Vol 85, No 12 (2014)
ARTICLES
Epidural analgesia during labour: a retrospective cohort study on its effects on labour, delivery and neonatal outcome
Piotr Hincz, Lech Podciechowski, Mariusz Grzesiak, Wojciech Horzelski, Jan Wilczyński
DOI: 10.17772/gp/1883
·
Ginekol Pol 2014;85(12).
Vol 85, No 12 (2014)
ARTICLES
Abstract
Objectives: to evaluate the impact of epidural analgesia (EA) on labor, delivery and neonatal status. Material and methods: retrospective, observational, cohort study comprising 5593 pregnant women who met the inclusion criteria (singleton pregnancy, cephalic presentation, 37-42 weeks of gestation). Out of them, 2496 had EA and 3097 constituted the control group.
Main outcome measures: incidence of labor complications and operative deliveries in women who received EA, neonatal status assessed by Apgar score in 1- and 5-minute, and cord pH values. Results: Labor complications were more frequently observed in the epidural group, with an almost 1.5-fold higher incidence in nulliparous (16.32% vs. 11.29%) and 1.4-fold in multiparous women (9.86% vs. 7.08%). Stepwise logistic regression confirmed that EA is a significant risk factor for labor complications in nulliparous women (OR 1.27, 95% CI 1.03-1.58) and for forceps delivery in multiparous women (5.20, 95% CI 3.31-8.17). Also, EA is an important risk factor for both, low cord arterial pH <7.10 (OR 1.98, 95% CI 1.28-3.09, p=0.0023) and low Apgar score at 1 minute (OR=4.55, 95% CI 2.35-8.80, p<0.0001). Crucially, there was no difference in the incidence of a low Apgar score at 5 minutes. Conclusions: EA constitutes an independent risk factor for operative vaginal delivery in multiparous women, but
has no effect on the incidence of cesarean sections, either in nulliparous or multiparous women. EA also increases the risk of labor complications, low 1-minute Apgar score and low umbilical cord pH, but is not associated with low 5-minute Apgar score.
Abstract
Objectives: to evaluate the impact of epidural analgesia (EA) on labor, delivery and neonatal status. Material and methods: retrospective, observational, cohort study comprising 5593 pregnant women who met the inclusion criteria (singleton pregnancy, cephalic presentation, 37-42 weeks of gestation). Out of them, 2496 had EA and 3097 constituted the control group.
Main outcome measures: incidence of labor complications and operative deliveries in women who received EA, neonatal status assessed by Apgar score in 1- and 5-minute, and cord pH values. Results: Labor complications were more frequently observed in the epidural group, with an almost 1.5-fold higher incidence in nulliparous (16.32% vs. 11.29%) and 1.4-fold in multiparous women (9.86% vs. 7.08%). Stepwise logistic regression confirmed that EA is a significant risk factor for labor complications in nulliparous women (OR 1.27, 95% CI 1.03-1.58) and for forceps delivery in multiparous women (5.20, 95% CI 3.31-8.17). Also, EA is an important risk factor for both, low cord arterial pH <7.10 (OR 1.98, 95% CI 1.28-3.09, p=0.0023) and low Apgar score at 1 minute (OR=4.55, 95% CI 2.35-8.80, p<0.0001). Crucially, there was no difference in the incidence of a low Apgar score at 5 minutes. Conclusions: EA constitutes an independent risk factor for operative vaginal delivery in multiparous women, but
has no effect on the incidence of cesarean sections, either in nulliparous or multiparous women. EA also increases the risk of labor complications, low 1-minute Apgar score and low umbilical cord pH, but is not associated with low 5-minute Apgar score.
Keywords
epidural analgesia / labor / delivery / cesarean section // instrumental delivery
Title
Epidural analgesia during labour: a retrospective cohort study on its effects on labour, delivery and neonatal outcome
Journal
Ginekologia Polska
Issue
Vol 85, No 12 (2014)
Page views
1185
Article views/downloads
1699
DOI
10.17772/gp/1883
Bibliographic record
Ginekol Pol 2014;85(12).
Keywords
epidural analgesia / labor / delivery / cesarean section // instrumental delivery
Authors
Piotr Hincz
Lech Podciechowski
Mariusz Grzesiak
Wojciech Horzelski
Jan Wilczyński