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June 9, 1999

Epidural Analgesia and Cesarean Delivery—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(22):2084-2087. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-22-jbk0609

To the Editor: The US national cesarean delivery rate has hovered around 22% to 23% for the past decade.1 Interventions that have a small but clinically significant effect on cesarean delivery rates may go unnoticed because small effects require relatively large sample sizes to show statistical significance.

The meta-analysis by Halpern et al2 reported an insignificant effect of epidural analgesia on cesarean delivery rates. However, it did not consider a priori 2 critically important issues: (1) the quantification of a clinically relevant change in outcome that might be the result of the clinical intervention under study and (2) calculations to determine the number of patients needed to statistically evaluate the data for the presence or absence of significant changes. Consequently, the analysis includes too few patients to prove convincingly the negative results that it professes.

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