Correlation Study Of The Effects Of Combined Spinal Epidural Labor Analgesia On Labor Outcome And Intrapartum Fever

BACKGROUND:Delivery pain is in the second place after burning pain in the medical pain index.Excessive pain can cause adverse effects on mother and child,and it is also a major reason for the high rate of cesarean section in China.Labor analgesia is a good thing for the maj ority of women,and its using history in China has been more than sixty years.Unfortunately,the study shows that even in the first-tier cities,the rate of labor analgesia is still less than 10%.The reason,apart from the limitations of traditional concepts,the imperfect medical system and the shortage of medical personnel,is that people are more concerned about their impact on mother and infant.Combined spinal epidural block is the main way of labor analgesia in clinical situation,for its advantages of quick onset and good analgesic effect.Whereas the disadvantage is that it is easy to cause fever at birth.When pregnant women have intrapartum fever,especially high fever,it may lead to fetal distress,intrauterine fetal death,fetal intrauterine infection,neonatal septicemia and other adverse pregnancy outcomes.Therefore,it is urgent to study the effect of the combined spinal epidural block on the maternal and infant outcome and the related factors causing fever during labor,so as to realize the real painless and safe delivery.OBJECTIVES:To explore the effect of combined lumbar epidural analgesia on the delivery process and maternal and infant pregnancy outcome,and to explore the effect of intrapartum fever on maternal and baby's pregnancy outcome after labor analgesia,and to explore the related risk factors of fever during labor.METHODS:A total of 242 parturients in Zhujiang Hospital of Southern Medical University from January 1,2016 to July 31,2017 were selected as the analgesic group,and 242 cases of non labor analgesia in the same period were established as non analgesic groups.The analgesic group was divided into fever group(82 cases)and non fever group(160 cases)according to whether there was intrapartum fever.To compare the effects of different groups on the labor and delivery mode,and the outcome of maternal and child delivery,and to explore the causes of fever through logistic regression analysis.RESULTS:Compared with the non analgesic group,the first stage,the second stage of labor and the total labor time of the analgesic group were prolonged(P<0.05);the application rate of oxytocin,the episiotomy rate and the intrapartum fever rate of the analgesic group were all increased(P<0.05),and there was no statistical difference between the two groups in apparatus delivery rate,cesarean section rate,the mean postpartum blood loss,and rate of neonatal asphyxia.However,the conversion rate of infant of analgesic group was significantly higher than that of the non analgesic group.Compared with the non fever group,the first stage of labor and total labor times were prolonged(P<0.05).The episiotomy rate,the cesarean section rate and the mean postpartum blood loss and the rate of newborns was also increased(P<0.05).Logistic regression analysis showed that the basal temperature before analgesia and the duration of labor after labor analgesia were the high risk factors of fever at birth(OR>1.0,P<0.05).CONCLUSION1.The implementation of labor analgesia may increase the labor time,increase the risk of intrapartum fever and the episiotomy rate,but it has no obvious adverse effects on the delivery mode and the security of the parturient,which is worthy of generalizing.Labor analgesia can increase the conversion rate of neonates,which may be related to the increasing intrapartum fever in the analgesia group.2.The parturient with intrapartum fever after labor analgesia may have a prolonged delivery time,an increasing cesarean section rate,an increasing postpartum blood loss,and an increasing neonate-conversion rate.We should actively treat the fever during labor to avoid the occurrence of adverse maternal and infant outcomes.3.The related risk factors of intrapartum fever during labor analgesia include the basal temperature before analgesia and the duration of labor after labor analgesia.To avoid prolonged labor after labor analgesia,strict monitoring and active treatment for patients with higher initial temperature of labor analgesia are effective measures to avoid intrapartum fever.