Administration Of Epidural Analgesia Research Articles

Awareness among Pregnant Women about Epidural Analgesia: A Cross-Sectional Study.

Background Epidural analgesia (EPA) is an effective anesthetic technique to overcome pain during labor. This study aimed to evaluate the current awareness of EPA among pregnant women. Methods We carried out a cross-sectional study using a questionnaire to measure awareness about EPA among pregnant women visiting the obstetrics and gynaecology clinic in King Abdulaziz Medical City in Jeddah. Following the results, a group of women was selected and educated by trained medical students. Results This study comprised 105 women. We found that 25 (23.8%) respondents revealed a complete lack of knowledge regarding EPA, 63 (60%) showed minimal awareness, and 17 (16.2%) were aware of EPA from various sources. The gravidity and history of EPA administration were significantly associated with knowledge. Multigravida women and those who had received EPA showed higher level of knowledge (p=0.048 and p < 0.001, respectively). In addition, there was a significant association between the level of education and request for EPA (p=0.027). Forty-one participants were enrolled in an educational program that explained the importance of EPA. Twenty (48.8%) women decided to undergo EPA during delivery; however, 7 (17.7%) refused and 14 (34.1%) were not sure about their decision. Conclusion This study revealed a lack of awareness about EPA among pregnant women. Educational programs were effective as many participants chose EPA following the educational session as a form of pain relief during labor. We recommend the implementation of routine education on EPA in vaginal delivery during antenatal visits for all pregnant women.

Chorioamnionitis and its association with neonatal and maternal adverse outcomes in women with and without epidural analgesia administration

ObjectiveTo evaluate neonatal fever and adverse maternal and neonatal outcomes in febrile laboring women and assess whether the time interval between epidural analgesia (EA) administration and chorioamnionitis is associated with these complications. MethodsA retrospective cohort study at a university affiliated medical center between 2003 and 2015. Included were women who underwent term vaginal delivery attempt and diagnosed with chorioamnionitis. The primary outcomes compared between febrile women with and without EA were neonatal fever and adverse neonatal and maternal outcomes. The association between time from EA to fever (<6, 6–12, >12 h) and maternal and neonatal complications was also assessed. ResultsDuring the study period, 1,933 women with chorioamnionitis were assessed. Of them, 1,810 (93.6%) received EA prior to fever and 123 (6.4%) febrile parturients did not receive EA. Neonatal fever and other neonatal adverse outcomes were similar in the EA vs. non-EA group (2.2% vs. 0.8% and 2.7% vs. 4.9% (NS)), except for transient tachypnea of the newborn rates which were lower in the EA group (1.4% vs. 4.1%, p = 0.043). Maternal complications were similar, besides for higher rates of instrumental deliveries found in the EA group (24.0% vs. 5.7%, p < 0.001). Time between EA and fever onset was not associated with neonatal complications in logistic regression analysis. ConclusionNeonatal and maternal outcomes are similar in febrile laboring women with and without EA. The time interval between EA and onset of fever is not associated with increased rates of neonatal fever or adverse outcomes and should not affect the management of labor.

Sonographic fetal head circumference is associated with trial of labor after cesarean section success.

The purpose is to study the association of the fetal sonographic head circumference (SHC) with trial of labor after cesarean (TOLAC) success rate, among women with no prior vaginal deliveries. A retrospective case-control study including all women with no prior vaginal delivery undergoing TOLAC during 3/2011-6/2020 with a sonographic estimated fetal weight within one week from delivery. TOLAC success and failure groups were compared. Of 1232 included women, 948 (76.9%) delivered vaginally. The mean fetal SHC was smaller in the TOLAC success group (330 ± 10 vs. 333 ± 11mm, p < 0.001). In a multivariate regression analysis, predelivery BMI, hypertensive disorders, gestational age at prior CD, SHC and epidural analgesia administration were independently associated with TOLAC success. A ROC analysis of the multivariable model composed of the factors found independently associated with TOLAC success, excluding SHC, yielded an area under curve of 0.659 (95% CI 0.622-0.697) compared with 0.668 (95% CI 0.630-0.705) with SHC included. Smaller SHC is independently associated with TOLAC success among women that did not deliver vaginally before, and has additive clinical value for the prediction of TOLAC success when combined with non-sonographic factors.

SATISFACTION OF PARTURIENTS WITH EPIDURAL ANALGESIA DURING DELIVERY: ANALYSIS OF QUESTIONNAIRE AT A SINGLE HOSPITAL CENTER.

