Epidural analgesia and operative delivery: a ten-year population-based cohort study in The Netherlands

Wassen, Martine M L H; Hukkelhoven, Chantal W.P.M.; Scheepers, Hubertina C.J.; Smits, Luc; Nijhuis, Jan G.; Roumen, Frans J.M.E.

doi:10.1016/j.ejogrb.2014.10.023

Cited by 33 publications

(24 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Anwar S [30] conducted a quasi-experimental study and found that epidural analgesia did prolong the duration of second stage of labor and increased the instrumental delivery rate (58% vs 12%). Wassen MM [31] found the rate of epidural tripled increased from 7.7 to 21.9% over a 10-years span while the rates of CD and operative vaginal delivery did not change too much in the Netherlands. Our study showed that with the increase of NA rate, the rates of operative vaginal delivery remained nearly unchanged.…”

Section: Discussionmentioning

confidence: 98%

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study

Zhao

Gao

Sun

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

Background No Pain Labor &Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service (NA). Methods NA was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia were analyzed from January 2015 to April 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 (p < 0.001); the rate of CD was 48.1% (3577/7360) and stable from January to May 2015 (p>0.05), then decreased from 50.4% in May 2015 to 36.3% in April 2016 (p < 0.001); the rate of MRCD was 11.4% (406/3577) and also stable from January to May 2015 (p>0.05), then decreased from 10.8% in May 2015 to 5.7% in April 2016 (p < 0.001). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation (p>0.05). There was a negative correlation between the rate of NA and rate of overall CD, r = − 0.782 (95%CI [− 0.948, − 0.534], p<0.001), and between the utilization rate of NA and rate of MRCD, r = − 0.914 (95%CI [− 0.989, − 0.766], p<0.001). The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged, and there was no correlation between the rate of NA and anyone of those rates from January 1st 2015 to April 30th 2016 (p>0.05). Conclusions Our study shows that the rates of CD and MRCD in our department were significantly decreased from May 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery with the help of NPLD.

show abstract

Section: Discussionmentioning

confidence: 98%

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study

Zhao

Gao

Sun

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Our study showed that with the increase of NA rate, the rates of operative vaginal delivery remained nearly unchanged. As we all well know that it is di cult to study the effect of epidural analgesia on operative vaginal delivery rates under preconditions that are not double-blind [30,31] . The reason why the instrumental delivery was increased may be probably due to that the presence of decent analgesia makes it much easier for obstetricians to apply forceps or vacuum [30] .…”

Section: Discussionmentioning

confidence: 99%

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: A 16-month retrospective study

Zhao

GAO

Sun

et al. 2020

Preprint

View full text Add to dashboard Cite

Background No Pain Labor ＆Delivery (NPLD) is a nongovernmental project to increase access to safe neuraxial analgesia through specialized training. This study explores the change in overall cesarean delivery (CD) rate and maternal request CD(MRCD) rate in our hospital after the initiation of neuraxial analgesia service. Methods A neuraxial labor analgesia（NA） was initiated in May 1st 2015 by the help of NPLD. Since then, the application of NA became a routine operation in our hospital, and every parturient can choose to use NA or not according to her own requirement. The monthly rates of NA, CD, MRCD, multiparous women, intrapartum CD, episiotomy, postpartum hemorrhage (PPH), operative vaginal delivery and neonatal asphyxia of vaginal delivery were analyzed from January 1st 2015 to April 30th 2016. Results The rate of NA in our hospital was getting increasingly higher from 26.1% in May 2015 to 44.6% in April 2016 ( p< 0.001); the rate of CD was decreased from 50.4% in May 2015 to 36.3% in April 2016 ( p< 0.001); the rate of MRCD was decreased from 10.8% in May 2015 to 5.7% in April 2016 ( p< 0.001); but the rates of overall CD and MRCD remained stable at a high level from January to May 2015( p ＞0.05). At the same time, the rate of multiparous women remained unchanged during the 16 month of observation ( p ＞0.05). There was a negative correlation between the rate of NA and rate of overall CD, r=-0.803 (95%CI[-0.951, -0.642], p =0.002), and between the utilization rate of NA and rate of MRCD, r=-0.790 (95%CI[-0.971, -0.497], p =0.004).The rates of episiotomy, PPH, operative vaginal delivery and neonatal asphyxia in women who underwent vaginal delivery as well as the rates of intrapartum CD, neonatal asphyxia, and PPH in women who underwent CD remained unchanged from January 1st 2015 to April 30th 2016 . Conclusions: Our study shows that the rates of CD and MRCD in our department were significantly decreased from January 1st 2015 to April 30th 2016, which may be due to the increasing use of NA during vaginal delivery.

