| Objective:In the process of childbirth,the stress response caused by childbirth pain will prolong the maternal labor process,increase the maternal physical consumption,increase the maternal oxygen consumption,and may cause the newborn hypoxia or even asphyxia,seriously affecting the safety of mother and baby [1].Compared with conventional labor without analgesia,epidural labor analgesia can reduce the pain during labor to a tolerable level [2],effectively reduce the harm caused by pain,reduce the fear of pregnant women,and enable them to complete labor in a more efficient labor process.In recent years,China has been vigorously promoting epidural labor analgesia,but its usage rate is relatively low [3].The preliminary investigation shows that most pregnant women still have doubts about epidural labor analgesia and worry about its adverse effects on themselves and the fetus.The researchers reviewed a large number of literatures and found that the effects of epidural labor analgesia on maternal and infant are still controversial.In addition,there are few meta-integrations of the literatures for this type of research,so it is necessary to integrate the new literature reports and conduct quantitative analysis in a timely manner.In order to integrate recent research results with the latest information more effectively,promote the clinical application of epidural labor analgesia,and improve the success rate of natural labor,this study intends to obtain more scientific and reasonable evidence through meta-analysis,and promote labor analgesia more scientifically in the clinical process.Methods:1.253 cases of subjects were investigated by using the questionnaire on general condition of pregnant women and the questionnaire on knowledge intention of labor analgesia,to explore the status quo,intention and reasons of pregnant women's understanding of labor analgesia.2.The knowledge network in China(CNKI)databases,ten thousand medical database,weipu journal database(VIP)and Chinese biomedical journal database(CBM),Pubmed,Medline,Embase and Cochrane library such as the relevant literatures from the domestic and foreign well-known database retrieval labor analgesia,collected at home and abroad since the self-built database published reports of epidural labor analgesia research in both Chinese and English,as far as possible fully to collect information on epidural labor analgesia,with revman5.3 software for meta analysis.Results:1.Investigation and analysis of the reasons for the low application rate of labor analgesia in pregnant women(1)comparison of the general conditions of the survey subjects and knowledge of labor analgesia in different characteristics of pregnant women with epidural anesthesia The age of pregnant women ranged from 20 to 46(28.65±3.37)years old,and the gestational age ranged from 14 to 40(26.23±5.65)weeks.The results of nonparametric test showed that age,educational level,average monthly income,gestational weeks,number of deliveries,and whether the labor test all affected the understanding of labor analgesia of pregnant women under epidural anesthesia.(2)pregnant women's knowledge of epidural analgesia during childbirth:Results show that 53.63% of pregnant women do not know whether epidural analgesia used in natural birth,62.50% are not sure whether it can relieve labor pain,don't know that epidural anesthesia is 68.95% of doctors,midwives,the anesthesiologist or nurse to operate,86.29% do not know whether the implementation of epidural labor analgesia affect normal eating and activity,lower overall understanding.(3)multiple linear regression analysis of pregnant women's score of labor analgesia awareness of epidural anesthesiaEducation level,gestational week,monthly income and number of births were related to the knowledge score of pregnant women,and the effects ranged from large to small.The higher the educational level,the larger the gestational weeks,the greater the monthly average income,the more times of childbirth,and the higher the score of pregnant women for epidural labor analgesia knowledge.(4)willingness of pregnant women to use epidural anesthesia for labor analgesia:Only 21.37% of pregnant women were willing to perform labor analgesia during childbirth.Among the 78.63% of pregnant women who are not willing to use labor analgesia,57.95% of pregnant women refuse to use it because they are worried that it will have a bad effect on mother and child,and 31.28% are not satisfied with its effect because they don't know much about labor analgesia.