Epidural analgesia is one of the most common methods of relieving labor pain. The objective of this study was to examine the effectiveness of epidural analgesia, maternal satisfaction and relationship between the effectiveness of epidural analgesia and various factors. Data were analyzed retrospectively and collected during 2022. A total of 60 parturients participated in the study. Data were collected through a questionnaire before the parturient was discharged from the hospital. The mean assessment of pain on a 1-10 numeric rating scale before epidural analgesia was 7.7 and 3.4 after administration of epidural analgesia. The median assessment of pain before epidural analgesia was 8 (7¬¬-8), and the median assessment of pain after epidural analgesia was 3 (2-5). The average satisfaction with epidural analgesia on a 1-10 scale was 8.11, and the median satisfaction was 10 (7-10). Total of 35 (58.3%) parturients rated satisfaction with 10. Statistically significant association between the effectiveness of epidural analgesia and parity, dilution of administered levobupivacaine, fentanyl administration, and level of education was not found. Childbirth pain is significantly alleviated by the application of epidural analgesia and the satisfaction of parturients is very high.

Effectiveness and Safety in the Postoperative Period after the Epidural Insertion with Local Anesthetics and Steroids

Introduction: Postoperative analgesia is one of the major concerns to significant patients posted for major surgeries. One of the gold standard techniques to control postoperative pain in significant surgeries like lower abdominal and lower limb surgeries is epidural analgesia administration with local anesthetic and opioids. The difficulty in developing a realistic risk/benefit analysis of epidural analgesia has led clinicians to frequently wonder if epidurals are beneficial for post-operative pain management and whether the procedure is safe, which has limited the adoption of the technique. The effectiveness and safety in the postoperative period after the epidural insertion with local anesthetics and steroids in persons posted for surgery are discussed in this review.&#x0D; Methodology: This review article was written with a systemic literature review with the help of a data search machine-like Pub Med, Scopus, web of sciences, and Google scholar. In this article, observational studies and case reports were included.&#x0D; Review Findings: The administration of substantial dosages of opioid and LA medications in the intensive care environment can achieve total dynamic pain alleviation, i.e., complete lack of discomfort while moving and coughing, after extensive upper abdominal surgery was achieved. A more practical method is to assess discomfort while movement or sneezing, to have a patient who can move, breathe deeply, and cough successfully while scoring three or less on a VAS scale recorded during moving.&#x0D; Conclusions: Continuing thoracic epidural anesthesia with a lower dose Local Anesthetics–opioids combo or single-shot epidural injections seems to have the potential to provide good dynamic pain management for several persons, particularly patients undergoing significant abdominal and thoracic operations. Timely mobilization, as well as speedy recovery, require this level of pain alleviation.

Epidural analgesia during labor and its optimal initiation time-points: A real-world study on 400 Chinese nulliparas.

Recent research has suggested that 6 cm of cervical dilation should be the threshold for the active labor phase, and it has confirmed that epidural analgesia (EA) is a safe method of pain relief during labor. However, the evidence provided for these findings comes mainly from randomized controlled clinical trials (RCTs), which suffer from the limitation of real-world generalizability.To test the generalizability of the conclusions from these previous RCTs, we conducted a prospective cohort, real-world study (RWS) on 400 Chinese term nulliparas. A total of 200 of the participants (the EA group) received EA upon request. The participants in the EA group were further subdivided as follows according to their cervical dilation when the EA administration was initiated (CDE): [EA1 group (CDE < 3 cm), EA2 group (3 cm ≤ CDE < 6 cm), and EA3 group (CDE ≥ 6 cm)]. We compared the labor duration of the EA group versus the non-EA (NEA) group, and the NEA group versus the 3 EA subgroups. We also compared delivery outcomes between the EA and NEA groups.The median total labor duration for the EA group [676 (511–923) minutes] was significantly longer than that of the NEA group [514 (373–721) minutes] (P < 0.001). The median durations of both the first- and second-stages of labor for the EA group [600 (405–855) minutes, 68 (49–97) minutes] were longer than those of the NEA group [420 (300–630) minutes, 50 (32–85) minutes] (P < .001, P < .001)]. In addition, the median total labor durations in both the EA1 [720 (548–958) minutes] and EA2 groups [688 (534–926) minutes] were longer than in the NEA group (P < .001 and P < .001, respectively), and the first- and second-stage labor durations of these subgroups were similar to their total labor durations. A Cox regression analysis showed that EA was associated with longer first-stage labor [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.42–0.71, P < .001] and longer second-stage labor (HR 0.66, 95% CI 0.51–0.85, P = .001). The delivery modes and neonatal outcomes between the EA and NEA groups were not statistically different, however.Our findings suggest that EA administered before a cervical dilation of 6 cm may be associated with longer total, first-, and second-stage labor durations compared with no EA, while later EA administration is not. In addition, though EA prolongs labor duration, it does not impact delivery outcomes. These results confirm the significance of a 6 cm cervical dilation threshold in real-world labor settings.

