The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Ambrosetti, Fedora; Grandi, Giovanni; PETRELLA, Elisabetta; SAMPOGNA, Veronica; Donno, L; Rinaldi, Laura; Ghirardini, Anna Maria; Facchinetti, Fabio

doi:10.1016/j.xagr.2023.100207

Cited by 2 publications

(5 citation statements)

References 48 publications

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“…Laboring women often require the quicker onset provided by the dural puncture epidural technique and early-NA to alleviate pain during cervical dilation of less than 2-3 cm [ 13 , 14 ]. At the same time, NA is associated with a prolonged duration of first, second and total stage of labor [ 2 , 15 , 16 ], intrapartum CD, operative vaginal delivery [ 15 ], intrapartum fever [ 3 , 4 ], and adverse maternal and neonatal outcomes [ 17 ]. With the implementation of the three-child policy, there has been an increase in multiparous women opting for vaginal delivery in China.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies consistently demonstrated that NA prolongs the durations of the first, second, and total stages of labor [ 2 , 15 , 16 ]. It has been suggested that the use of NA may prolong the duration of the first stage of labor by around 30 min and the second stage by approximately 15 min compared to labor without NA [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies suggests that NA is associated with higher rates of intrapartum CD and operative vaginal deliveries [ 3 , 15 , 16 ]. Some studies [ 15 , 20 ] found that NA resulted in a lower rate of episiotomies in primiparous women, but was associated with a higher rate of instrumental vaginal deliveries and intrapartum CD.…”

Section: Discussionmentioning

confidence: 99%

“…The influence of NA on maternal and neonatal outcomes has been extensively investigated and continues to be a subject of ongoing research [ 2 , 16 , 23 ]. Guglielminotti J et al [ 24 ] found that the use of NA is associated with a 14% decrease in the risk of severe maternal morbidity, with more than one-fifth of the observed association attributed to the decreased risk of PPH.…”

Section: Discussionmentioning

confidence: 99%

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Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Cheng,

Xiong,

et al. 2024

BMC Anesthesiol

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Background The mechanism underlying maternal fever and prolonged labor progression associated with neuraxial analgesia (NA) remains elusive, raising concerns among certain pregnant women regarding the application of NA during vaginal delivery. This study aimed to investigate the impact of early and late NA on maternal and neonatal outcomes in multiparous women. Methods This retrospective study collected data from 1119 multiparous women with singleton pregnancies, full term and live births at our labor and delivery center between August 1st, 2021 and July 31st, 2022. Based on the timing of NA initiation, participants were categorized into three groups: no-NA, early-NA and late-NA. The no-NA group comprised of 172 women who did not receive NA during vaginal delivery; the early-NA group included 603 women in which NA was initiated when cervical dilation was between 0.5 and 2.0 cm; and the late-NA group comprising 344 cases in which NA was initiated at the cervical dilation of ≥ 2 cm. Maternal and neonatal outcomes were observed, including durations of the first, second, third and total stage of labor, the rate of intrapartum cesarean delivery (CD), intrapartum fever, postpartum hemorrhage (PPH), transfer to intensive care unit (ICU), admission to the neonatal intensive care unit (NICU), meconium-stained amniotic fluid, and neonatal Apgar scores at 1 and 5 min. Results No differences were noted in the maternal age, body mass index (BMI) on admission, gestations, parity, gestational weeks at delivery and neonatal birth weight, or the rate of gestational diabetes mellitus (GDM) and hypertension disorder did not significantly differ among the three groups (p > 0.05). The no-NA group had shorter durations of first stage, second stage of labor compared to the early-NA or late-NA group (median, 215.0 min and 10.0 min vs. 300.0 min and 12.0 min vs. 280.0 min and 13.0 min) (p < 0.05), but no differences were observed between the early-NA and late-NA group (p > 0.05). There were no differences in the rate of intrapartum CD, intrapartum fever, PPH, maternal transferred to ICU, neonatal transfer to NICU, meconium-stained amniotic fluid, and postpartum stay ≥ 7d, as well as the neonatal the Apgar scores at 1 and 5 min among the three groups (p > 0.05). Conclusion NA is associated with extended durations of the first, second and total stages of labor. However, the early initiation of NA in multiparous women (cervical dilation within 0.5-2.0 cm) does not increase the risk of intrapartum CD or intrapartum fever. These findings endorse the secure utilization of early NA for pain relief during labor in multiparous women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Cheng,

Xiong,

et al. 2024

BMC Anesthesiol

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“…In rare cases, epidural anesthesia can lead to severe complications such as neuropathy or hematoma [14]. However, it is reassuring to note that despite these potential complications, studies have shown that epidural anesthesia does not increase the risk of cesarean section but may prolong the second stage of labor [15].…”

Section: Introductionmentioning

confidence: 99%

Involving a Dedicated Epidural-Caring Nurse in Labor Ward Practice Improves Maternal Satisfaction towards Childbirth: A Retrospective Study

Chang

et al. 2023

Healthcare

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The quality of healthcare is crucially linked to patient satisfaction, particularly in the provision of neuraxial analgesia for labor pain. Neuraxial analgesia for labor pain control should ideally be readily available when requested. However, in real-world practice, anesthesiologists may not always respond immediately to maternal demands, which can compromise the quality of care. To address this issue, this study aimed to evaluate the effectiveness of involving a dedicated nurse in epidural care to improve maternal satisfaction. This study was conducted in a single tertiary center. Medical records of women with singleton pregnancies above 36 gestational weeks who received neuraxial analgesia for labor pain control were reviewed (N = 354). Among them, 104 women (29%) received care from a dedicated nurse. The results showed that involving a dedicated nurse led to higher maternal satisfaction scores before (4.7 ± 0.5 versus 4.5 ± 0.6, p = 0.001), during (4.7 ± 0.6 versus 4.5 ± 0.6, p = 0.002), and at 24 h postpartum (4.7 ± 0.5 versus 4.5 ± 0.5, p = 0.001), without any adverse impact on maternal, neonatal, or epidural-related complications. These findings suggest that allocating a dedicated nurse to epidural care can effectively enhance maternal satisfaction and potentially improve overall care quality.

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The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Cited by 2 publications

References 48 publications

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study

Involving a Dedicated Epidural-Caring Nurse in Labor Ward Practice Improves Maternal Satisfaction towards Childbirth: A Retrospective Study

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