| Objective:To analyze the safety of Combined Spinal Epidural Analgesia in labor analgesia on progress of labor,maternal,especially primipara,and neonatal outcomes.To provide reference for clinical promotion of labor analgesia especially Combined Spinal Epidural Analgesia.Methods:We collected 957 data about pregnant women who were hospitalized and delivered in the Affiliated Hospital of Yan’an University from January 1,2021 to September 30,2021.By the standard of inclusion and exclusion,one case of accidental detachment of epidural catheter and one case of analgesia failure in the process of delivery were excluded,and the number of 506 pregnant women conform to standard were finally included.The maternal were divided into a combined spinal-epidural analgesia group(CSEA group)and a non-combined spinal-epidural analgesia group(NCSEA group)on the basis of the concrete analgesic way.There were 262 cases in CSEA group and 244 cases in NCSEA group.The CSEA group used ombined spinal epidural analgesia and the NCSEA group with the whole-course doula accompaniment,while the NCSEA group used the analgesia with the whole-course doula accompany.Collect general information of puerperae: gestational age(day),height,weight,body mass index(BMI);intrapartum data: mode of labor initiation,the uterine orifice 4 ～ 10 cm of the first stage of labor,length of the second and third stages of labor,use of oxytocin during labor,complications during labor,etc;postpartum data:postpartum complications,postpartum hospital stays;neonatal conditions: Apgar score,amniotic fluid properties,birth weight,data were sorted and statistically analyzed.results:1.Comparison the stages of labor between two groups: the duration of uterine opening 4 ～ 10 cm in CSEA group was shorter than that in NCSEA group,and have significant differences(P<0.05);The second stage of labor in CSEA group was longer than that in NCSEA group(P<0.05);There was no significant difference in the third stage of labor between two groups(P>0.05).2.Comparison of abnormal conditions during labor between two groups:There was significant difference in abnormal fetal heart monitoring between CSEA group(42 cases,19.3%)and NCSEA group(57 cases,33.1%)(P<0.05);There was no significant difference in slow progress of labor,abnormal fetal posture and amniotic fluid fecal staining between the two groups(P>0.05).3.Contrast of oxytocin usage between two groups: There was no significant difference in oxytocin usage between two groups(P>0.05).4.Comparison of delivery way between two groups: The rate of cesarean section in CSEA group was lower than that in NCSEA group(P<0.05);There was no significant difference in the rates of episiotomy,forceps delivery and non intervention vaginal delivery between two groups(P>0.05).5.Comparison of postpartum conditions between the two groups: The postpartum fever rate in CSEA group(4 cases,11.8%)was significantly different from that in NCSEA group(12 cases,36.4%)P>0.05);There was no significant difference in postpartum hemorrhage rate between the two groups(P>0.05).6.Comparison of neonate outcomes between two groups: There was no significant difference in Apgar score of 1 minute ≤ 7 and 5 minutes ≤ 7 between the two groups(P>0.05).Conclusions:1.The time of the first stage of labor especially in the uterine orifice 4 ～ 10 cm could be reduce by combined spinal epidural analgesia.And it also can prolong the duration of the second stage of labor,but it is still within the normal range on the whole;Combined spinal epidural analgesia did not affect the use rate of oxytocin during labor;Abnormal fetal monitoring,slow progress of labor,abnormal fetal posture and intrapartum fever may occur during labor,but they have no serious impact;It can reduce the probability of conversion to cesarean section in the process of primipara;Postpartum hospital stay was not extended.2.Combined spinal epidural analgesia has no significant effect on neonatal Apgar score;There was no significant effect on the characteristics of amniotic fluid;It will not lead to adverse neonatal outcomes.3.Combined spinal epidural analgesia is safe for labor and recommended for widespread at clinical use. |
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