Cervical dilation at the time of epidural catheter insertion is not associated with the degree of prolongation of the first or second stages of labor, or the rate of instrumental vaginal delivery.

Epidural analgesia (EA) is an established option for efficient intrapartum analgesia. Meta-analyses have shown that EA differentially affects the first stage of labor but prolongs the second. The question of EA timing remains open. We aimed to investigate whether EA prolongs delivery in total and whether the EA administration timing vis-à-vis cervical dilation at catheter insertion is associated with a modulation of its effects on the duration of the first and second stages, as well as the rate of instrumental vaginal delivery in primiparas and multiparas. A retrospective electronic medical records-based study of 18870 singleton term deliveries occurring in our institution from 2003 to 2015. Cervical dilation was determined within a half-hour of EA administration. We examined whether cervical dilation at EA administration correlated with the duration of the first and/or second stage, with the rate of prolonged second stage, and with the rate of interventional delivery. The study group was stratified to 10 subgroups defined by 1-cm intervals of cervical dilation at EA administration. Logistic regression modeling was applied to analyze the association between EA timing and rate of instrumental delivery while controlling for possible confounders. In primiparas, receiving EA correlated with longer medians of active first stage (+51minutes; P<.001) and second stage (+55minutes; P<.001). In multiparas, median increases in active first stage (+43minutes; P<.001) and second stage (+8minutes; P<.001) were noted. The timing of EA, vis-à-vis cervical dilation (1-10cm) was not associated with a substantial modulation of these effects. Logistic regression showed that cervical dilation at EA was not associated with a higher instrumental vaginal delivery rate. Epidural analgesia prolonged the first and second stages of labor vs no epidural. Having EA was associated with a higher instrumental delivery rate but not with higher rates of maternal or neonatal complications, in primi- and multiparas. Importantly, the timing of EA, vis-à-vis cervical dilation, was not associated with substantial changes in the duration of labor stages or the instrumental delivery rate. Thus, EA may be offered early in the first stage of labor.

Epidural analgesia for the treatment of colic attack with retrocaval ureter in late pregnancy complicated with marginal placenta previa: a case report

BackgroundRetrocaval ureter was diagnosed in a woman complaining of ureteric pain in the last trimester of pregnancy. We describe the rationale behind the administration of epidural analgesia for her colic attack.Case presentationA 41-year-old pregnant woman was hospitalized with a diagnosis of a marginal placenta previa at 34 weeks and 5 days of pregnancy. Her right ureter encircled the dorsal aspect of the inferior vena cava (IVC) and was compressed by a growing fetus, causing hydronephrosis. Her right lower back pain was exacerbated every day, till an epidural catheter was inserted. Her estimated glomerular filtration rate (eGFR) and hematocrit worsened, and an elective cesarean section was performed.ConclusionEpidural analgesia only provided pain relief for a few days. When a pregnant woman presents with a retrocaval ureter and severe pain, short-term epidural analgesia should be considered after evaluating the complex medical condition and size of the fetus.

Role of maternal characteristics and epidural analgesia on caesarean section rate in groups 1 and 3 according to Robson’s classification: a cohort study in an Italian university hospital setting

ObjectiveTo investigate the role of maternal characteristics and epidural analgesia (EA) on caesarean section (CS) rates in selected groups by using the Robson 10-Group Classification System (RTGCS).DesignCohort study.SettingDepartment of Obstetrics...

