The effect of labor epidural analgesia on maternal–fetal outcomes: a retrospective cohort study

Wang, Qian; Zheng, Sen; Ni, Yufei; Lu, Yuanyuan; Bing, Zhang; Lian, Qingquan; Hu, Mingpin

doi:10.1007/s00404-018-4777-6

Cited by 42 publications

(48 citation statements)

References 19 publications

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“…A similar result was seen in studies by Rouse et al, 19 Herrera-Gómez et al 8 and Wisborg et al 20 Conversely, a recent Cochrane meta-analysis by Anim-Somuah et al 14 concluded that EA is not associated with a higher rate of NICU admission. Previous studies by Wang et al 62 and Soncini et al 21 also did not find an association between EA and NICU admission. The difference in observation could be partially due to the difference in the NICU admission criteria of different institutions.…”

Section: Discussionmentioning

confidence: 75%

“…6,7,17,54,61 None of them found any correlation between EA and 5 minute Apgar score. A recent study by Wang et al 62 also found no association between EA and Apgar score at one or 5 minutes. The correlation of low 1 minute Apgar with epidural analgesia observed by Hincz Petal 59 and Herrera-Gómez et al 8 might be attributable to the difference in the opioid used.…”

Section: Discussionmentioning

confidence: 86%

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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: 75%

Section: Discussionmentioning

confidence: 86%

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

Salameh¹,

Paraparambil²,

Abedin³

et al. 2020

IJWH

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“…According to the data collected from Shijiazhuang Obstetrics and Gynecology Hospital where the project was rst introduced in 2008, the rate of overall CD decreased from 40.5% to 33.6% in the period when the rate of neuraxial labor analgesia increased from 0 to 33.5% [20]. At the second A liated Hospital, Wenzhou Medical University, Wang Q found that as the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5%, at the same time the rate of episiotomy and severe perineal injury were decreased [21] . Our results are in accordance with those observational studies on the use of NA with the help of NPLD [7,[20][21] .…”

Section: Discussionmentioning

confidence: 98%

“…At the second A liated Hospital, Wenzhou Medical University, Wang Q found that as the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5%, at the same time the rate of episiotomy and severe perineal injury were decreased [21] . Our results are in accordance with those observational studies on the use of NA with the help of NPLD [7,[20][21] . In our study, before the implement of NA, the rates of overall CD and MRCD were stable and high from January 1 st to May 30 th 2015, but with the increase of usage of NA, both of them were dropped.…”

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

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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.

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“…There are lots of studies in which the effects of epidural in labor and long term fetal status are analyzed [31][32][33][34][35][36]. Most of them conclude that there are similar perinatal outcomes in patients undergoing epidural analgesia during labor and those without epidural analgesia.…”

Section: Discussionmentioning

confidence: 99%

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

Delgado¹,

García²,

León³

et al. 2018

Clinics Mother Child Health

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Introduction: Epidural analgesia is a consolidated therapeutic technique generally used for the relief of labor pain. Since its introduction in obstetrics, there have been many studies that evaluate the effect that this type of analgesia has over the course of labor, and its possible repercussions on the mother and the fetus/newborn by analyzing data at birth. However, there exist very few studies that analyze the early effect that epidural analgesia has on the fetus. Objectives: The main objective of this study is to analyze the early effects of epidural analgesia on the fetal status by evaluating the possible changes in the acid-base fetal state, the most precise way to evaluate fetal wellbeing during labor, and cardiotocographic (CTG) tracing of the fetal heart rate after the administration of an epidural. Methods: This is a prospective study of 193 patients, in which a determination of the fetal acid-base equilibrium was done before the administration of epidural analgesia and repeated 60 min afterwards, evaluating possible changes in the results motivated by analgesia. Results: There was a statistically significant descent on fetal blood pH after the administration of epidural analgesia, as well as a significant increase in the number of fetal heart traces with alterations. The descent of fetal pH was greater in patients that had some gestational associated conditions. Conclusion: The administration of epidural analgesia during the first stage of labor caused, as an early effect, a significant descent in fetal blood pH, without that descent being clinically relevant over the fetal status in healthy fetuses. There must be a strict control in fetuses with some initial alteration in the CTG tracings. Keywords Acid-base balance; Epidural; Early effect of epidural in fetus; Fetal blood pH C li nics in M o th er an d C h il d Healt h

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The effect of labor epidural analgesia on maternal–fetal outcomes: a retrospective cohort study

Abstract: Implementation of labor epidural analgesia increased the vaginal delivery rate and use of labor epidural analgesia is safe to parturients and fetus.

Cited by 42 publications

References 19 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>

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

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

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