Objective To provide a basis for medical workers to choose the best analgesic method for labor by comparing the effect between combined spinal-epidural analgesia and continuous epidural analgesia on cesarean section rate. Methods A computerized search was performed in CNKI

Wanfang Data

VIP

CBM

PubMed

and EMBASE to identify all studies on randomized controlled trials (RCTs) of combined spinal-epidural analgesia versus continuous epidural analgesia during labor published up to January 2020. Finally

12 articles were included in the study according to the inclusion and exclusion criteria. The Cochrane quality assessment tool was used to assess the methodological quality

and RevMan 5.3 software was used to perform a statistical analysis of the primary outcome measure

cesarean section rate

and the secondary outcome measures

analgesic efficacy

postpartum blood loss

and total labor time. Results A total of 12 RCTs involving 2 266 parturients were included in the analysis. The results of the meta-analysis showed that compared with the continuous epidural analgesia group

the combined spinal-epidural analgesia group had a significantly lower cesarean section rate (RR = 0.47

Z = 6.24

P < 0.05)

a significantly better analgesic effect (RR = 1.16

Z = 6.52

P < 0.05)

and a significantly shorter total labor time （MD = -1.41

Z = 2.17

P < 0.05）

but there was no significant difference in postpartum blood loss between the two groups （MD = -21.67

Z = 1.44

P > 0.05）. Conclusion Available evidence suggests that compared with continuous epidural analgesia

combined spinal-epidural analgesia has a lower rate of cesarean section

a better analgesic effect

and a shortened total labor time; there is no significant difference in postpartum hemorrhage; combined spinal-epidural analgesia in labor is more beneficial for vaginal delivery

reducing unnecessary cesarean section.