Maternal quality of life in routine labor epidural analgesia versus labor analgesia on request: results of a randomized trial

IntroductionThe purpose of this study was to evaluate the changes in maternal quality of life (QOL) from pregnancy to 6 weeks after delivery between routine labor epidural analgesia (EA) and pain relief on maternal request only.Methods\\Women delivering of a singleton in cephalic presentation beyond 36 + 0 weeks’ gestation were randomly allocated to EA as a routine during labor (routine EA group), or to any kind of analgesia on request only (control group). The Short Form health survey (SF-36) was used to assess women’s QOL before randomization, and 6 weeks postpartum. Data were analyzed according to the intention to treat principle.ResultsA total of 488 women were included, and antepartum as well as postpartum SF-36 questionnaires were filled in by 356 (73.0%) women, 176 (49.4%) in the routine EA group, and 180 (50.6%) in the control group. Changes from the QOL antepartum to the QOL 6 weeks postpartum were comparable between both groups, also in the subgroup of women in the control group who gave birth without any pain medication (n = 41, 22.8%). Maternal age and the incidence of adverse events related to EA, which were both higher in the routine EA group, had no influence on the changes in QOL. Differences in request for pain relief were comparable with other studies.ConclusionRoutine administration of EA during labor and pain relief on maternal request only are associated with comparable changes of women’s QOL antepartum to 6 weeks postpartum.

Early Effect of Epidural Analgesia on Fetal Acid-base Balance in the First Stage of Labour

Introduction: Epidural analgesia is a consolidated therapeutic technique generally used for the relief of labor pain. Since its introduction in obstetrics, there have been many studies that evaluate the effect that this type of analgesia has over the course of labor, and its possible repercussions on the mother and the fetus/newborn by analyzing data at birth. However, there exist very few studies that analyze the early effect that epidural analgesia has on the fetus. Objectives: The main objective of this study is to analyze the early effects of epidural analgesia on the fetal status by evaluating the possible changes in the acid-base fetal state, the most precise way to evaluate fetal wellbeing during labor, and cardiotocographic (CTG) tracing of the fetal heart rate after the administration of an epidural. Methods: This is a prospective study of 193 patients, in which a determination of the fetal acid-base equilibrium was done before the administration of epidural analgesia and repeated 60 min afterwards, evaluating possible changes in the results motivated by analgesia. Results: There was a statistically significant descent on fetal blood pH after the administration of epidural analgesia, as well as a significant increase in the number of fetal heart traces with alterations. The descent of fetal pH was greater in patients that had some gestational associated conditions. Conclusion: The administration of epidural analgesia during the first stage of labor caused, as an early effect, a significant descent in fetal blood pH, without that descent being clinically relevant over the fetal status in healthy fetuses. There must be a strict control in fetuses with some initial alteration in the CTG tracings.

Epidural Analgesia During Childbirth and Postpartum Depressive Symptoms: A Population-Based Longitudinal Cohort Study.

Severe pain has been linked to depression, which raises the question of whether epidural analgesia (EDA) during childbirth is associated with a reduced risk of postpartum depression (PPD). This association has been explored previously, but the studies were restricted by small sample sizes and the inability to control for relevant confounders. This study aimed to investigate the association between the administration of EDA and the development of PPD after adjusting for sociodemographic, psychosocial, and obstetric variables. Data were retrieved from the Biology, Affect, Stress, Imaging and Cognition (BASIC) project (2009-2017), a population-based longitudinal cohort study of pregnant women conducted at Uppsala University Hospital, Sweden. The outcome was PPD at 6 weeks postpartum, defined as a score of ≥12 points on the Edinburgh Postnatal Depression Scale (EPDS). Information was collected through medical records and self-reported web-based questionnaires during pregnancy and 6 weeks after childbirth. Only primiparous women with spontaneous start of childbirth were included (n = 1503). The association between EDA and PPD was examined in multivariable logistic regression models, adjusting for sociodemographic, psychosocial, and obstetric variables. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). Of the 1503 women included in the analysis, 800 (53%) reported use of EDA during childbirth. PPD at 6 weeks postpartum was present in 193 (13%) women. EDA was not associated with higher odds of PPD at 6 weeks postpartum after adjusting for suspected confounders (age, fear of childbirth, antenatal depressive symptoms; adjusted OR [aOR] = 1.22; 95% CI, 0.87-1.72). EDA was not associated with the risk of PPD at 6 weeks postpartum after adjusting for sociodemographic, psychosocial, and obstetric variables. However, these findings do not preclude a potential association between PPD and childbirth pain or other aspects of EDA that were not assessed in this study.

