Comparative effects of epidural analgesia and intramuscular morphine on maternal and neonatal outcomes: a retrospective cohort study

Abstract

BackgroundThe global practice of pain management during labor involves the use of Epidural Analgesia (EA) or intramuscular (IM) morphine. However, the impact of these methods on maternal and neonatal short-term outcomes remains unclear. ObjectiveThe study evaluates labor exposure to EA and IM morphine on NICU admission rates and explores other associated maternal and neonatal factors like sepsis, respiratory distress, instrumental delivery, birth traumas, low APGAR scores, and chorioamnionitis. Study DesignA study at the Women's Wellness and Research Center in Qatar analyzed 7,721 low-risk normal vaginal deliveries from January 2017 to April 2018. Results were analyzed using descriptive and backward stepwise multinomial regression analysis, categorizing outcomes based on pain management during active labor. ResultsOf the sample, 2606 women received EA, 1338 received IM morphine, 286 received both, and 3304 received neither. Multinomial regression analysis revealed no differences in NICU admissions in the EA group as well as the IM morphine group as compared to the nongroup. However, the analysis showed a significant association between the combined use of EA and IM morphine and NICU admission due to respiratory depression (aOR= 8.63, 95% CI 1.07-69.46, p-value = 0.04). Moreover, there was a significant association between prolonged duration of the second stage of labor and receiving EA alone (aOR=1.02, 95% CI 1.01-1.02, p-value < 0.001) or both EA and IM morphine (aOR=1.02, 95% CI 1.01-1.03, p-value < 0.001). In addition, the combined use of EA and IM morphine was associated with gestational age (aOR= 1.86, 95% CI 1.19-2.90, p-value =0.01) and baby gender (aOR= 3.72, 95% CI 1.54-9.01, p-value =0.003). IM morphine alone was only linked to low Apgar scores at 1 minute (aOR=6.29, 95%CI 1.33-29.83, p-value=0.02). ConclusionThe study found no significant association between EA or IM morphine use during labor and NICU admissions. However, other specific outcomes were associated with the use of EA, IM morphine, or both. Further research is warranted to enhance understanding and optimize pain management protocols.