Abstract
BackgroundThe trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture. This study aimed to evaluate the effect of epidural analgesia on primary labor outcome [success rate of vaginal birth after cesarean (VBAC)], parturient complications and neonatal outcomes after TOLAC in Chinese multiparas based on a strictly uniform TOLAC indication, management and epidural protocol.MethodsA total of 423 multiparas undergoing TOLAC were enrolled in this study from January 2017 to February 2018. Multiparas were divided into two groups according to whether they received epidural analgesia (study group, N = 263) or not (control group, N = 160) during labor. Maternal delivery outcomes and neonatal characteristics were recorded and evaluated using univariate analysis, multivariable logistic regression and propensity score matching (PSM).ResultsThe success rate of VBAC was remarkably higher (85.55% vs. 69.38%, p < 0.01) in study group. Epidural analgesia significantly shortened initiating lactation period and declined Visual Analogue Score (VAS). It also showed more superiority in neonatal umbilical arterial blood pH value. After matching by PSM, multivariable logistic regression revealed that the correction of confounding factors including epidural analgesia, cervical Bishop score at admission and spontaneous onset of labor were still shown as promotion probability in study group (OR = 4.480, 1.360, and 10.188, respectively; 95%CI = 2.025–10.660, 1.113–1.673, and 2.875–48.418, respectively; p < 0.001, p = 0.003, and p < 0.001, respectively).ConclusionsEpidural analgesia could reduce labor pain, and no increased risk of postpartum bleeding or uterine rupture, as well as adverse effects in newborns were observed. The labor duration of multiparas was increased, but within acceptable range. In summary, epidural analgesia may be safe for both mother and neonate in the three studied hospitals.Trial registrationChineses Clinical Trial Register, ChiCTR-ONC-17010654. Registered February 16th, 2017.
Highlights
The trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture
423 multiparas enrolled into the final analysis were divided into two groups according to whether they received epidural analgesia or not during labor
The factors including hospitals, time from last cesarean section, cervical dilation at admission < 3 cm, and spontaneous onset of labor in study group were notably different from those in control group (p < 0.05). These baseline factors were statistically different, subsequent univariate analysis, multivariate logistic regression and propensity score matching (PSM) may eliminate the effect of these confounding factors
Summary
The trial of labor after cesarean section (TOLAC) is a relatively new technique in mainland of China, and epidural analgesia is one of the risk factors for uterine rupture. Grobman WA et al [6] created a nomogram using factors available at the first prenatal visit and developed a useful tool to measure patient-specific VBAC success rate. These studies indicate that multiparas with an expected success rate of > 50% are appropriate candidates for TOLAC, which needs to be clinically validated
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