651858.CD003934.pub4

Nageotte 1997.

Methods Randomised trial.
Participants 761 women, California, U.S.A.

  • 253 study participants: nulliparous

  • 252 control participants:nulliparous

  • 256 participants not used for this review because they received a different epidural intervention: nulliparous.


Inclusion Criteria:
Parity: nulliparous,
Pluralty: not stated,
Gestation: 36 weeks or more,
Onset of labour: spontaneous or induced for spontaneous rupture of membranes at 36 weeks or more,
Other: fetus in the vertex position; requesting epidural analgesia.
Interventions Study group:

  • 253 women were encouraged to ambulate (n = 253).


Ambulation was defined as a minimum of five mins of walking per hour.
Control group:

  • 252 women were discouraged to ambulate.


All women:
‐ had CSE.
 ‐ received a minimum of 1000 mL of lactated Ringer's solution intravenously during the 30 mins preceding the placement of the epidural needle. CSE ‐ intrathecal narcotic with a continuous low‐dose epidural infusion. After the location of the epidural space with an 18‐gauge Tuohy needle, a 11.9 cm 27‐gauge Whitacre spinal needle was passed through the epidural needle into the subarachnoid space. Then 10 g of sufentanil in 2 mL of normal saline was infused and the spinal needle removed. An epidural catheter was advanced 3 cm into the epidural space and a continuous infusion of 0.0625 % bupivacaine with 2 g of fentanyl per millilitre was given at a rate of 12 mL per hour.
 ‐ Subsequent bolus doses of epidural solution were given as requested (12 mL of 0.0625% bupivacaine).
Outcomes Maternal Outcomes:

  1. Mode of birth.

  2. Maternal pain.

  3. Hypotension requiring intervention.


Neonatal Outcomes:

  1. Apgar scores.
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Described as 'randomly assigned'.
Allocation concealment (selection bias) Unclear risk Not stated.
Blinding (performance bias and detection bias) 
 Women High risk Not feasible.
Blinding (performance bias and detection bias) 
 Clinical staff High risk Not feasible.
Blinding (performance bias and detection bias) 
 Outcome assessor Unclear risk Not stated.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No stated losses to follow‐up.
Selective reporting (reporting bias) Unclear risk Unclear.