Timing of administration of epidural analgesia and risk of operative delivery in nulliparous women: A case–control randomised study

Background and Aim: Epidural analgesia (EA) offers an effective form of labour analgesia. The time of administration of EA and its relationship with the mode of delivery is controversial. Our study tried to assess whether early initiation of epidural analgesia influences the obstetric outcome in nulliparous women. Materials and Methods: This was a case control, randomised study which included 60 parturients in spontaneous labour divided into two equal groups, the cases and controls. Cases received EA with 10 mL of 0.125% injection bupivacaine, whereas the control group received a systemic opioid (injection pethidine 100 mg intramuscularly) for pain relief. Cases were further divided into parturients receiving EA at a cervical dilatation of 3 cm or less classified as the early epidural group and those receiving EA at 4 cm or more classified as the late epidural group. The modes of delivery for the study population were recorded. Data analysis was done using Wilcoxon two-sample test. P

Risk Assessments of Epidural Analgesia During Labor and Delivery.

Epidural analgesia (EA) is one of the methods of choice for labor pain relief, but its adverse effects on the mother and child remain controversial. The objective of this study was to determine whether there is an association between the use of EA and different aspects of labor. The author(s) analyzed the effect of EA on different aspects of labor in a retrospective cohort observational study of deliveries in a public Spanish hospital during a 3-year period. Women with EA administration were found to increase the risk of stimulated labor, reduce the percentage of spontaneous deliveries, increase the risk of instrumental labor due to stalled labor or loss of fetal well-being, and increase the percentage of episiotomies. However, women with EA were not and increased risk for perineal laceration or the condition of the membranes at the delivery or with the type of placental expulsion. Thus, the administration of EA should be assessed in each case by the health care professional.

A comprehensive analysis of continuous epidural analgesia's effect on labor and neonates in maternal hypertensive disorder patients.

Maternal hypertensive disorder is one of the most common and severe medical complications during pregnancy. Epidural analgesia administration is widely used during labor process. To evaluate the potential advantage or disadvantage of continuous epidural analgesia's on labor and neonates for maternal hypertensive disorder patients comprehensively. We have retrospectively analyzed 232 patients who diagnosed as maternal hypertensive disorder in our hospital since 2015. Among which, 126 patients including 28 cases of severe preeclampsia were administrated with continuous epidural analgesia (Analgesia group), the other 106 patients were untreated (Control group). We have compared the maternal age, body weight, gestational weeks, period for the first and second labor stage; the incidence of eclampsia, natural labor, cesarean section, forceps delivery and postpartum hemorrhage between these two groups respectively; furthermore, we recorded patients who received oxytocin and antihypertensive treatment during the delivery progress as well as evaluated the neonate body weight, Apgar score and performed umbilical cord blood gas analysis. Continuous epidural analgesia does not affect the first and second labor stage period (p=0.36), However, there is a significantly higher demand for oxytocin treatment (36.5% Vs 19.8%, p<0.01) and a significantly lower requirement for antihypertensive treatment (22.2% Vs 81.1%, p<0.001) in analgesia group compared to control group. We also notice that the natural delivery ratio in analgesia group is higher than control group and most importantly, continuous epidural analgesia can increase 1min Apgar score and has no other effect on neonates' body weight, umbilical cord blood gas parameters, 5min and 10min Apgar score. Our result based on a large cohort comprehensive analysis indicates that continuous epidural analgesia can benefit both maternal hypertensive disorder patients and neonates without any side effect.

Acupuncture and Acupressure in Labor.

Acupuncture and acupressure, 2 modalities of Traditional Chinese Medicine, are based on reducing pain and symptoms of disease through balancing yin and yang. Acupuncture and acupressure have been used in China for reduction of labor pain, labor augmentation, and other intrapartum indications for more than 2 millennia. This article presents a review of the current literature that has addressed the effects of acupuncture and acupressure on intrapartum events. Studies of acupuncture have demonstrated that acupuncture may reduce labor pain, the use of pharmacologic agents, the use of forceps and vacuum-assisted births, and the length of labor. Studies that examined the effect of acupuncture on labor that is induced or augmented for premature rupture of membranes have found that acupuncture may increase the degree of cervical ripening but does not reduce the amount of oxytocin or epidural analgesia administration, nor does it shorten length of induced labor. Acupressure may reduce labor pain and labor duration, but acupressure has not been found to increase cervical ripening or induce labor. There are insufficient studies about acupuncture and acupressure and their effects on labor at this time, and there is need for further research. Areas of uncertainty include efficacy, optimal point selection, best techniques, and length of time for point stimulation.

