The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study
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Asghar Hajipour
,
Alireza Montaseri
,
Mojgan Rahimi
,
Amirhossein Orandi
,
Laila Rahmah
,
Shahram Samadi
Abstract
This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence.
2. Al Rifai R, Practice. Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan: analysis of population survey data, 2002–2012. Glob Health Sci Pract 2014;2:195-209.
3. Poole JH. Analgesia and anesthesia during labor and birth: Implications for mother and fetus. J Obstet Gynecol Neonatal Nurs 2003;32:780-93.
4. Anim‐Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non‐epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018;5:CD000331.
5. Eriksen LM, Nohr EA, Kjaergaard H. Mode of delivery after epidural analgesia in a cohort of low‐risk nulliparas. Birth 2011;38:317-26.
6. Herrera-Gómez A, García-Martínez O, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C, Ocaña-Peinado FM. Retrospective study of the association between epidural analgesia during labour and complications for the newborn. Midwifery 2015;31:613-6.
7. Bandyopadhyay KH, Afzal M, Mishra AK, Paul A. Labor epidural analgesia: Past, present and future. Indian J Pain 2014;28:71-81.
8. Deshmukh VL, Ghosh SS, Yelikar KA, Gadappa SN., India Go. Effects of epidural labour analgesia in mother and foetus. J Obstet Gynaecol India 2018;68:111-6.
9. Labor S, Maguire S. The pain of labour. Rev Pain 2008;2:15-9.
10. Capogna G, Camorcia M, Stirparo S, Valentini G, Garassino A, Farcomeni A. Multidimensional evaluation of pain during early and late labor: a comparison of nulliparous and multiparous women. Int J Obstet Anesth 2010;19:167-70.
11. Mohammad N, Xueping H, Hasan T, Miao, Ara S. Experience of using epidural labour analgesia in developing countries: effects to feotus and mother. J Anesth Crit Care Open Access 2021;13:5-10.
12. Ohel G, Gonen R, Vaida S, Barak S, Gaitini L. Early versus late initiation of epidural analgesia in labor: does it increase the risk of cesarean section? A randomized trial. Am J Obstet Gynecol 2006;194:600-5.
13. Crawford SJ. Lumbar epidural block in labour: a clinical analysis. Br J Anaesth 1972;44:66-74.
14. Vaajala M, Kekki M, Mattila V, Kuitunen I. The association between epidural labor analgesia and the fetal outcome and mode of delivery of the second twin: a nationwide register-based cohort study in Finland. Int J Obstet Anesth 2023:56:103924.
15. Stuart KA, Krakauer H, Schone E, Lin M, Cheng E, Meyer GS. Labor epidurals improve outcomes for babies of mothers at high risk for unscheduled cesarean section. J Perinatol 2001;21:178-85.
16. Chen Y, Ye X, Wu H, Yuan X, Yu X, Wu H, et al. Delivery, maternal and neonatal outcomes in nulliparous women with gestational diabetes undergoing epidural labour analgesia: a propensity score-matched analysis. BMJ Open 2022;12:e060245.
17. Han B, Xu M. A comprehensive analysis of continuous epidural analgesia’s effect on labor and neonates in maternal hypertensive disorder patients. Pregnancy Hypertens 2017:7:33-8.
18. Tanaka H, Kamiya C, Katsuragi S, Tanaka K, Yoshimatsu J, Ikeda T. Effect of epidural anesthesia in labor; pregnancy with cardiovascular disease. Taiwan J Obstet Gynecol 2018;57:190-3.
19. Shekhawat H, Shrivastava D, Dhurve K, Shelke U, Deo A. Effect of epidural labor analgesia on fetal heart rate and neonatal outcome. J Datta Meghe Inst Med Sci Univ 2020;15:382-6.
20. Chowdhury MA, Tanvirul Haque AKM, Ehsan A, Mahbub Khan M, Fardous J, Al Mamun AS, et al. Evaluate and Outcome Safety of Epidural Analgesia in Surgical Practice for Labor Pain: Study on Tertiary Hospital in Bangladesh. Sch J App Med Sci 2021;10:1574-80.
21. Hughes D, Simmons S, Brown J, Cyna A. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2003:CD003401-CD.
22. Mercer JS, Erickson-Owens DA, Graves B, Haley MM. Health Ws. Evidence-based practices for the fetal to newborn transition. J Midwifery Womens Health 2007;52:262-72.
| Files | ||
| Issue | Vol 61 No 9 (2023) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v61i9.15284 | |
| Keywords | ||
| Epidural analgesia Emergency cesarean section rate Neonatal outcomes Apgar scores | ||
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