Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study

Yagi, Taro; Kinose, Yasuto; Bun, Michiko; Horai, Megumi; Matsuda, Chie; Miyake, Tetsuo; Mimura, Kazuya; Otaki, Chiyo; Endo, Masayuki; Kimura, Tadashi

doi:10.1007/s00540-022-03125-9

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…In our study, an epidural is strongly associated with a higher risk of a non-elective c-section, independent of the presence of a support person. This result is consistent with studies from Ireland [ 48 ], the Netherlands [ 49 ], Australia [ 50 , 51 ] and Japan [ 52 ] that found an increased risk of c-section among women given epidurals, but contradictory to some studies [ 53–55 ].…”

Section: Discussionsupporting

confidence: 88%

“…labor induction, epidural anesthesia) and a cascade of interventions throughout labor may disrupt hormonal physiology and introduce risks to the woman or her baby, both in the short and long term [ 58 ]. The use of epidural has been associated with more frequent use of oxytocin to speed up labor [ 52 , 63 , 64 ]. Epidural during labor may interfere with the release of oxytocin, which may prolong labor and, as a result, increase the need to stimulate labor with artificial oxytocin, the action of which is slightly different from that of natural oxytocin [ 10 , 65 ].…”

Section: Discussionmentioning

confidence: 99%

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Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Nenko

Kopeć-Godlewska

Towner

et al. 2023

Evolution, Medicine, and Public Health

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Background and Objectives Birth is a critical event in women’s lives. Since humans have evolved to give birth in the context of social support, not having it in modern settings might lead to more complications during birth. Our aim was to model how emotional factors and medical interventions relate to birth outcome in hospital settings in Poland, where c-section rates have doubled in the last decade. Methodology We analyzed data from 2363 low-risk primiparous women who went into labor with the intention of giving birth vaginally. We used a model comparison approach to examine the relationship between emotional and medical variables and birth outcome (vaginal or c-section), including sociodemographic control variables in all models. Results A model with emotional factors better explained the data than a control model (ΔAIC = 470.8); women with continuous personal support during labor had lower odds of a c-section compared to those attended by hospital staff only (OR = 0.12, 95% CI = 0.09 - 0.16). A model that included medical interventions also better explained the data than a control model (ΔAIC = 133.6); women given epidurals in particular had an increased odds of a c-section over those who were not (OR = 3.55, 95% CI = 2.95 - 4.27). The best model included variables for both the level of personal support and the use of epidural (ΔAIC = 598.0). Conclusions and implications Continuous personal support during childbirth may be an evolutionarily informed strategy for reducing complications, including one of the most common obstetrical complications in modern hospital settings, the c-section.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Nenko

Kopeć-Godlewska

Towner

et al. 2023

Evolution, Medicine, and Public Health

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“…Numerous studies suggests that NA is associated with higher rates of intrapartum CD and operative vaginal deliveries [ 3 , 15 , 16 ]. Some studies [ 15 , 20 ] found that NA resulted in a lower rate of episiotomies in primiparous women, but was associated with a higher rate of instrumental vaginal deliveries and intrapartum CD. Yagi T et al [ 20 ] observed a higher CD rate in deliveries with NA compared to those without NA in Robson group 1 pregnancies and Robson group 2a pregnancies.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies [ 15 , 20 ] found that NA resulted in a lower rate of episiotomies in primiparous women, but was associated with a higher rate of instrumental vaginal deliveries and intrapartum CD. Yagi T et al [ 20 ] observed a higher CD rate in deliveries with NA compared to those without NA in Robson group 1 pregnancies and Robson group 2a pregnancies. Among multiparous women, there was no significant difference in the rates of instrumental delivery and intrapartum CD between early-NA(initiated at cervical dilation was ≤ 3 cm) and late-NA(initiated at cervical dilation was ≤3 cm) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Cheng,

Xiong,

et al. 2024

BMC Anesthesiol

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Background The mechanism underlying maternal fever and prolonged labor progression associated with neuraxial analgesia (NA) remains elusive, raising concerns among certain pregnant women regarding the application of NA during vaginal delivery. This study aimed to investigate the impact of early and late NA on maternal and neonatal outcomes in multiparous women. Methods This retrospective study collected data from 1119 multiparous women with singleton pregnancies, full term and live births at our labor and delivery center between August 1st, 2021 and July 31st, 2022. Based on the timing of NA initiation, participants were categorized into three groups: no-NA, early-NA and late-NA. The no-NA group comprised of 172 women who did not receive NA during vaginal delivery; the early-NA group included 603 women in which NA was initiated when cervical dilation was between 0.5 and 2.0 cm; and the late-NA group comprising 344 cases in which NA was initiated at the cervical dilation of ≥ 2 cm. Maternal and neonatal outcomes were observed, including durations of the first, second, third and total stage of labor, the rate of intrapartum cesarean delivery (CD), intrapartum fever, postpartum hemorrhage (PPH), transfer to intensive care unit (ICU), admission to the neonatal intensive care unit (NICU), meconium-stained amniotic fluid, and neonatal Apgar scores at 1 and 5 min. Results No differences were noted in the maternal age, body mass index (BMI) on admission, gestations, parity, gestational weeks at delivery and neonatal birth weight, or the rate of gestational diabetes mellitus (GDM) and hypertension disorder did not significantly differ among the three groups (p > 0.05). The no-NA group had shorter durations of first stage, second stage of labor compared to the early-NA or late-NA group (median, 215.0 min and 10.0 min vs. 300.0 min and 12.0 min vs. 280.0 min and 13.0 min) (p < 0.05), but no differences were observed between the early-NA and late-NA group (p > 0.05). There were no differences in the rate of intrapartum CD, intrapartum fever, PPH, maternal transferred to ICU, neonatal transfer to NICU, meconium-stained amniotic fluid, and postpartum stay ≥ 7d, as well as the neonatal the Apgar scores at 1 and 5 min among the three groups (p > 0.05). Conclusion NA is associated with extended durations of the first, second and total stages of labor. However, the early initiation of NA in multiparous women (cervical dilation within 0.5-2.0 cm) does not increase the risk of intrapartum CD or intrapartum fever. These findings endorse the secure utilization of early NA for pain relief during labor in multiparous women.

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Programmed intermittent epidural bolus regimen vs continuous epidural infusion: a retrospective study of motor block and obstetric outcomes using the Robson’s Ten Group Classification System

Joyce,

Free,

Calpin

et al. 2024

International Journal of Obstetric Anesthesia

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Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study

Cited by 5 publications

References 34 publications

Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Emotional factors, medical interventions and mode of birth among low-risk primiparous women in Poland

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Programmed intermittent epidural bolus regimen vs continuous epidural infusion: a retrospective study of motor block and obstetric outcomes using the Robson’s Ten Group Classification System

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