| BACKGROUND:With the development of the new management standard of labor,the number of women with>24 hours of total labor increased gradually,making women need to tolerate longer time of labor pain while getting more trial labor opportunities.Epidural analgesia is considered as the gold standard of labor analgesia and has better analgesic effects than other forms of analgesia techniques.However,does epidural labor analgesia improve labor outcomes by alleviating maternal pain in women with total labor>24 hours?So far,there is no research report on this aspect at home and abroad.Therefore,the purpose of this study was to investigate the effect of epidural labor analgesia under the new labor management mode on the delivery outcome of women with total labor>24 hours.OBJECTIVES:To investigate the effects of epidural labor analgesia on the delivery mode and maternal and infant prognosis of women with>24 hours total labor under the new labor management mode,and to analyze the related factors affecting the time of labor.METHODS:This study retroactively included parturiens who were subjected to vaginal trialdelivery in Shenzhen Maternal and Child Health Hospital from September 1,2018 to May 1,2020 and who had a total labor duration>24 hours.According to whether or not epidural labor analgesia was performed,the parturiens were divided into analgesic group(group E,n=296)and non-analgesic group(group N,n=14).The differences in delivery mode,maternal and infant prognosis and labor process between the two groups were compared,and the relevant factors affecting the time of labor process were discussed by regression analysis.RESULTS:(1)Mode of delivery:only one parturient in Group E(0.3%)converted to cesarean section after 24 hours of total labor;there was no significant difference in forceps rate(9.5%in Group E;7.1%in group n)and suction rate(4.7%in Group E;0%in group n)(P>0.05);episiotomy(OR=4.144,P=0.003)and time of second labor(OR=1.012,P<0.001)were associated with the increase of total labor There was a significant correlation between the instrument delivery rate of 24 hour parturients.(2)Maternal and infant outcomes:there were no significant differences in perineal lateral incision,cervical laceration,postpartum hemorrhage,amniotic fluid pollution between the two groups(P>0.05);there were no significant differences in gender,head circumference,weight,fetal distress rate,neonatal asphyxia rate,umbilical cord around neck rate,NICU conversion rate between the two groups(P>0.05);the amniotic fluid(OR=3.609,P=0.007)and instrument delivery(OR=3.346,P=0.012)were independent risk factors for neonatal conversion to NICU.(3)Time of labor:the time of the second stage of labor(102.2±69.2 min in Group E;57.0±41.9 min in group N,t=3.789,P=0.020)was significantly different between the two groups(P<0.05);the time of the first stage of labor,the time of the third stage of labor and the total time of labor was no significant difference between the two groups(P>0.05).CONCLUSION:1.BMI and parity may affect the choice of epidural labor analgesia,but the analgesia of epidural labor will not increase the rate of delivery of instruments.2.Epidural analgesia does not affect the prognosis of mothers and infants with total labor process>24 hours.Perineum lateral incision and second labor process are independent factors influencing the delivery of instruments,while amniotic fluid condition and instrument delivery will increase the NICU rate of newborn.3.Epidural analgesia can prolong the second labor course of the parturient who has a total labor course of more than 24 hours,but it has no effect on the first,third and total labor process,and does not affect the prognosis of mother and newborn. |
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