Short Citation: Lancet 2001;358(9275):19-23.
PubMed PMID: 11454372
Full Citation: Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet 2001;358(9275):19-23.
Organ System: Respiratory
Science Area: Pharmacology / Medical Therapy
Article Type: Randomised Control Trial
Study Size: 1054
Findings: The normal vaginal delivery rate was 35.1% in the traditional epidural group, 42.7% in the low-dose combined spinal group (odds ratio 1.38 [95% CI 1.01-1.89]; p=0.04); and 42.9% in the low-dose infusion group (1.39 [1.01-1.90]; p=0.04). These differences were accounted for by a reduction in instrumental vaginal delivery. Overall, 5 min APGAR scores of 7 or less were more frequent with low-dose technique. High-level resuscitation was more frequent in the low-dose infusion group.
Authors' Conclusions: The use of low-dose epidural techniques for labour analgesia has benefits for delivery outcome. Continued routine use of traditional epidurals might not be justified.
Additional comments from Journal Gems contributors: The message from the COMET trial is that low-dose techniques offer the best chance of a spontaneous vaginal delivery (SVD) with satisfactory analgesia.