Effect of epidural analgesia in trial of labor after cesarean on maternal and neonatal outcomes in China: a multicenter, prospective cohort study

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.

The effect of epidural analgesia on maternal-neonatal outcomes: a retrospective study

“…However, this did not affect the normal vaginal delivery rate, the inci- dence of episiotomy, and other adverse maternal or neonatal outcomes. Our results are consistent with recent studies that EA during delivery does not increase the rate of vaginal delivery, and EA during delivery is safe for both mothers and fetuses [17,18]. A 2018 Cochrane review suggested that EA had no effect on the risk of cesarean section [19].…”

“…This finding suggested that there should be a dose-response relationship between the concentration of epidural local anesthetics and the effect of the second stage of labor. These authors' findings are similar to recent findings that minimum local analgesic concentrations of epidural sufentanil or ropivacaine provided satisfactory and safe analgesia for parturients, while they had a low incidence rate of side effects [18,25].…”

Epidural analgesia at trial of labour after caesarean section. A retrospective cohort study over 12 years

“…Domestic and foreign studies on the application of EA in TOLAC are mostly small or retrospectively analysed. We found only one prospective cohort study evaluating the use of EA in 263 multiparas [18]. In this study, the success rate of TOLAC was 85.5% without differences in maternal (UR, blood loss) and neonatal (Apgar, pH, NICU) outcomes irrespective of the use of EA.…”

“…In 2019, the American Association of Obstetricians and Gynaecologists' (ACOG) guidelines explicitly recommended use of EA in TO-LAC [2]. Similarly, Sun et al [18] found no increased risk of postpartum bleeding or UR with the use of EA in multiparas [19,20]. However, even if TOLAC is increasingly recommended in selected cases, EA is still not widely used due to controversy.…”

Degree of intrapartum fever and associated factors: Three group analysis of no fever, borderline and overt fever

“…Efforts to reduce labor pain and related studies continue, 6 but it has been proven that the regional anesthesia works best in labor pain. Regional anesthesia by epidural analgesia has been widely adopted in vaginal delivery as well as cesarean section 7,8 . It is well known that labor epidural can be associated with the development of intrapartum fever and adverse pregnancy and neonatal outcomes, 9 but the underlying mechanisms remain unclear 10,11 .…”