You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Effect of second-stage 0.25% epidural bupivacaine on the outcome of labor.
Abstract 1:
OBJECTIVE To evaluate the effect of second-stage epidural bupivacaine on the outcome of labor . METHODS Two groups of 35 patients each were r and omly allocated to receive continuous epidural bupivacaine throughout labor ( group 1 ) or until an 8-cm dilatation of the cervix ( group 2 ) . RESULTS There was no significant difference between the 2 groups in the rates of instrument deliveries and in their Apgar scores . CONCLUSIONS The administration of continuous epidural bupivacaine ( 0.25 % ) throughout labor and delivery does not seem to affect the outcome of labor


Title 2:
Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor.
Abstract 2:
A r and omized , double-blind , placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.0625 % bupivacaine-0.0002 % fentanyl during the second stage of labor in nulliparous women . When the cervix was fully dilated , coded study solution was substituted for the known bupivacaine-fentanyl solution . The study solution for 29 patients was 0.0625 % bupivacaine-0.0002 % fentanyl ; 34 patients received saline placebo . The two groups had similar pain scores during the first stage of labor . During the second stage , pain scores were significantly higher in the saline-placebo group at each 30-min interval between 60 and 150 min after the diagnosis of full cervical dilation . Similarly , there was a significant difference between the two groups in global assessment of analgesia quality during the second stage , but the difference occurred in those patients with a second-stage duration of greater than or equal to 60 min . Among the women who delivered vaginally , eleven of 28 ( 39 % ) women in the bupivacaine-fentanyl group , versus five of 34 ( 15 % ) in the saline-placebo group , had surgical perineal anesthesia for vaginal delivery ( P less than .05 ) . Six of 28 ( 21 % ) women in the bupivacaine-fentanyl group , and five of 34 ( 15 % ) in the saline-placebo group , underwent instrumental vaginal delivery ( P = NS ) . The median duration of the second stage of labor was 53 min ( range = 5 - 283 ) in the bupivacaine-fentanyl group , and 63 min ( range = 16 - 181 ) in the saline-placebo group ( P = NS ) . ( ABSTRACT TRUNCATED AT 250 WORDS


Title 3:
The Influence of Continuous Epidural Bupivacaine Analgesia on the Second Stage of Labor and Method of Delivery in Nulliparous Women
Abstract 3:
A r and omized , double blind , placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.125 % bupivacaine beyond a cervical dilatation of 8 cm in nulliparous women . When the cervix was ≥ 8 cm dilated , coded study solution was substituted for the known 0.125 % bupivacaine solution . The study solution for 46 patients was 0.125 % bupivacaine ; 46 patients received saline . During the first stage of labor , 44 ( 96 % ) women in the bupivacaine group , and 45 ( 98 % ) in the saline group , had analgesia of excellent or good quality . During the second stage , 36 ( 82 % ) women in the bupivacaine group , versus 18 ( 41 % ) women in the saline group , had analgesia of excellent or good quality ( P < .0001 ) . Six ( 13 % ) women in each group underwent cesarean delivery after the start of the study solution . Among the women who delivered vaginally , the mean ( ±S.D. ) duration of the second stage of labor was 124 ( ±70 ) min in the bupivacaine group , versus 94 ( ±54 ) min in the saline group ( P < .05 ) . Twenty-one of 40 ( 53 % ) women in the bupivacaine group , versus 11 of 40 ( 28 % ) in the saline group , underwent instrumental vaginal delivery ( P < .05 ) . Twenty-eight of 40 ( 70 % ) women in the bupivacaine group , versus six of 40 ( 15 % ) in the saline group , had surgical perineal anesthesia for vaginal delivery ( P < .0001 ) . There were no significant differences between groups in Apgar scores or umbilical cord blood acid-base values . We conclude that , under the conditions of the present study , epidural bupivacaine infusion beyond a cervical dilatation of 8 cm provided satisfactory analgesia , but prolonged the second stage of labor and increased the frequency of instrumental delivery in nulliparous women . However , maintenance of epidural bupivacaine analgesia did not result in an increased incidence of abnormal position of the vertex or a more frequent performance of cesarean section