show abstract

“…On the other hand, differences in regional guidelines and in adherence to national guidelines may explain a part of the large variation in type of pain medication and involvement of a paediatrician. Use of epidural analgesia for women with a single fetus in cephalic position after 37 weeks’ gestation, has almost tripled between 2000 and 2009 in the Netherlands (from 7.7 to 21.9%) [ 59 ]. In 2008, a multidisciplinary guideline on pain medication was published, in which adequate pain relief upon request for all women during labour was advised, with epidural analgesia as the most effective method for pain relief.…”

Section: Discussionmentioning

confidence: 99%

Regional variations in childbirth interventions in the Netherlands: a nationwide explorative study

Seijmonsbergen-Schermers

Zondag

Nieuwenhuijze

et al. 2018

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundAlthough interventions in childbirth are important in order to prevent neonatal and maternal morbidity and mortality, non-indicated use may cause avoidable harm. Regional variations in intervention rates, which cannot be explained by maternal characteristics, may indicate over- and underuse. The aim of this study is to explore regional variations in childbirth interventions in the Netherlands and their associations with interventions and adverse outcomes, controlled for maternal characteristics.MethodsChildbirth intervention rates were compared between twelve Dutch regions, using data from the national perinatal birth register for 2010–2013. All single childbirths from 37 weeks’ gestation onwards were included. Primary outcomes were induction and augmentation of labour, pain medication, instrumental birth, caesarean section (prelabour, intrapartum) and paediatric involvement. Secondary outcomes were adverse neonatal and maternal outcomes. Multivariable logistic regression analyses were used to adjust for maternal characteristics. Associations were expressed in Spearman’s rank correlation coefficients.ResultsMost variation was found for type of pain medication and paediatric involvement. Epidural analgesia rates varied from between 12 and 38% (nulliparous) and from between 5 and 14% (multiparous women). These rates were negatively correlated with rates of other pharmacological pain relief, which varied from between 15 and 43% (nulliparous) and from between 10 and 27% (multiparous). Rates of paediatric involvement varied from between 37 and 60% (nulliparous) and from between 26 and 43% (multiparous). For instrumental vaginal births, rates varied from between 16 and 19% (nulliparous) and from between 3 and 4% (multiparous). For intrapartum caesarean section, the variation was 13–15% and 5–6%, respectively. A positive correlation was found between intervention rates in midwife-led and obstetrician-led care at the onset of labour within the same region. Adverse neonatal and maternal outcomes were not lower in regions with higher intervention rates. Higher augmentation of labour rates correlated with higher rates of severe postpartum haemorrhage.ConclusionsMost variation was found for type of pain medication and paediatric involvement, and least for instrumental vaginal births and intrapartum caesarean sections. Care providers and policy makers should critically audit remarkable variations, since these may be unwarranted. Limited variation for some interventions may indicate consensus for their use. Further research should focus on variations in evidence-based interventions and indications for the use of interventions in childbirth.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1795-0) contains supplementary material, which is available to authorized users.

show abstract

Epidural analgesia and operative delivery: a ten-year population-based cohort study in The Netherlands

Cited by 33 publications

References 28 publications

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: a 16-month retrospective study

The effect of initiating neuraxial analgesia service on the rate of cesarean delivery in Hubei, China: A 16-month retrospective study

Regional variations in childbirth interventions in the Netherlands: a nationwide explorative study

Contact Info

Product

Resources

About