The Rate of Epidural Analgesia in Labor with Maternal And Neonatal Outcome at Tertiary Hospital in Oman

Abstract

Objectives: The primary objective is to determine the epidural analgesia rate and its effect on the mode of delivery. The secondary objectives are to assess patient satisfaction, duration of second stage of labour and incidence of maternal, fetal and neonatal outcomes. Methods: A retrospective cohort design utilized in this study, involving all pregnant women received epidural analgesia in labour at Sultan Qaboos University Hospital over 3 years period (March 2020 to March 2023). All data is collected from the delivery register at Delivery ward, SQUH track care system, and epidural record chart. Women’s information remained confidential. All entered data in the SPSS program is stored in a passwordprotected computer. Results: There was a total of 7076 deliveries, out of which 389 received epidural analgesia, with a rate of 5.0% (95% CI: 5.0 – 6.0). Out of 389 deliveries, around half were nulliparous and the other half were multiparous. The rate of spontaneous vaginal delivery constituted 60.7%. On the other hand, instrumental deliveries and LSCS constituted 14.9% and 24.4% respectively. The median and mean (±SD) period of 2nd stage were 24.0 and 38.3±40.1. Only 1% of all included patients had prolonged second stage of labor. The rate of oxytocin use was 54.5%, and around 52.4% of it was among nulliparous. 148 patients (52.5% ) reported full benefit from epidural analgesia use, compared to 6% who reported no benefit. In addition, 12.7% of CTG showed fetal distress and postpartum hemorrhage constituted 6.7% among delivered ladies. The study showed that 10.0% of included ladies suffered one or more of post-partum complications, including fever (n 13, 3.3%), headache (n 10, 2.6%), backache (n 3, 0.8%), hypotension (n 9, 2.3%), urine retention (n 3, 0.8%), pruritus (n 1, 0.3%), and nausea and vomiting (n 1, 0.3%). 6.2% was the rate of NICU admissions among the newborns. Conclusions: The study revealed that 5% was the rate of epidural analgesia usage and spontaneous vaginal delivery was the main mode of delivery. However, the indications for delivery by cesarean section or instruments were not related to epidural analgesia in labour. In addition, there was no significant adverse effect on maternal, fetal and neonatal outcome. Based on that, we need to elaborate more on epidural analgesia awareness and usage in order to be offered. Although some previous reviewed studies reported adverse effects of epidural analgesia on labour outcome. Future researches are recommended including prospective design study, bigger sample size, wider variation and multicenter studies.