Abstract
BackgroundEpidural analgesia is considered one of the most effective methods for pain relief during labor. However, it is not clear whether similar effects of epidural analgesia on the progression of labor, modes of delivery, and perinatal outcomes exist between nulliparous and multiparous women.Methodology/Principal FindingsA retrospective cohort study was conducted to analyze all deliveries after 37 weeks of gestation, with the exclusion of pregnancies complicated by multiple gestations and fetal anomalies and deliveries without trials of labor; these criteria produced a study population of n=16,852. A multivariable logistic regression model was constructed to control for confounders. In total, 7260 of 10,175 (71.4%) nulliparous and 2987 of 6677 (44.7%) multiparous parturients were administered epidural analgesia. The independent factors for intrapartum epidural analgesia included a low prepregnancy body mass index, genetic amniocentesis, group B streptococcal colonization of the genito-rectal tract, and augmentation and induction of labor. In the nulliparous women, epidural analgesia was a significant risk factor for operative vaginal delivery (adjusted odds ratio [OR] 2.14, 95% confidence interval [CI] 1.80-2.54); however, it was a protective factor against Caesarean delivery (adjusted OR 0.62, 95% CI 0.55-0.69). Epidural analgesia remained a significant risk factor for operative vaginal delivery (adjusted OR 2.17, 95% CI 1.58-2.97) but not for Caesarean delivery (adjusted OR 1.09, 95% CI 0.77-1.55) in the multiparous women. Furthermore, the women who were administered epidural analgesia during the trials of labor had similar rates of adverse perinatal outcomes compared with the women who were not administered epidural analgesia, except that a higher rate of 1-minute Apgar scores less than 7 was noted in the nulliparous women who were administered epidural analgesia.Conclusions/SignificanceIntrapartum epidural analgesia has differential effects on the modes of delivery between nulliparous and multiparous women, and it is not associated with adverse perinatal outcomes.
Highlights
Epidural analgesia is considered one of the most effective methods for pain relief during labor, and the intrapartum use of epidural analgesia has substantially increased over the previous two decades [1]
We examined the associations between epidural analgesia and the following adverse perinatal outcomes: neonatal death, admission to the neonatal intensive care unit (NICU), 1-minute and 5-minute Apgar scores 500 ml for vaginal delivery and >1000 ml for Caesarean delivery)
We demonstrated that intrapartum epidural analgesia has differential effects on the modes of delivery between nulliparous and multiparous women and that it is not associated with adverse perinatal outcomes
Summary
Epidural analgesia is considered one of the most effective methods for pain relief during labor, and the intrapartum use of epidural analgesia has substantially increased over the previous two decades [1]. Some studies have even indicated that epidural analgesia was a protective factor against a Caesarean delivery [2,12,11]. The reasons for these variations have been difficult to interpret and could be related to differences in the methodologies, study populations, and management styles of different hospitals. It is not clear whether similar effects of epidural analgesia on the progression of labor, modes of delivery, and perinatal outcomes exist between nulliparous and multiparous women
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