Perinatal outcome of vaginal delivery with epidural analgesia initiated at the early or late phase of labor period: A retrospective cohort study in the Japanese population

Abstract

Most perinatal outcomes between the early and late phases of initiated epidural analgesia were not markedly different in our Japanese population, even when using a new definition of labor phase.

Does the timing of neuraxial analgesia initiation in elective induction of multiparous women prolong the duration of delivery?

“…Although the majority of these studies were conducted in nulliparous spontaneous labor, the results of our study for the elective induction of labor in multiparous women appear to be in concordance regarding the effect on labor duration. In nulliparous women, the durations of labor with early and late neuraxial analgesia initiation were comparable 6–9,11 . Our study's findings are in line with these previous findings.…”

“…The only previous study that assessed the effects of the timing of analgesia initiation on multiparous women with spontaneous labor was conducted at a Japanese institution by Shiro et al 6 Similar to our study, the authors reported no statistically significant difference between the early and late groups in the first stage of labor 6 . However, the labor durations in the present study were shorter than those reported by Shiro et al (468 min in the early group and 372 min in the late group) 6 . We speculate that our active management of labor with oxytocin and the artificial rupture of the membrane could have contributed to the shorter duration.…”

“…Labor progress is affected by race and labor management 17,18 ; therefore, research must be conducted within the Japanese population and institutions to gain insight into the situation in Japan specifically 6 . It has been reported that the first stage of labor was prolonged by the early administration of combined spinal‐epidural analgesia (CSEA) in Japanese parturients, which is in contrast with the findings of previous similar studies.…”

“…Previous studies have indicated that the timing of neuraxial analgesia initiation does not affect the duration of delivery; however, the majority of these studies were conducted in nulliparous spontaneous labor 5–12 . The course of labor differs between nulliparous and multiparous women, 13 and between spontaneous and induced labor 14 ; therefore, it is essential to consider the patient's background when interpreting these results.…”

“…Previous studies have indicated that the timing of neuraxial analgesia initiation does not affect the duration of delivery; however, the majority of these studies were conducted in nulliparous spontaneous labor. [5][6][7][8][9][10][11][12] The course of labor differs between nulliparous and multiparous women, 13 and between spontaneous and induced labor 14 ; therefore, it is essential to consider the patient's background when interpreting these results. Previous studies have associated labor induction at 39 weeks of pregnancy with lower perinatal morbidity and mortality in low-risk multiparous women, as well as a reduction in the number of cesarean deliveries; these data have led to an increase in the rates of labor induction in Western countries.…”