Effects Of Different Timing Of Labor Analgesia On The Course Of Labor,Hemodynamics,Maternal And Fetal Outcomes In Primiparas With Pregnancy-Induced Hypertension

Objective:To analyse the effects of different timing of delivery analgesia on the course of labor,Hemodynamics and outcomes of mothers and infants in primipara with pregnancy-induced hypertension,the aim of this study is to find out a more optimized program of labor analgesia in order to alleviate the pain of primipara with pregnancy-induced hypertension during labor,and to obtain better maternal and infant outcomes,so as to provide reference for clinical practice.Methods:Sixty primiparas with pregnancy-induced hypertension were selected from from December 2021 to December 2022.According to the inclusion and exclusion criteria,60primiparas with pregnancy-induced hypertension were selected.The parturients were divided into two groups:Group A and Group B,with 30 cases in each group.In Group A,labor analgesia was performed when the dilatation of the uterus was≥4 cm.After the successful epidural puncture,the epidural tube was implanted and connected to the labor analgesia pump,in Group B,the patients had regular and continuously enhanced contractions,lasting more than 30 seconds,visible progressive disappearance of cervical canal,dilatation of uterus less than 4 cm and fetal presentation before and after the onset of analgesia.The analgesia method was the same as that in Group A.The time of the first stage,the second stage and the third stage of labor were recorded at 5 min before analgesia（T₀）,5 min after analgesia（T₁）,15min after analgesia（T₂）,30 min after analgesia（T₃）,and when the ostium of uterus was fully opened（T₄）,the pain was assessed with visual analogue scale（VAS）,the blood pressure and heart rate at T₀,T₁and T₄were collected,and the general information,obstetrical data and neonatal data were collected Two hours after delivery,the bleeding volume and the rate of cesarean section were recorded,and the umbilical artery blood was collected for arterial blood gas analysis.Results:（1）There were no significant differences in age,height,weight and BMI（kg/m²）between the two groups（P>0.05）.（2）There was no significant difference in the first,second and third stages of labor between the two groups（P>0.05）.（3）Comparison of the VAS scores of maternal analgesia effect between the two groups and the comparison between the two groups showed that the VAS scores of group A at T₀,T₁,T₃and T₄were significantly higher than those of group B,and the difference was significant（P<0.05）;There was no significant difference in VAS score at T₂（P>0.05）;VSA scores of the two groups before and after analgesia showed a decreasing trend over time compared with T₁,T₂,T₃and T₄,respectively,and the difference was statistically significant（P<0.05）and the VAS score of group A at different time points was higher than that of group B at different time points,which was statistically significant（P<0.05）.（4）The rate of transferring to cesarean section was higher in group a than that in Group B（P<0.05）.（5）There was no significant difference in 2 hour postpartum hemorrhage between the two groups（P>0.05）.（6）At T₀,T₁and T₄,the MAP values of the two groups were statistically significant（P<0.05）,and the mean MAP values of group A were higher than that of Group B.The MAP of T₁and T₄in Group A was significantly higher than that of T₀in Group A（P<0.05）,the MAP of T₁and T₄in Group B was significantly different from that of T₀in Group B（P<0.05）.（7）There was no significant difference in heart rate at T₀,T₁and T₄between the two groups（P>0.05）.There was no significant difference in HR between Group A and group a（P>0.05）,but there was significant difference between Group A and group A（P<0.05）.The HR of T₁and T₄in Group B was significantly higher than that of T₀（P<0.05）.（8）There was no significant difference in Apgar score between the two groups at 1 min and 5 min（P>0.05）,but there was no significant difference in p H,HCO₃and PCO₂in umbilical arterial blood gas analysis between the two groups（P>0.05）.Conclusions:Compared with labor analgesia for primiparas with hypertension during the incubation period,there was no difference in the duration of labor between the two groups,but the latent period analgesia could make the parturients get better labor experience,and the rate of transferring cesarean section was obviously lower than that in the active period,in the short term,there is no adverse effect on the puerpera and newborn,so it is a suitable time for analgesia intervention.