Impact of Epidural Analgesia in Labour on Neonatal and Maternal Outcomes

Söderholm, Nora Tawhid; Türkmen, Şahruh

doi:10.4236/ojog.2018.89080

Cited by 3 publications

(4 citation statements)

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“…Majority of previous studies had similar observation. 7,17,18,[56][57][58] Hintz et al 59 and Tawhid Soderholm et al 15 found a decrease in cord arterial pH <7.1 in association with EA. One study 19 observed better cord pH in patients with EA.…”

Section: Discussionmentioning

confidence: 98%

“…This observation was noted in previous studies also. 7,15 Gestational diabetes is associated with significant neonatal morbidity. 16,65,66 There was no significant difference between the groups in terms of the number of gestational diabetic mothers.…”

Section: Discussionmentioning

confidence: 99%

“…The vast majority of previous studies had observed this association between EA and increased instrumental delivery. 6,7,14,15,36,40 However, the post hoc subgroup analysis of a recent Cochrane review 14 showed that this effect is not seen in recent studies (after 2005), suggesting that modern approaches to epidural analgesia in labor did not increase this outcome.…”

Section: Discussionmentioning

confidence: 99%

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<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Salameh¹,

Paraparambil²,

Abedin³

et al. 2020

IJWH

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Background: Epidural Analgesia (EA) is the most effective and most commonly used method for pain relief during labor. Some researchers have observed an association between EA and increased neonatal morbidity. But this observation was not consistent in many other studies. Objectives: The primary objective of the study was to examine whether exposure to epidural analgesia increased the risk of NICU admission. The secondary objectives included the risks of clinical chorioamnionitis, instrumental delivery, neonatal depression, respiratory distress, birth trauma, and neonatal seizure during the first 24 hours of life. Methods: This was a retrospective cohort study involving 2360 low-risk nulliparous women who delivered at AWH, Qatar, during the two years between January 2016 December and 2017. Short-term neonatal outcomes of the mothers who received EA in active labor were compared with a similar population who did not receive EA. As secondary objectives, labor parameters like maternal temperature elevation, duration of the second stage of labor, and instrumental delivery were compared. Results: Significantly higher numbers of neonates were admitted to the NICU from the EA group (P<0.001, OR 1.89, 95% CI 1.45 to 2.46). They were more likely to have respiratory distress (P=0.01, OR 1.49, 95% CI 1.07 to 2.07), birth injuries (P=0.02, OR =1.71, 95% CI 1.06 to 2.74), admission temperature>37.5°C (P=0.04, OR 3.40, 95% CI 1.00 to 11.49), need for oxygen on the first day (P=0.04, OR 1.44, 95% CI 1.01 to 2.07) and receive antibiotics (P<0.001, OR 2.06,95% CI 1.47 to 2.79). There was no difference in the Apgar score at 1 minute (P=0.12), need of resuscitation at birth (P=0.05), neonatal white cell count (P=0.34), platelet count (P=0.38) and C reactive protein (P=0.84). Mothers who received EA had a lengthier second stage (P<0.001), temperature elevation >37.5°C (P<0.001, OR 7.40, 95% CI 3.93 to 13.69) and instrumental delivery (P<0.001, OR 2.13, 95% CI 1.69 to 2.68). Conclusion: EA increases NICU admission, antibiotic exposure, neonatal birth injuries, need for positive pressure ventilation at birth, and respiratory distress in the first 24 hours of life. Mothers on epidural analgesia have prolonged second stage of labor, a higher rate of instrumental delivery, meconium-stained amniotic fluid, fetal distress, and temperature elevation.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Salameh¹,

Paraparambil²,

Abedin³

et al. 2020

IJWH

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“…Tawhid et al studied epidural analgesia in 1,449 parturient and found out that the rate of assisted vaginal delivery was significantly higher in the epidural analgesia group compared to the nonepidural analgesia group. 11 Agrawal et al concluded after the study on 120 parturient that there is no significant difference in neonatal outcome in parturient undergoing labor analgesia. 10 Vincent studied epidural analgesia in 1,500 parturient and reported good neonatal outcome and no significant adverse effects in neonates.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Labor Analgesia with Patient-controlled Analgesia Pump: An Observational Study