Title 4:
Maternal expectations and experiences of labour pain — options of 1091 Finnish parturients
Abstract 4:
A prospect i ve survey of 1091 Finnish parturients was conducted in order to ascertain mothers ' expectations for labour pain relief , to measure the actual pain during all three stages of labour and to question their satisfaction and the adequacy of pain relief on the third day following delivery . Antenatal expectations for pain relief were surveyed . Mothers were question ed on pain levels in the delivery room and 3 days after giving birth . Pain levels were ascertained using a  visual pain score method . Antenatally , 90 % of all parturients anticipated a need for pain relief during labour . In the delivery room over 80 % of all parturients described their pain as very severe to intolerable , only 4 % of the multiparous had low pain scores ( 0–2 ) . After pain treatment 50 % of multiparous women still had pain scores from 8 to 10 , which reflects a lack of effective pain relief . Dissatisfaction with the childbirth experience was very low , and was associated with instrumental deliveries , but not with the usage of analgesia . 51 % of all parturients complained of inadequate pain relief during childbirth , which , in multiparous women , was significantly associated with the second stage of labour


Title 5:
Benefits of Continuous Infusion Epidural Analgesia Throughout Vaginal Delivery
Abstract 5:
Two groups of nulliparous women with fetuses in singleton vertex presentation received continuous infusion epidural analgesia ( EDA ) with bupivacaine :  group A ( 90 parturients )  without infusion analgesia in the second stage of labor and group B ( 90 parturients )  with infusion analgesia throughout delivery . The groups were compared regarding pain relief , duration of the second stage , persistent malrotation of the fetal head , and rate of instrumental vaginal delivery . The continuous infusion EDA gave satisfactory pain relief in 93.3 % of the parturients in group A and 97.8 % in group B. The duration of second stage was the same in both groups . There were more persistent mal‐rotations of the fetal head in group A , but the malrotation did not affect the mode of deli : very . The rate of instrumental vaginal delivery was 25.5 % in both groups . The main cause of operative intervention was delay in the second stage . When the continuous infusion technique is used , it seems unreasonable to discontinue the EDA and thereby deprive the parturient of analgesia during the second stage


Title 6:
Continuous Infusion Epidural Analgesia With Lidocaine: Efficacy and Influence During the Second Stage of Labor
Abstract 6:
A r and omized double-blind study evaluated the analgesic efficacy and influence of maintaining a continuous epidural infusion of 0.75 % lidocaine during the second stage of labor in nulliparous women . When the cervix was 8 cm or more dilated , unidentified study solution was substituted for the known 0.75 % lidocaine solution and continued until delivery . The study solution for 26 patients was 0.75 % lidocaine ; 27 subjects received saline . During the first stage of labor , 88 % of women in the lidocaine group and 81 % of women in the saline group had analgesia of excellent or good quality , a nonsignificant difference . During the second stage , there was a tendency ( not statistically significant ) toward improved analgesia quality in the lidocaine patients , but there was no significant difference in the frequency of perineal anesthesia ( 23 % lidocaine , 7 % saline ) . There was no difference between the groups in the duration of the second stage of labor ( 73 ± 63 versus 76 ± 48 minutes ) . Operative delivery frequency was similar ( 31 and 37 % ) , as were umbilical cord blood acid-base values . It is concluded that maintenance of the continuous epidural infusion of 0.75 % lidocaine did not prolong the second stage of labor , but it also did not significantly differ from saline in quality of second stage analgesia or frequency of perineal anesthesia


Title 7:
Second stage of labour with or without extradural analgesia
Abstract 7:
Two groups of parturients who had received selective extradural analgesia were studied . In Group A patients the regional block was allowed to wear off for the second stage of labour whereas in Group B patients  ' analgesia was maintained throughout labour
REVIEW ERS ' CONCLUSIONS There is insufficient evidence to support the hypothesis that discontinuing epidural analgesia late in labour reduces the rate of instrumental delivery .
There is evidence that it increases the rate of inadequate pain relief in the second stage of labour .