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

Robson classification cesarean delivery, cervical dilation epidural analgesia mode of delivery neonatal outcomes nulliparous women obstetrical anesthesia vaginal delivery

Journal

AJOG global reports
ISSN: 2666-5778
Titre abrégé: AJOG Glob Rep
Pays: United States
ID NLM: 101777907

Informations de publication

Date de publication:
May 2023
Historique:
medline: 12 5 2023
pubmed: 12 5 2023
entrez: 11 5 2023
Statut: epublish

Résumé

The use of epidural analgesia represents the gold standard for pain management during labor, but the influence of the use of epidural analgesia on delivery mode is not fully understood. This study aimed to analyze the impact of epidural analgesia on the delivery mode, namely, cesarean delivery, vaginal delivery, and operative vaginal delivery rates, in Robson class 1 women. A retrospective cohort study was conducted on all Robson class 1 women who delivered from January 1, 2019, to December 31, 2019, in the University Hospital of Modena. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were maternal, anesthesiologic, and neonatal effects of epidural analgesia (duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission). A total of 744 women were included in the final analysis, of which 198 (26.6%) underwent epidural analgesia on request and 546 (73.4%) did not. In women with and without epidural analgesia, the cesarean delivery rate was 8.1% vs 7%, the vaginal delivery rate was 79.3% vs 81.1%, and the operative vaginal delivery rate was 12.6% vs 11.9%, respectively. A significant increase in both the first stage of labor (66.3±38.5 vs 43.8±38.8 minutes; The use of epidural analgesia was not associated with an increased risk of cesarean delivery or operative vaginal delivery in Robson class 1 women. Further investigations are needed to evaluate its impact on the duration of labor, namely the duration of the first stage of labor, and on the possible advantages of starting epidural analgesia at an early stage.

Sections du résumé

BACKGROUND BACKGROUND
The use of epidural analgesia represents the gold standard for pain management during labor, but the influence of the use of epidural analgesia on delivery mode is not fully understood.
OBJECTIVE OBJECTIVE
This study aimed to analyze the impact of epidural analgesia on the delivery mode, namely, cesarean delivery, vaginal delivery, and operative vaginal delivery rates, in Robson class 1 women.
STUDY DESIGN METHODS
A retrospective cohort study was conducted on all Robson class 1 women who delivered from January 1, 2019, to December 31, 2019, in the University Hospital of Modena. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were maternal, anesthesiologic, and neonatal effects of epidural analgesia (duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission).
RESULTS RESULTS
A total of 744 women were included in the final analysis, of which 198 (26.6%) underwent epidural analgesia on request and 546 (73.4%) did not. In women with and without epidural analgesia, the cesarean delivery rate was 8.1% vs 7%, the vaginal delivery rate was 79.3% vs 81.1%, and the operative vaginal delivery rate was 12.6% vs 11.9%, respectively. A significant increase in both the first stage of labor (66.3±38.5 vs 43.8±38.8 minutes;
CONCLUSION CONCLUSIONS
The use of epidural analgesia was not associated with an increased risk of cesarean delivery or operative vaginal delivery in Robson class 1 women. Further investigations are needed to evaluate its impact on the duration of labor, namely the duration of the first stage of labor, and on the possible advantages of starting epidural analgesia at an early stage.

Identifiants

DOI: 10.1016/j.xagr.2023.100207 PMID: 37168548 PMC: PMC10165263
pubmed: 37168548
doi: 10.1016/j.xagr.2023.100207
pii: S2666-5778(23)00048-5
pmc: PMC10165263
doi:

Types de publication

Journal Article

Langues

eng

Pagination

100207

Informations de copyright

© 2023 The Authors.