(5)pregnant women's understanding of the analgesic effects of epidural anesthesia during childbirth:The results showed that 28.22% of pregnant women did not know whether epidural analgesia had an effect on labor time,29.44% thought it would prolong labor,and 27.02%thought it would shorten labor.In terms of the influence on postpartum pregnant women,only 17.74% thought there was no adverse effect,33.87% thought it would cause back pain,13.31% thought it would cause headache,18.95% thought it would cause other adverse effects,and 16.13% said they did not know whether there were adverse effects.In terms of the impact on newborn health,46.77% of pregnant women said that they did not know whether epidural analgesia had any impact on newborn health,and 27.42% believed that it would have some adverse impact on newborn health.(6)qualitative research results:(1)for labor analgesia to maternal and neonatal effects of error is the main reason for its refusal to use labor analgesia(2)the fear of pain is it choose cesarean delivery and don't want to use one of the reasons for labor analgesia(3)most of the pregnant women in labor analgesia or expectation,hope hospital and social channels to provide more and more rich content for understanding and choice.2.Results of Meta analysis(1)the first stage of laborThe first stage of labor time of epidural labor analgesia group was significantly shorter than that of the non-analgesia group,and the difference was statistically significant(MD=-43.96,95%CI(-76.19,-11.73),P<0.05)(2)second stage of laborThe second stage of labor time of epidural labor analgesia group was significantly prolonged compared with that of the non-analgesia group,and the difference was statistically significant(MD=11.40,95%CI(5.59,17.22),P<0.05).(3)postpartum blood lossThere was no statistically significant difference in postpartum blood loss between the epidural analgesia group and the non-analgesia group(MD=-2.28,95%ci(-8.83,3.19),P >0.05).(4)Apgar score of neonatesThere was no significant difference in Apgar score between the epidural labor analgesia group and the non-analgesia group(MD=0.02,95%ci(-0.03,0.08),P > 0.05).(5)cesarean section rateCompared with the non-analgesic group,the cesarean section rate of epidural labor analgesia group was significantly reduced,and the difference was statistically significant(OR=0.67,95%ci(0.54,0.85),P < 0.05).(6)instrument midwifery rateThere was no significant difference in the rate of instrumental midwifery between the two groups(OR=1.12,95%ci(0.84,1.49),P > 0.05).(7)oxytocin usageThe use rate of oxytocin in epidural labor analgesia group was significantly higher than that in the non-analgesia group,and the difference was statistically significant(OR=1.65,95%ci(1.25,2.18),P < 0.05).(8)incidence of fetal distressThe incidence of fetal distress in epidural labor analgesia group was significantly lower than that in the non-analgesia group(OR=0.57,95%ci(0.36,0.92),P < 0.05).(9)incidence of neonatal asphyxiaThere was no significant difference in the incidence of neonatal asphyxia between the two groups(OR=0.83,95%ci(0.39,1.77),P > 0.05).(10)incidence of adverse reactions in pregnant women The incidence of adverse reactions in the epidural labor analgesia group was significantly higher than that in the non-analgesia group,with statistically significant differences(OR=9.11,95%ci(2.72,30.58),P < 0.05).Conclusion:1.Pregnant women have insufficient understanding of the safety of epidural labor analgesia and little overall understanding of it.The fear of its adverse effects may be an important reason for the low use rate of epidural labor analgesia among pregnant women.2.In terms of labor time,epidural analgesic labor may shorten the first labor time and prolong the second labor time to some extent compared with traditional labor without analgesia.However,due to the moderate heterogeneity of data,the conclusion still needs to be further verified.3.In terms of the influence on neonates,epidural analgesia in childbirth can significantly reduce the fetal distress rate,but there is no adverse effect in terms of neonatal Apgar score and neonatal asphyxia rate.4.In terms of the influence on puerpera,the results showed that epidural analgesia had no adverse effect on postpartum blood loss,but it may cause certain side effects;5.The results showed that epidural analgesia significantly reduced cesarean section rate,but had no significant effect on instrument midwifery rate,which resulted in increased use of oxytocin to some extent. |
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