Vol 92, No 9 (2021)
Research paper
Published online: 2021-04-13

open access

Page views 1555
Article views/downloads 1017
Get Citation

Connect on Social Media

Connect on Social Media

The effect of epidural analgesia on maternal-neonatal outcomes: a retrospective study

Xingxing Liu1, Rong Zeng2, Qifeng Chen3, Di Ke4, Zhaoqiong Zhu1
Pubmed: 33914328
Ginekol Pol 2021;92(9):637-641.


Objectives: Epidural analgesia is commonly used for relieving labor pain in contemporary clinical practice. The rate of pregnant women who request epidural analgesia during labor has been increasing annually, leading to a debate on the effect of epidural analgesia on maternal or neonatal outcomes.
Material and methods: The medical records of nulliparous women with a term singleton pregnancy from January to December 2019 at the Affiliated Hospital of Zunyi Medical University were retrospectively reviewed. The women were divided into those who received epidural analgesia during delivery and those who did not receive it. Maternal and neonatal outcomes were assessed.
Results: A total of 528 women met the inclusion criteria. The overall labor analgesia rate was 43.0% (227). Women with epidural analgesia had a significantly longer second stage [34.5 (22.8–65.3) vs 27.0 (18.0–41.3) min, p < 0.001] and total duration of labor [698.5 (493.5–875.0) vs 489.5 (344.0-676.3) min, p < 0.001] compared with those without epidural. There were no significant relationships between epidural analgesia and the normal vaginal delivery rate, the incidence of episiotomy, and other adverse maternal or neonatal outcomes (p > 0.05).
Conclusions: Epidural analgesia can prolong the second stage of labor, but this is no increased risk for both mother and neonate.

Article available in PDF format

View PDF Download PDF file


  1. Hawkins JL. Epidural analgesia for labor and delivery. N Engl J Med. 2010; 362(16): 1503–1510.
  2. Jones L, Othman M, Dowswell T, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012(3): CD009234.
  3. Martínez AH, Almagro JJ, García-Suelto MMC, et al. Epidural Analgesia and Neonatal Morbidity: A Retrospective Cohort Study. Int J Environ Res Public Health. 2018; 15(10).
  4. Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, et al. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery. 2015; 31(6): 613–616.
  5. Cheng YW, Shaffer BL, Nicholson JM, et al. Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol. 2014; 123(3): 527–535.
  6. Törnell S, Ekéus C, Hultin M, et al. Low Apgar score, neonatal encephalopathy and epidural analgesia during labour: a Swedish registry-based study. Acta Anaesthesiol Scand. 2015; 59(4): 486–495.
  7. Hung TH, Hsieh TT, Liu HP. Differential effects of epidural analgesia on modes of delivery and perinatal outcomes between nulliparous and multiparous women: a retrospective cohort study. PLoS One. 2015; 10(3): e0120907.
  8. Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2005(4): CD000331.
  9. Laughon SK, Berghella V, Reddy UM, et al. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol. 2014; 124(1): 57–67.
  10. Herrera-Gómez A, De Luna-Bertos E, Ramos-Torrecillas J, et al. Risk Assessments of Epidural Analgesia During Labor and Delivery. Clin Nurs Res. 2018; 27(7): 841–852.
  11. Hasegawa J, Farina A, Turchi G, et al. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome. J Anesth. 2013; 27(1): 43–47.
  12. Ravelli ACJ, Eskes M, de Groot CJM, et al. Intrapartum epidural analgesia and low Apgar score among singleton infants born at term: A propensity score matched study. Acta Obstet Gynecol Scand. 2020; 99(9): 1155–1162.
  13. Altman M, Sandström A, Petersson G, et al. Prolonged second stage of labor is associated with low Apgar score. Eur J Epidemiol. 2015; 30(11): 1209–1215.
  14. Reynolds F. The effects of maternal labour analgesia on the fetus. Best Pract Res Clin Obstet Gynaecol. 2010; 24(3): 289–302.
  15. Wang K, Cao L, Deng Q, et al. The effects of epidural/spinal opioids in labour analgesia on neonatal outcomes: a meta-analysis of randomized controlled trials. Can J Anaesth. 2014; 61(8): 695–709.
  16. Obstetrics group of anesthesiology society of Chinese medical association. Expert consensus on labor analgesia. J Clin Anesthesiol. 2016; 32: 816–818.
  17. Wang Q, Zheng SX, Ni YF, et al. The effect of labor epidural analgesia on maternal-fetal outcomes: a retrospective cohort study. Arch Gynecol Obstet. 2018; 298(1): 89–96.
  18. Sun J, Yan X, Yuan A, et al. Effect of epidural analgesia in trial of labor after cesarean on maternal and neonatal outcomes in China: a multicenter, prospective cohort study. BMC Pregnancy Childbirth. 2019; 19(1): 498.
  19. Anim-Somuah M, Smyth RMd, Cyna AM, et al. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011; 5(12): CD000331.
  20. Spong CY, Berghella V, Wenstrom KD, et al. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012; 120(5): 1181–1193.
  21. Rouse D, Weiner S, Bloom S, et al. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. American Journal of Obstetrics and Gynecology. 2009; 201(4): 357.e1–357.e7.
  22. Roberts CL, Raynes-Greenow CH, Upton A, et al. Management of labour among women with epidural analgesia. Aust N Z J Obstet Gynaecol. 2003; 43(1): 78–81.
  23. Shen X, Li Y, Xu S, et al. Epidural Analgesia During the Second Stage of Labor: A Randomized Controlled Trial. Obstet Gynecol. 2017; 130(5): 1097–1103.
  24. Chestnut DH, Laszewski LJ, Pollack KL, et al. Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor. Anesthesiology. 1990; 72(4): 613–618.
  25. Zeng H, Guo F, Lin B, et al. The effects of epidural analgesia using low-concentration local anesthetic during the entire labor on maternal and neonatal outcomes: a prospective group study. Arch Gynecol Obstet. 2020; 301(5): 1153–1158.
  26. Capogna G, Celleno D, Fusco P, et al. Relative potencies of bupivacaine and ropivacaine for analgesia in labour. Br J Anaesth. 1999; 82(3): 371–373.