A systematic review, including a meta-analysis, on the timing\udeffects of neuraxial analgesia (NA) on cesarean and instrumental\udvaginal deliveries in nulliparous women was conducted. Of\ud20 articles identified, 9 met the inclusion quality criteria (3,320\udparticipants). Cesarean delivery (odds ratio, 1.00; 95% confidence\udinterval, 0.82–1.23) and instrumental vaginal delivery\ud(odds ratio, 1.00; 95% confidence interval, 0.83–1.21) rates were\udsimilar in the early NA and control groups. Neonates of women\udwith early NA had a higher umbilical artery pH and received\udless naloxone. In the early NA group, fewer women were not\udcompliant with assigned treatment and crossed over to the\udcontrol group. Women receiving early NA for pain relief are not\udat increased risk of operative delivery, whereas those receiving\udearly parenteral opioid and late epidural analgesia present a\udhigher risk of instrumental vaginal delivery for nonreassuring\udfetal status, worse indices of neonatal wellness, and a lower\udquality of maternal analgesia.
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