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Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study.
Arch Gynecol Obstet. 2023 04; 307(4):1233-1241.AG

Abstract

PURPOSE

To compare the effects of epidural analgesia (EA) and combined spinal epidural analgesia (SEA) on labor and maternal-fetal outcomes.

METHODS

We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal-fetal outcomes were retrieved from the prospectively collected delivery room database and medical records.

RESULTS

SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 min. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06-1.64, p = 0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34-0.9, p = 0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes.

CONCLUSIONS

SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal-fetal outcomes will allow concluding about the superiority of one technique upon the other.

Links

Authors+Show Affiliations

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy. Department of Obstetrics and Gynecology, Santa Chiara Hospital, APSS Trento, Trento, Italy.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.

Department of Anesthesia and Intensive Care, AOUI Verona, University of Verona, Verona, Italy.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy. boscomariachiara@gmail.com.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.

Department of Obstetrics and Gynecology, Santa Chiara Hospital, APSS Trento, Trento, Italy.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.

Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy.

MeSH

PregnancyFemaleHumansRetrospective StudiesLabor, ObstetricAnalgesia, EpiduralPain ManagementAnesthesia, SpinalAnalgesia, Obstetrical

Pub Type(s)

Journal Article

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

35599249

Citation

Lazzari, Cecilia, et al. "Effects of Neuraxial Analgesia Technique On Labor and Maternal-fetal Outcomes: a Retrospective Study." Archives of Gynecology and Obstetrics, vol. 307, no. 4, 2023, pp. 1233-1241.

Lazzari C, Raffaelli R, D'Alessandro R, et al. Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study. Arch Gynecol Obstet. 2023;307(4):1233-1241.

Lazzari, C., Raffaelli, R., D'Alessandro, R., Simonetto, C., Bosco, M., Zorzato, P. C., Uccella, S., Taddei, F., Franchi, M., & Garzon, S. (2023). Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study. Archives of Gynecology and Obstetrics, 307(4), 1233-1241. https://doi.org/10.1007/s00404-022-06600-6

Lazzari C, et al. Effects of Neuraxial Analgesia Technique On Labor and Maternal-fetal Outcomes: a Retrospective Study. Arch Gynecol Obstet. 2023;307(4):1233-1241. PubMed PMID: 35599249.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Effects of neuraxial analgesia technique on labor and maternal-fetal outcomes: a retrospective study. AU - Lazzari,Cecilia, AU - Raffaelli,Ricciarda, AU - D'Alessandro,Roberto, AU - Simonetto,Chiara, AU - Bosco,Mariachiara, AU - Zorzato,Pier Carlo, AU - Uccella,Stefano, AU - Taddei,Fabrizio, AU - Franchi,Massimo, AU - Garzon,Simone, Y1 - 2022/05/22/ PY - 2022/03/23/received PY - 2022/04/27/accepted PY - 2022/5/23/pubmed PY - 2023/3/22/medline PY - 2022/5/22/entrez KW - Combined spinal epidural analgesia, Epidural analgesia KW - First stage of labor KW - Labor analgesia KW - Labor duration KW - Maternal–fetal outcomes SP - 1233 EP - 1241 JF - Archives of gynecology and obstetrics JO - Arch Gynecol Obstet VL - 307 IS - 4 N2 - PURPOSE: To compare the effects of epidural analgesia (EA) and combined spinal epidural analgesia (SEA) on labor and maternal-fetal outcomes. METHODS: We retrospectively identified and included 1499 patients with a single cephalic fetus who delivered at the study center from January 2015 to December 2018 and received neuraxial analgesia at the beginning of the active phase of labor (presence of regular painful contractions and cervical dilatation between 4 and 6 cm). Data including analgesia, labor characteristics, and maternal-fetal outcomes were retrieved from the prospectively collected delivery room database and medical records. RESULTS: SEA was associated with a shorter first stage of labor than EA, with a median difference of 60 min. On multivariable ordinal logistic regression analysis, neuraxial analgesia, gestational age, fetal weight, labor induction, and parity were independently associated with the first stage length: patients in the EA group were 1.32 times more likely to have a longer first stage of labor (95% CI 1.06-1.64, p = 0.012) than those in the SEA group. Additionally, a significantly lower incidence of fundal pressure was performed among patients who underwent SEA (OR 0.55, 95% CI 0.34-0.9, p = 0.017). No associations were observed between the used neuraxial analgesia technique and other outcomes. CONCLUSIONS: SEA was associated with a shorter length of the first stage of labor and a lower rate of fundal pressure use than EA. Further studies confirming the effects of SEA on labor management and clarifying differences in maternal-fetal outcomes will allow concluding about the superiority of one technique upon the other. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/35599249/Effects_of_neuraxial_analgesia_technique_on_labor_and_maternal_fetal_outcomes:_a_retrospective_study_ DB - PRIME DP - Unbound Medicine ER -