Effect of epidural analgesia with opioids on the prevalence of urinary retention in dogs undergoing surgery for cranial cruciate ligament rupture

To determine whether epidural administration of opioids was associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. Retrospective cohort study. 179 client-owned dogs undergoing elective surgery for cranial cruciate ligament rupture. Medical records of 179 dogs that underwent surgical correction for cranial cruciate rupture between January 2009 and October 2012 were reviewed; 120 received epidural administration of opioids and 59 did not. Signalment, type of procedure, administration of epidural analgesia, time to first postanesthetic urination, and number of urinations during the first 24 hours were evaluated and compared between groups. Administration of preservative-free morphine into the epidural space was not significantly associated with time to first urination following anesthetic recovery or the total number of urinations within the first 24 hours of anesthetic recovery. Administration of a hydromorphone bolus IV following surgery was significantly associated with urinary retention, compared with administration of either morphine boluses or fentanyl constant rate infusions following surgery. No other variables were significantly associated with urinary retention. Administration of preservative-free morphine into the epidural space was not associated with clinically important urinary retention in dogs undergoing elective orthopedic procedures. Systemic administration of opioids may be associated with urinary retention.

Women's perception of the onset of labour and epidural analgesia: A prospective study

Objectivechildbearing women and their midwives differ in their diagnoses of the onset of labour. The symptoms women use to describe the onset of labour are associated with the process of labour. Perinatal factors and women's attitudes may be associated with the administration of epidural analgesia. Our study aimed to assess the correlation between women's perception of the onset of labour and the frequency and timing of epidural analgesia during labour. Designprospective cohort study. Setting41 maternity units in Lower Saxony, Germany. Participants549 nulliparae (as defined in the “Methods” section) and 490 multiparae giving birth between April and October 2005. Women were included after 34 completed weeks of gestation with a singleton in vertex presentation and planned vaginal birth. Measurementsthe association between women's symptoms at the onset of labour and the administration of epidural analgesia – frequency, timing in relation to onset of labour and cervical dilatation – was assessed. The analysis was performed by Kaplan–Meiers estimation, logistic regression and Cox regression. Findingsa total of 174 nulliparae and 49 multiparae received epidural analgesia during labour. Nulliparae received it at a median time of 5.47hrs (range: 0.25–51.17hrs) after onset of labour, at a median cervical dilatation of 3.3cm (range: 1.0–10.0cm). In multiparae, epidural analgesia was applied at a median time of 3.79hrs (range: 0.42–28.55hrs) after onset of labour; the median cervical dilatation was 3.0cm (range: 1.0–8.0cm). Women who were admitted with advanced cervical dilatation received epidural analgesia less often. Women who defined their onset of labour earlier than it was diagnosed by their midwives received epidural analgesia earlier. Gastrointestinal symptoms and irregular pain at the onset of labour were associated with later administration of epidural analgesia. Induction of labour was associated with a reduced interval from the onset of labour to epidural analgesia. Key conclusionswomen's self-diagnosis of the onset of labour and their perception of their labour duration when meeting their midwives has some impact on their admission to the labour ward and the timing of epidural analgesia. Implications for practiceconsideration of women's own perceptions and expectations regarding the onset and process of labour is necessary for individual care during labour.

Analysing adverse effects of epidural analgesia in labour

Epidural analgesia is a widely available method of pain relief in labour in Western countries. This article analyses the various adverse outcomes of labour and birth after the administration of epidural analgesia. A literature review found that the use of intrapartum epidural analgesia for women with low-risk pregnancy has not only disempowered women but can also lead to maternal and fetal morbidity connected with major obstetric interventions, such as operative deliveries. Epidural analgesia also interferes with breastfeeding success and effective oxytocin circulation in the maternal blood-stream, and may even impact on childhood behavioural development.

Mode of Delivery After Epidural Analgesia in a Cohort of Low-risk Nulliparas

Abstract: Background: Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between epidural analgesia and mode of delivery. Methods: Data were obtained from a prospective cohort from nine Danish labor wards and comprised 2,721 term nulliparous women with spontaneous onset of labor and a singleton fetus in cephalic presentation. Information about epidural analgesia, mode of delivery, and birth complications was obtained by the staff attending labor. Additional information was provided from self-administered questionnaires in gestational week 37. Multiple logistic regression analyses were used to estimate the association between epidural analgesia and birth outcomes. Results are presented as crude and adjusted odds ratios (OR [95% CI]). Results: Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1–8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3–2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5–8.2). Conclusions: In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction. (BIRTH 38:4 December 2011)