Abstract
BackgroundAccording to some published studies, neuraxial analgesia may be associated with prolonged labor and an increased risk for instrumental vaginal delivery. However, its effects on episiotomy are unknown. This study aimed to examine the incidence of episiotomy with and without combined spinal–epidural analgesia (CSEA) during labor.MethodsThis was a retrospective cohort study, in which the computerized medical records of nulliparous women with singleton, cephalic and live births were reviewed and women with and without CSEA were matched based on their propensity scores. Univariate and multivariate analyses were used to examine the association between CSEA and the incidence of episiotomy during vaginal delivery.ResultsIn the cohort study with 11,994 vaginal deliveries, 5748 received CSEA and 6246 did not receive CSEA. 4116 CSEA women were successfully matched with 4116 Non-CSEA women. In the univariate analysis, the incidence of episiotomy was 47.4% in the CSEA group and 44.7% in the Non-CSEA group. However, after a multivariable logistic regression analysis, CSEA did not increase the risk of episiotomy (adjusted OR, 1.080; 95% confidence interval [CI], 0.988–1.180).ConclusionsThe use of CSEA during labor and vaginal delivery did not increase the risk of episiotomy.
Highlights
According to some published studies, neuraxial analgesia may be associated with prolonged labor and an increased risk for instrumental vaginal delivery
The final cohort consisted of 5748 women in the combined spinal–epidural analgesia (CSEA) group and 6246 women in the Non-CSEA group
The univariate analyses showed an increased risk of episiotomy in the CSEA group
Summary
According to some published studies, neuraxial analgesia may be associated with prolonged labor and an increased risk for instrumental vaginal delivery. This study aimed to examine the incidence of episiotomy with and without combined spinal–epidural analgesia (CSEA) during labor. Painful labor may cause adverse effects for the mother and the fetus. Neuraxial analgesia is the most effective technique for pain relief during labor. In the United States, its use has almost tripled from 22% in 2003 to 61% in 2008 [1], while in France more than 75% women received neuraxial analgesia during labor [2]. As an important measure of the quality, National Quality Forum recommended limiting episiotomy because it increased risks of pain, laceration, Zhou et al BMC Anesthesiology (2017) 17:88 between CSEA and the incidence of episiotomy during vaginal delivery
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