<p>Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity</p>

Abstract

Background: Epidural Analgesia (EA) is the most effective and most commonly used method for pain relief during labor. Some researchers have observed an association between EA and increased neonatal morbidity. But this observation was not consistent in many other studies. Objectives: The primary objective of the study was to examine whether exposure to epidural analgesia increased the risk of NICU admission. The secondary objectives included the risks of clinical chorioamnionitis, instrumental delivery, neonatal depression, respiratory distress, birth trauma, and neonatal seizure during the first 24 hours of life. Methods: This was a retrospective cohort study involving 2360 low-risk nulliparous women who delivered at AWH, Qatar, during the two years between January 2016 December and 2017. Short-term neonatal outcomes of the mothers who received EA in active labor were compared with a similar population who did not receive EA. As secondary objectives, labor parameters like maternal temperature elevation, duration of the second stage of labor, and instrumental delivery were compared. Results: Significantly higher numbers of neonates were admitted to the NICU from the EA group (P<0.001, OR 1.89, 95% CI 1.45 to 2.46). They were more likely to have respiratory distress (P=0.01, OR 1.49, 95% CI 1.07 to 2.07), birth injuries (P=0.02, OR =1.71, 95% CI 1.06 to 2.74), admission temperature>37.5°C (P=0.04, OR 3.40, 95% CI 1.00 to 11.49), need for oxygen on the first day (P=0.04, OR 1.44, 95% CI 1.01 to 2.07) and receive antibiotics (P<0.001, OR 2.06,95% CI 1.47 to 2.79). There was no difference in the Apgar score at 1 minute (P=0.12), need of resuscitation at birth (P=0.05), neonatal white cell count (P=0.34), platelet count (P=0.38) and C reactive protein (P=0.84). Mothers who received EA had a lengthier second stage (P<0.001), temperature elevation >37.5°C (P<0.001, OR 7.40, 95% CI 3.93 to 13.69) and instrumental delivery (P<0.001, OR 2.13, 95% CI 1.69 to 2.68). Conclusion: EA increases NICU admission, antibiotic exposure, neonatal birth injuries, need for positive pressure ventilation at birth, and respiratory distress in the first 24 hours of life. Mothers on epidural analgesia have prolonged second stage of labor, a higher rate of instrumental delivery, meconium-stained amniotic fluid, fetal distress, and temperature elevation.

Epidural anesthesia during childbirth — retrospective analysis of maternal and neonatal results

“…Based on the results of our own research, it was found that the age of women who used epidural anesthesia is significantly lower than those who did not. In a study conducted in Qatar (Asia) by Salameh K. et al [19], the same conclusions were found, however, their result was not statistically significant. In contrast, Antonakou A. et al [20] noted that English women with epidural anesthesia were significantly older.…”

“…Salameh K. et al [19] noted that the gestational age in the group of women who used epidural anesthesia is significantly higher compared to women who were not anaesthetized. Our study also confirmed this result as statistically significant.…”

Is Unfavourable Cervix prior to Labor Induction Risk for Adverse Obstetrical Outcome in Time of Universal Ripening Agents Usage? Single Center Retrospective Observational Study

“…The confounding factor in this study may be related to the difference in the percentage of epidural analgesia (EA) between groups. Some literature data indicate that EA correlates with increases neonatal care unit admission of newborns (OR 1.89, 95% CI 1.45 to 2.46), respiratory distress (OR 1.49, 95% CI 1.07 to 2.07) and need for oxygen in first day of life (OR 1.44, 95% CI 1.01 to 2.07) [ 21 ]. However, literature data do not indicate an increased risk of acidosis in children born during deliveries with EA [ 22 ].…”

Relationship between delivery with anesthesia and postpartum depression: The Japan Environment and Children’s Study (JECS)

“…Epidural anesthesia during delivery is the most common and widely accepted method of pain relief during labor [ 1 – 3 ]. Although the proportion of pregnant women requesting pain control with anesthesia varies internationally between 20%-70% [ 2 , 3 ], the proportion in Japan continues to be relatively low.…”