The Effect of Epidural Analgesia on the Delivery Outcome of Induced Labour: A Retrospective Case Series

Angeliki Antonakou, Dimitrios Papoutsis, Angeliki Antonakou, Dimitrios Papoutsis

Abstract

Objective. To investigate whether the use of epidural analgesia during induced labour was a risk factor for instrumental vaginal delivery and caesarean section (CS) delivery. Study Design. This was a retrospective case series of primigravidae women being induced at term for all indications with a normal body mass index (BMI) at booking and under the age of 40 years. Results. We identified 1,046 women who fulfilled the inclusion criteria of which 31.2% had an epidural analgesia. Those with an epidural analgesia had significantly greater maternal age, higher BMI, greater percentage of oxytocin usage, and a longer first and second stage of labour. Women with an epidural analgesia had a higher instrumental delivery (37.9% versus 16.4%; p < 0.001) and CS delivery rate (26% versus 10.1%; p < 0.001). Multivariable analysis indicated that the use of an epidural was not a risk factor for a CS delivery but was a risk factor for an instrument-assisted delivery (adjusted OR = 3.63; 95% CI: 2.51-5.24; p < 0.001). Conclusion. Our study supports the literature evidence that the use of an epidural increases the instrumental delivery rates. It has also added that there is no effect on CS delivery and the observed increase is due to the presence of confounding factors.

Conflict of interest statement

The authors declare that there are no competing interests regarding the publication of this paper.

References

    1. Department of Health. Statistical Bulletin-NHS Maternity Statistics, England: 2003-2004. London, UK: Department of Health; 2004.
    1. Osterman M. J. K., Martin J. A., Menacker F. Expanded health data from the new birth certificate, 2006. National Vital Statistics Reports. 2009;58(5):1–24.
    1. Jones L., Othman M., Dowswell T., et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database of Systematic Reviews. 2012;(3)CD009234
    1. Anim-Somuah M., Smyth R. M., Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews. 2011;12CD000331
    1. Boyle A., Reddy U. M., Landy H. J., Huang C.-C., Driggers R. W., Laughon S. K. Primary cesarean delivery in the United States. Obstetrics and Gynecology. 2013;122(1):33–40. doi: 10.1097/AOG.0b013e3182952242.
    1. Smith G. C. S., Cordeaux Y., White I. R., et al. The effect of delaying childbirth on primary cesarean section rates. PLoS Medicine. 2008;5(7) doi: 10.1371/journal.pmed.0050144.e144
    1. Sebire N. J., Jolly M., Harris J. P., et al. Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. International Journal of Obesity. 2001;25(8):1175–1182. doi: 10.1038/sj.ijo.0801670.
    1. Harkins J., Carvalho B., Evers A., Mehta S., Riley E. T. Survey of the factors associated with a woman's choice to have an epidural for labor analgesia. Anesthesiology Research and Practice. 2010;2010:8. doi: 10.1155/2010/356789.356789
    1. Lancaster S. M., Schick U. M., Osman M. M., Enquobahrie D. A. Risk factors associated with epidural use. Journal of Clinical Medicine Research. 2012;4:119–126.
    1. Torricelli M., Voltolini C., Conti N., Bocchi C., Severi F. M., Petraglia F. Weight gain regardless of pre-pregnancy BMI and influence of fetal gender in response to labor induction in postdate pregnancy. Journal of Maternal-Fetal and Neonatal Medicine. 2013;26(10):1016–1019. doi: 10.3109/14767058.2013.766712.
    1. Baranova A., Gowder S. J., Schlauch K., et al. Gene expression of leptin, resistin, and adiponectin in the white adipose tissue of obese patients with non-alcoholic fatty liver disease and insulin resistance. Obesity Surgery. 2006;16(9):1118–1125. doi: 10.1381/096089206778392149.
    1. NICE Guideline. Induction of Labour. National Collaborating Centre for Women's and Children's Health. National Institute for Health and Clinical Excellence. London, UK: RCOG Press; 2008.
    1. Hasegawa J., Farina A., Turchi G., Hasegawa Y., Zanello M., Baroncini S. Effects of epidural analgesia on labor length, instrumental delivery, and neonatal short-term outcome. Journal of Anesthesia. 2013;27(1):43–47. doi: 10.1007/s00540-012-1480-9.
    1. Leighton B. L., Halpern S. H. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. American Journal of Obstetrics and Gynecology. 2002;186(supplement 5):S69–S77. doi: 10.1067/mob.2002.121813.
    1. Halpern S. H., Leighton B. L., Ohlsson A., Barrett J. F. R., Rice A. Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis. The Journal of the American Medical Association. 1998;280(24):2105–2110. doi: 10.1001/jama.280.24.2105.
    1. Tsuzuki Y., Yamashita Y., Hattori Y., et al. Pain-reducing anesthesia prevents oxidative stress in human term placenta. Journal of Clinical Biochemistry and Nutrition. 2016;58(2):156–160. doi: 10.3164/jcbn.15-138.
    1. Cambic C. R., Wong C. A. Labour analgesia and obstetric outcomes. British Journal of Anaesthesia. 2010;105:i50–i60. doi: 10.1093/bja/aeq311.
    1. Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. The Lancet. 2001;358(9275):19–23. doi: 10.1016/s0140-6736(00)05251-x.
    1. Chen S.-Y., Lin P.-L., Yang Y.-H., et al. The effects of different epidural analgesia formulas on labor and mode of delivery in nulliparous women. Taiwanese Journal of Obstetrics and Gynecology. 2014;53(1):8–11. doi: 10.1016/j.tjog.2012.01.039.
    1. Singh S. K., Yahya N., Misiran K., Masdar A., Nor N. M., Yee L. C. Combined spinal-epidural analgesia in labour: its effects on delivery outcome. Brazilian Journal of Anesthesiology. 2016;66(3):259–264. doi: 10.1016/j.bjane.2014.09.006.

Source: PubMed

3
Předplatit