Jadeja¹,

Singh²,

Chellani³

2019

Journal on Recent Advances in Pain

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Aim: Providing labor analgesia has always been a challenge, more so because of controversies and myths associated with labor. This study was done to observe the effect of patient-controlled epidural labor analgesia on incidence of conversion to cesarean section, maternal satisfaction, maternal complication and neonatal outcomes. Materials and methods: A total of 25 consenting ASA grade I-II parturients in active labor with a cervical dilatation of 3-5 cm were randomly selected for the study. The labor analgesia was given after putting epidural catheter in L2/L3 intervertebral space and then parturient were put on continuous infusion of ropivacaine 0.1% with PCA pump after bolus dose of ropivacaine 0.2% with 25 μg fentanyl. The parturients were observed for the incidence of instrumental delivery and incidence of conversion to cesarean section along with duration of labor, maternal satisfaction score and fetal outcome. Results: The rate of cesarean sections was 8.3% in labor analgesia parturients. Only one forceps delivery was done in labor analgesia parturients. No neonatal deaths were noted in labor analgesia parturients. No major maternal complications like hypotension or bradycardia were encountered. The mean satisfaction score was 3.88/5 in study group. Conclusion: Patient-controlled labor analgesia with low dose ropivacaine infusion with PCA pump provides excellent maternal satisfaction for patients undergoing normal vaginal delivery along with decrease in cesarean section rate and good fetal outcome. Clinical significance: Patient-controlled labor analgesia using PCA pump is a novel technique and it provides nearly painless vaginal delivery to the parturient along with excellent fetal outcome and with minimal maternal side-effects.

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Maternal childbirth experience and pain relief methods: a retrospective 7-year cohort study of 85 488 parturients in Finland

et al. 2022

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ObjectivesThe aim of this study was to analyse the relation between the used labour pain relief and childbirth experience measured by Visual Analogue Scale (VAS).DesignA retrospective cohort study.SettingChildbirth in five Helsinki University Hospital delivery units from 2012 to 2018.Primary outcome measureChildbirth experience measured by VAS and classified in three groups (negative VAS=1–5, positive VAS=6–8 and highly positive=9–10).ResultsThe use of epidural or non-epidural compared with non-medical pain relief methods decreased the likelihood to experience highly positive childbirth for primiparous (adjusted OR (aOR)EPIDURAL=0.64, 95% CI 0.57 to 0.73; and aORNON-EPIDURAL=0.76, 95% CI 0.66 to 0.87) and multiparous (aOREPIDURAL=0.90, 95% CI 0.84 to 0.97 and aORNON-EPIDURAL=0.80, 95% CI 0.74 to 0.86) parturients. The effects of epidural differed between primiparas and multiparas. In multiparas epidural was associated with decreased odds for experiencing negative childbirth compared with the non-medical group (aOR=0.70, 95% CI 0.57 to 0.87), while the effect of epidural was considered insignificant in primiparas (aOR=1.28, 95% CI 0.93 to 1.77).ConclusionWhile the use of medical—epidural and non-epidural—pain relief methods were not associated with odds for experiencing negative childbirth in primiparas, using epidural helps to avoid negative experience in multiparas. However, the odds for experiencing highly positive childbirth were decreased if the parturients used any medical pain relief for both primiparas and multiparas. Consequently, the effect of pain relief on the childbirth experience is strongly confounded by indication. Thus, the use of pain relief per se plays a limited role in the complex formation of the overall childbirth experience.

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Impact of Epidural Analgesia in Labour on Neonatal and Maternal Outcomes

Cited by 3 publications

References 50 publications

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Ambulatory Labor Analgesia with Patient-controlled Analgesia Pump: An Observational Study

Maternal childbirth experience and pain relief methods: a retrospective 7-year cohort study of 85 488 parturients in Finland

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