The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

Naito, Yusuke; Ida, Mitsuru; Yamamoto, Ryo; Tachibana, Kunihide; Kinouchi, Keiko

doi:10.1186/s40981-019-0260-z

Cited by 13 publications

(18 citation statements)

References 12 publications

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“…There was no difference between the groups (P=0.05, OR 1.57, 95% CI 0.99 to 2.49) Herrera-Gomez et al 8 and Greenwell et al 34 observed the increased need for any assisted ventilation in the EA group. Antonio et al 7 and Naito et al 58 looked for the need for advanced resuscitation and did not find any difference between the groups.…”

Section: Discussionmentioning

confidence: 95%

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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: 95%

“…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%

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

Salameh¹,

Paraparambil²,

Abedin³

et al. 2020

IJWH

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“…Another study has also shown second-stage labor prolongation with the use of epidural analgesia [ 10 ]. A study by Naito et al demonstrated increased duration of both the first and second stages of labor with epidural analgesia [ 20 ]. Cochrane review by Anim-Somuah et al demonstrated longer first and second stages of labor with increased chances of oxytocin augmentation in an epidural group than in the opioid group [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Epidural Analgesia on Labor Pain and Course of Labor in Primigravid Parturients: A Prospective Non-randomized Comparative Study

Deepak¹,

Kumari²,

Mohanty³

et al. 2022

Cureus

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Background and aim: The aim of this study was to compare the effects of epidural analgesia on relief of labor pain, progress, and outcome of labor in primigravid parturients to those who did not receive any analgesia. Methods: This was a hospital-based, quasi-experimental study conducted on 70 primigravid parturients at term with a single fetus in a cephalic presentation in active labor. Parturients who were willing to receive epidural analgesia formed group S (n=35) and parturients who refused epidural analgesia formed group C (n=35). The primary objective was to compare alleviation of pain measured by the Visual Analogue Scale (VAS) score. Secondary objectives were to compare the duration of labor, mode of delivery, and neonatal outcome. Results: Pain intensity was significantly lower in group S compared to group C at all measured points of time (p<0.001). There was a quick fall in mean VAS score in group S from 7.94 to 3.86 within 20 min with the bolus dose, it further dropped to 1.03 after 3 h. Further, 88.6% of parturients in groups rated their pain relief as excellent and good satisfaction score. Prolongation of active phase of the first stage of labor (>6 h) was not significant (17.1 % in epidural group versus 5.7% in control group; p=0.259). However, prolongation of the second stage of labor (> 2h) was significant (18.2% in study group versus 0% in control group; p=0.024). The rate of cesarean section, instrumental vaginal delivery, and neonatal outcome was similar in both groups. No adverse effects were observed on maternal vitals, fetal heart rate and Apgar score at 5 min. Conclusion: Epidural analgesia alleviated labor pain in all primigravid parturients who opted for it, without an increase in cesarean section and instrumental vaginal birth. Improved parturients' satisfaction with associated neonatal safety provides a positive birth experience. There was no effect on duration of active phase of the first stage of labor, but the duration of the second stage of labor was slightly prolonged.

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“…32 Maternal age, maternal body mass index, obesity, and epidural analgesia are some risk factors for cesarean section depending on prolonging labor. [33][34][35][36] The present study's primary purpose was to determine fetal adipose tissue components' effect on labor progression by excluding other risk factors that cause prolongation. We planned to see the effect of fetus soft tissue components on the diagnosis of labor protraction or arrest.…”

Section: Discussionmentioning

confidence: 99%

The effect of ultrasonographically measured fetal adipose tissue components on labor

Akselim

Karaşin

Altekin

et al. 2021

J of Obstet and Gynaecol

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Aim: To investigate whether increased fetal adiposity diagnosed ultrasonographical is associated with labor dystocia, and increased risk of operative delivery. Method: This was a prospective study and included 400 pregnant women between 37 and 41 weeks of gestation. In addition to standard ultrasonographic measurements, we evaluated fetal soft tissue thickness before delivery. We also recorded data on delivery method, shoulder dystocia, fetal birthweight and labor duration. We considered the period between 6 and 10 cm cervical opening as the active phase, and the period from full dilation to birth as the second stage. Results: While the vaginal delivery rate was 77.3%, a cesarean was performed in 22.7% of pregnant women. We found a positive correlation between fetal adipose tissue components and durations of the active phase and second-stage labor and the baby's birthweight. Also, we examined and determined that cesarean section and labor dystocia increased as the fetus adipose tissue thickness increased. We investigated the effect of parameters on the study results with logistic regression analysis and possible threshold values with receiver operating characteristics analysis. Conclusion: Our study evaluated the fetal adipose tissue complex during delivery was significant in terms of labor dystocia and operative delivery. We think it may be a guide for future studies in the literature.

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The effect of labor epidural analgesia on labor, delivery, and neonatal outcomes: a propensity score-matched analysis in a single Japanese institute

Cited by 13 publications

References 12 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>

Effects of Epidural Analgesia on Labor Pain and Course of Labor in Primigravid Parturients: A Prospective Non-randomized Comparative Study

The effect of ultrasonographically measured fetal adipose tissue components on labor

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