The effect of labor epidural analgesia on maternal–fetal outcomes: a retrospective cohort study
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To evaluate the impact of labor epidural analgesia on maternal–fetal safety outcomes in a signal Chinese academic medical center.
A single-intervention impact study was conducted at The Second Affiliated Hospital, Wenzhou Medical University. The study period was divided into three phases: (1) baseline phase: from January 1 and June 30, 2009 when no analgesic method was routinely employed during labor; (2) phase-in period: the epidural analgesia was implemented 8 a.m.–5 p.m. during weekdays; and (3) the post—No Pain Labor N’Delivery phase when the labor epidural was applied 24 h a day, 7 days a week, from June 1, 2010 and June 30, 2011. The maternal–fetal safety outcomes of delivery were compared between the different periods.
There were 15,415 deliveries with 42.3% of nulliparous parturients in the 31-month study period. As the primary outcomes, the labor epidural analgesia rate increased from 0 to 57%, the vaginal delivery rate increased, and cesarean delivery rate decreased by 3.5% after full implementation. As the secondary outcomes, the rate of episiotomy and severe perineal injury after the implementation periods were significant decreased. The rate of postpartum oxytocin administration was decreased by 17.8%. No significant difference between the baseline and implementation periods was found in the rate of postpartum hemorrhage, Apgar scores less than 7 at both 1 and 5 min, 7-day mortality, and the overall neonatal intensive care unit admission rate.
Implementation of labor epidural analgesia increased the vaginal delivery rate and use of labor epidural analgesia is safe to parturients and fetus.
KeywordsLabor epidural analgesia Vaginal delivery Cesarean delivery Oxytocin Postpartum hemorrhage Apgar scores
We thank Dr. Yun-Hong Zhang (Anesthesia of St. Louis) for helpful revision of the manuscript. L.-Q.H. established the “No Pain Labor & Delivery—Global Health Initiative” program, and L.-Q.H. and J.Z. introduced and implemented the protocol at the study site.
QW: data collection or management, data analysis, and manuscript writing/editing. SXZ: data collection or management and data analysis. YFN: data collection or management and data analysis. YYL: data analysis. BZ: data analysis. QQL: protocol/project development. MPH: protocol/project development.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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