| Objective To investigate the influence of epidural analgesia on labor duration and delivery outcomes under the new partogram recommendationMethods In this study,we recruited 400 term nulliparous women who were hospitalized in Tongji Hospital from May to October,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural analgesia group(EA group,N=200),and those who were not to the control group(C group,N=200).EA group were further divided into 3 subgroups according to cervical dilation when initiating epidural analgesia(CDE):EA1(CDE<3 cm),EA2(3 cm?CDE<6 cm),and EA3(CDE?6 cm)Labor duration and delivery outcomes between the two groups were analyzed by Student's t test,Mann-Whitney Utest and Chi-square test.Quantile regression models were used to further investigate the effect of epidural analgesia on labor duration.Kaplan-Meier curves were drawn using survival analysis model to compare the effects of different epidural analgesia timings on labor durationResults(1)The first-and second-stage labor duration of women with epidural analgesia were 600(405?855)min and 68(49?97)min respectively,which were significant longer than that of women without epidural analgesia[420(300-630)min and 50(32?85)min,respectively](P<0.001,P<0.001).(2)The results of quantile regression analysis showed that,for the first-stage labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles of the first stage of labor(all P<0.05).The regression coefficients increased(88.00?261.43)corresponding to the increasing percentiles of the labor duration(P10?P90).For the second-stage labor,epidural analgesia showed a significant prolongation only between the 10th and 75th percentiles(coefficients 8.37?17.70;all P<0.05).(3)EA1 group[675(445?900)min and 68(48?95)min](P<0.001,P=0.002)and EA2 group[600(413?840)min and 79(63?121)min](P<0.001,P<0.001)presented longer first-and second-stage labor duration than the control group,while EA3 group[465(289?740)min and 64(39?88)min](P=0.456,P=0,123)did not.The first-and second-stage labor durations between EA1 group and EA 2 group have no statistical difference(all P>0.05).(4)Although women in the epidural group had significant higher episiotomy rate[41.5%(78/188)vs.29.4%(57/191),P=0.013],more times of urine catheterization during labor[1(0?1)vs.0(0?1),P=0.004]and higher oxytocin infusion rate during labor[49.5%(99/200)vs.29.0%(58/200),P<0.001)compared with women in the control group,there was no significant difference in the delivery modes,postpartum hemorrhage rate and neonatal outcomes between the two groups(all P>0.05)Conclusions Epidural analgesia may associate with prolongation of the first and second stages of labor,especially with the first stage of labor.Initiating epidural analgesia before cervical dilation of 6 cm associates with prolonged labor duration,but whether initiating it before cervical dilation of 3 cm or delay until 3 cm to 6 cm had no statistical difference on the labor duration.Furthermore,epidural analgesia has no adverse effect on the delivery modes and neonatal outcomes. |
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