Epidural Analgesia and Any Vaginal Laceration

Myrick, Timothy; Sandri, Kelly Jo

doi:10.3122/jabfm.2018.05.170400

Cited by 13 publications

(8 citation statements)

References 17 publications

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“…Previous studies reported that no significant relationship between epidural usage and genital tract trauma [41][42][43]. Timothy et al even reported that epidural was negatively associated with laceration [44]. Compared with our study (the sample size is more than 4 million), the sample size of these previous studies was very small, the lowest is only about 200 [43] and the highest is less than 6000 [42].…”

Section: Discussioncontrasting

confidence: 84%

“…Compared with our study (the sample size is more than 4 million), the sample size of these previous studies was very small, the lowest is only about 200 [43] and the highest is less than 6000 [42]. In addition, Timothy et al's study included operative vaginal delivery as a mediator in the regression model [44], possibly resulting in overadjustment [45], and failing to correctly estimate the total effect of epidural analgesia. Changes in obstetric management could mediate the associations found in the current study.…”

Section: Discussionmentioning

confidence: 59%

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The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

Wang

et al. 2021

BMC Med

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Background There is a lack of national report of the labour neuraxial analgesia (NA) rates in China in recent years, especially after the national promotion policy. The adverse maternal and perinatal outcomes associated with NA in China are also unknown. The aim of this study is to estimate the trends of NA rates from 2012 to 2019, to evaluate the effect of national policy on promoting NA and to identify the association between NA and adverse outcomes in China. Methods We used the individual data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2019, covering 438 hospitals from 326 urban districts or rural counties in 30 provinces across China. The analysis was restricted to singleton pregnant women who underwent vaginal delivery at or after 28 completed weeks of gestation. We estimate the trends of NA rates between 2012 and 2019, both at the national and provincial levels using Bayesian multilevel model. We also estimated the effect of the national pilot policy launched in 2018 using interrupted time-series analysis and identified the association between NA and adverse outcomes using modified Poisson regression combined with propensity score analysis. Results Over the study period, 620,851 of 6,023,046 women underwent vaginal delivery with NA. The estimated national NA rates increased from 8.4% in 2012 to 16.7% in 2019. Most provinces experienced the same rapid rise during this period. The national pilot policy accelerated the rise of the rates. No differences were observed between women with NA and without any analgesia in the incidence of uterine atony, placental retention, intrapartum stillbirths and 1- and 5-min Apgar scores lower than 7. However, women with NA had higher incidences of genital tract trauma (adjusted relative risk (aRR) 1.53, 95% confidence interval (CI) 1.04–2.26) and maternal near miss (aRR 1.35, 95% CI 1.08–1.69), only in hospitals which were not covered by the national pilot policy and usually lack of sufficient equipment and personnel. Conclusions The national policy can effectively increase the NA rate. However, as genital tract trauma and maternal near miss may increase in low-resource hospitals, but not in high-resource hospitals, further study is required to identify the reasons.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 59%

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

Wang

et al. 2021

BMC Med

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“…A higher birthweight was found in the EA group, although this result was not related to an increased rate of episiotomy performed or to a worse extent of vaginoperineal tears. Myrick et al 45 confirmed our findings in their recent research. Concerning the 2 shoulder dystocia cases recorded, both were without any neonatal consequence, neonatal birthweights exceeded 4000 g, and none of their mothers had diabetes mellitus.…”

Section: Discussionsupporting

confidence: 91%

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Ambrosetti¹,

Grandi²,

PETRELLA³

et al. 2023

AJOG Global Reports

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“…Wassen et al showed that with increasing EA rates from 7.7% to 22% over ten years in the Netherlands, no similar increase in instrumental delivery was accompanied, 27 questioning the role of EA as a risk factor. Instrumental delivery is a known risk factor for higher grade perineal lacerations, 28,29 although the differences between groups in our study were quite close (2.8 vs. 3.2%) and are comparable to the literature [30][31][32] even with a more than twofold higher instrumental delivery rate with EA. The effect of EA on perineal lacerations is controversially reported, depending on the collective with beneficial, 28,31,33 negative 34 or no impact.…”

Section: Discussionsupporting

confidence: 82%

Epidural Analgesia during Routine Childbirth: A 10 Years Retrospective Analysis from the National Birth Registry Austria

Kraft

Wohlrab

Meyer

et al. 2020

Preprint

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Objectives To investigate the use and association of epidural analgesia (EA) on neonatal short-term outcome in vaginal childbirth at term of primiparous parturients. Design Retrospective cohort study. Setting Data of the National Birth Registry of Austria between 2008 and 2017. Population Primiparous women with spontaneous vaginal birth at term of singleton pregnancies in Austria. Methods Linear and logistic regression models to investigate an association of epidural analgesia on short-term neonatal outcome in propensity score adjusted cohorts. Main outcome measures: Short-term morbidity assessed by arterial cord pH and base excess. Secondary outcomes were admission to a neonatal intensive care unit, APGAR scores, and perinatal mortality. Results: Of 247 536 included deliveries, 52 153 received EA (21%). Differences in pH (7.24 vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89 ± 3.2 mmol/l vs. 6.15 ± 3.2 mmol/l; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR score at 5 minutes below 7 was more frequent with EA (OR 1.45; 95% CI 1.29 to 1.63). Admission to a neonatological intensive care unit occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2 (95% CI 1.14 to 1.26). EA was not associated with perinatal mortality (OR 1.33; 95% CI 0.79 to 2.25). Conclusions EA showed no relevant association with short-term morbidity. Higher rates of NICU admission and APGAR score after 5 minutes below 7 were observed with EA. Overall use of EA in Austria is low, and investigation of causes may be indicated.

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Epidural Analgesia and Any Vaginal Laceration

Cited by 13 publications

References 17 publications

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

The trends and associated adverse maternal and perinatal outcomes of labour neuraxial analgesia among vaginal deliveries in China between 2012 and 2019: a real-world observational evidence

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Epidural Analgesia during Routine Childbirth: A 10 Years Retrospective Analysis from the National Birth Registry Austria

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