Clinical Study Of Epidural Analgesia In Labor On Maternal And Neonatal Perinatal Outcomes

Objective To determine the effectiveness and safety of epidural analgesia during labor based on the effects on maternal and neonatal outcomes,in order to provide a clinical practice evidence for widely and successfully carrying out labor analgesia.Methods1 In a retrospective study,the medical records of 1578 nulliparous women with a singleton fetus in cephalic presentation who delivered at term of the Obstetric ward of Zhongda Hospital,China,between January 2016 and June 2017 were reviewed.According to the personal choice,988 women received epidural analgesia(analgesic group)and 590 received no labor analgesia(control group).Information about basic characteristics,labor duration,oxytocin augmentation,mode of delivery,postpartum hemorrhage,and neonatal outcome was obtained.2 SPSS 20.0 software is used to statistical analysis.The chi-square test,t test,Z test Kaplan-Meier curve and Logistic regression were performed for statistics.Results1 Basic data: The rate of labor analgesia was about 62.61%(988/1578)during the stage;There were no difference in maternal age,gestational week,pregnant frequency,education level,height,pre-pregnancy weight,history of abdominal or pelvic surgery,and complications of pregnancy in the two groups(P>0.05).Prepartum weight,weight gain and prepartum BMI were significantly higher among women who received analgesia(P<0.05).2 Analgesic effect: Comparison of VAS before and after analgesia in pregnant women was statistically significant(P<0.05).There was no significant difference in VAS between analgesic women before analgesia and no-analgesia(P>0.05).3 Maternal outcomes:(1)On the basis of Kaplan-Meier curve analysis,the median lengths ofthe first stage and second stage of labor in vaginal delivery were significantly higher among women who received analgesia than among those who received no analgesia(P<0.001 for both),there was a significant slowing of labor among participants given analgesia(log-rank:P<0.001);During labor,women using neuraxial analgesia were more than often underwent oxytocin augmentation,episiotomy,hand-turned fetal position;(2)152(9.6%)women underwent cesarean delivery,emergency cesarean was more frequent in the analgesia group than in the no-analgesia group(13% vs 4.1%,P<0.001);Maternal age,gestational week,height,pre-pregnant weight,weight gain,labor analgesia and neonatal birth weight were associated with the incidence of emergency cesarean(P<0.05);There was no significant difference in instrumental vaginal delivery(P>0.05).(3)The incidence of postpartum hemorrhage(PPH)was respectively 11.8%(117/988)in the analgesia and 7.3%(43/590)in no-analgesia group.The difference was statistically significant(P=0.001).Multivariate analysis showed that pre-pregnant weight,third stage of labor,assisted delivery,birth weight were associated with PPH(OR values:1.028,7.093,1.001,1.059;98%CI were1.002?1.055,2.330?21.589,1.001?1.002,1.001?1.119,respectively),not neuraxial analgesia(OR=1.391,95%CI:0.939?2.062,P>0.05).4 Analgesic adverse reactions: Maternal fever was more frequent in the neuraxial labor analgesia group than in the no-analgesia group(P=0.01).5 Fetal and neonatal outcomes: There was a significantly higher incidence of meconium-stained amniotic fluid(MSAF)with analgesia(P=0.009);Logistic regression analysis showed that the risk factors of MSAF included gestational age and first stage of labor,not epidural analgesia(P=0.099);There was no significant difference in 1min/5min Apgar scores and umbilical arterial blood gas scores between groups(P>0.05).Women with epidural labor analgesia gave birth to heavier neonates as compared with those without analgesia(P<0.001 for all).Conclusions1 Epidural labor analgesia for pain relief is strongly effective and causes slight side effects and has no adverse outcomes on fetal and neonates.2 The first stage and second stage of labor were prolonged,and emergency cesarean delivery was more frequent with analgesia,which is possibly correlated with maternal age,gestationalweek,weight,labor analgesia and neonatal birth weight,but height was a protective factor;Controlling weight properly during pregnancy to increase viginal delivery.3 Third stage of labor,assisted delivery,birth weight and pre-pregnant weight were risk factors on the incidence of PPH.4 the risk factors of MSAF included gestational age and first stage of labor;There is no correlation between neonatal umbilical artery blood gas and epidural analgesia.