Références

Eur J Obstet Gynecol Reprod Biol. 2014 Dec;183:125-31
pubmed: 25461365
J Obstet Gynaecol Res. 2019 Aug;45(8):1435-1441
pubmed: 31131486
Lancet Glob Health. 2015 May;3(5):e260-70
pubmed: 25866355
Int J Obstet Anesth. 2018 May;34:37-41
pubmed: 29501538
Int J Gynaecol Obstet. 2022 Nov;159(2):356-364
pubmed: 35277971
Obstet Gynecol. 2012 Nov;120(5):1181-93
pubmed: 23090537
Int J Gynaecol Obstet. 2020 Oct;151(1):39-42
pubmed: 32602939
Acta Obstet Gynecol Scand. 2023 Jan;102(1):76-81
pubmed: 36345990
Cochrane Database Syst Rev. 2014 Feb 13;(2):CD003249
pubmed: 24523225
Am J Obstet Gynecol MFM. 2022 Mar;4(2):100548
pubmed: 34871779
Obstet Gynecol. 2009 Jan;113(1):230
pubmed: 19104388
J Obstet Gynecol Neonatal Nurs. 2018 Jan;47(1):32-42
pubmed: 29221671
Cochrane Database Syst Rev. 2014 Oct 09;(10):CD007238
pubmed: 25300169
Obstet Gynecol. 2019 Dec;134(6):1368-1369
pubmed: 31764756
Anesthesiology. 2018 Jul;129(1):192-215
pubmed: 29561267
J Am Board Fam Med. 2018 Sep-Oct;31(5):768-773
pubmed: 30201673
Cochrane Database Syst Rev. 2013 Jun 23;(6):CD007123
pubmed: 23794255
Best Pract Res Clin Obstet Gynaecol. 2002 Feb;16(1):17-30
pubmed: 11866494
Am J Obstet Gynecol. 2002 Oct;187(4):824-8
pubmed: 12388957
Br J Anaesth. 2022 Oct;129(4):567-580
pubmed: 35934529
Acta Obstet Gynecol Scand. 2020 Jul;99(7):909-916
pubmed: 31976544
Cochrane Database Syst Rev. 2018 May 21;5:CD000331
pubmed: 29781504
J Midwifery Womens Health. 2020 Sep;65(5):609-620
pubmed: 32286002
Obstet Gynecol. 2013 Jul;122(1):27-32
pubmed: 23743461
J Clin Med. 2022 Oct 18;11(20):
pubmed: 36294447
Am J Obstet Gynecol. 2018 Aug;219(2):162-168
pubmed: 29660298
Anesth Analg. 2017 May;124(5):1571-1580
pubmed: 27828798
Women Birth. 2021 Sep;34(5):e435-e441
pubmed: 32928689
Chin Med J (Engl). 2020 Mar 5;133(5):597-605
pubmed: 32032081
Obstet Gynecol Clin North Am. 1999 Dec;26(4):695-709
pubmed: 10587963
Can J Anaesth. 2013 Sep;60(9):840-54
pubmed: 23925722
Birth. 2018 Dec;45(4):377-384
pubmed: 29790194
Obstet Gynecol Clin North Am. 2017 Dec;44(4):547-566
pubmed: 29078938
Minerva Ginecol. 2011 Aug;63(4):325-32
pubmed: 21747340
Anaesthesia. 2022 Aug;77(8):910-918
pubmed: 35607864
BJOG. 2016 Apr;123(5):667-70
pubmed: 26681211
Cochrane Database Syst Rev. 2018 Sep 28;9:CD005528
pubmed: 30264405
J Matern Fetal Neonatal Med. 2017 Feb;30(4):461-465
pubmed: 27050812
N Engl J Med. 2005 Feb 17;352(7):655-65
pubmed: 15716559
Am J Obstet Gynecol. 2016 Mar;214(3):361.e1-6
pubmed: 26928148
Acta Obstet Gynecol Scand. 2020 Sep;99(9):1155-1162
pubmed: 32142154
Arch Gynecol Obstet. 2020 May;301(5):1153-1158
pubmed: 32219521
Br J Anaesth. 2010 Dec;105 Suppl 1:i50-60
pubmed: 21148655
Anesthesiol Clin. 2017 Mar;35(1):1-14
pubmed: 28131113
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100136
pubmed: 33345875
Obstet Gynecol. 2014 Mar;123(3):527-535
pubmed: 24499753

Auteurs

Fedora Ambrosetti (F)

Department of Medical and Surgical Sciences for Mother, Child, and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (Dr Ambrosetti, XX Grandi, XX Petrella, XX Sampogna, and XX Facchinetti).

Giovanni Grandi (G)

Department of Medical and Surgical Sciences for Mother, Child, and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (Dr Ambrosetti, XX Grandi, XX Petrella, XX Sampogna, and XX Facchinetti).

Elisabetta Petrella (E)

Department of Medical and Surgical Sciences for Mother, Child, and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (Dr Ambrosetti, XX Grandi, XX Petrella, XX Sampogna, and XX Facchinetti).

Veronica Sampogna (V)

Department of Medical and Surgical Sciences for Mother, Child, and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (Dr Ambrosetti, XX Grandi, XX Petrella, XX Sampogna, and XX Facchinetti).

Lara Donno (L)

Anesthesia and Intensive Care Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (XX Donno, XX Rinaldi, and XX Ghirardini).

Laura Rinaldi (L)

Anesthesia and Intensive Care Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (XX Donno, XX Rinaldi, and XX Ghirardini).

Anna Maria Ghirardini (AM)

Anesthesia and Intensive Care Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (XX Donno, XX Rinaldi, and XX Ghirardini).
Anesthesia Unit, Ospedale di Sassuolo, Sassuolo, Italy (XX Ghirardini).

Fabio Facchinetti (F)

Department of Medical and Surgical Sciences for Mother, Child, and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (Dr Ambrosetti, XX Grandi, XX Petrella, XX Sampogna, and XX Facchinetti).

Classifications MeSH