Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries

Abstract

Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013–2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries.

Relationship between labour analgesia modalities and types of anaesthetic techniques in categories 2 and 3 intrapartum caesarean deliveries

“…Given the higher likelihood of encountering general anesthesia in laboring women who received remifentanil-PCA, it is imperative that parturients are counseled beforehand regarding the potential need for transition to general anesthesia and the associated complications thereof (especially a higher likelihood of gastric paresis with the consequent risk of regurgitation and aspiration) [36], should intrapartum CD become necessary. Despite many controversies regarding remifentanil efficacy and safety, remifentanil-PCA shows comparable delivery and neonatal outcomes to epidural analgesia within any of the Ten Groups Classification System (TGCD) labor types [17,19]. In the present analysis, remifentanil-PCA and epidural anesthesia also demonstrated comparable neonatal outcomes.…”

“…Remifentanil administration was halted in the event of pathological CTG changes, including reduced variability, bradycardia, tachycardia, or late decelerations. According to the institutional guidelines, contraindications for remifentanil-PCA use in labor include patient refusal, documented history of allergy to opioids, parenteral opioid medication administered within the previous two hours, opioid drug abuse, obstructive sleep apnoea, or unavailability of 1:1 midwife care [17][18][19].…”