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Delivery mode and maternal and neonatal outcomes of combined spinal–epidural analgesia compared with no analgesia in spontaneous labor: A single‐center observational study in Japan
Author(s) -
Kurakazu Masamitsu,
Umehara Nagayoshi,
Nagata Chie,
Yamashita Yoko,
Sato Masaki,
Sago Haruhiko
Publication year - 2020
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.14194
Subject(s) - medicine , odds ratio , confidence interval , apgar score , obstetrics , oxytocin , logistic regression , anesthesia , retrospective cohort study , pregnancy , gynecology , fetus , surgery , genetics , biology
Aim We aimed to assess the outcomes of combined spinal–epidural (CSE) analgesia compared with no analgesia in spontaneous labor. Methods We performed a retrospective cohort study of deliveries between 2008 and 2014 comparing two groups based on the use of CSE analgesia in both nulliparous and multiparous women. Adjusted odds ratios (aOR) were calculated using logistic regression analysis. Results Among 5247 (3334 nulliparous, 1913 multiparous) singleton deliveries, 3041 (2045, 996, respectively) patients received CSE analgesia and 2206 (1289, 917, respectively) had no analgesia. CSE analgesia was associated with increased risk of oxytocin augmentation ( P < 0.01), prolonged duration of labor ( P < 0.01), instrumental delivery (aOR, 3.35; 95% confidence interval (CI), 2.69–4.19 for nulliparous and aOR, 2.13; 95% CI, 1.32–3.53 for multiparous women), blood loss volume during vaginal delivery ( P < 0.01), meconium‐stained amniotic fluid (aOR, 1.23; 95% CI, 1.02–1.51 and aOR, 1.39; 95% CI, 1.01–1.93) and Apgar score less than 7 at 1 min (aOR, 1.85; 95% CI, 1.28–2.74 and aOR, 2.65; 95% CI, 1.35–5.61) in both nulliparous and multiparous women, respectively, and umbilical arterial blood gas pH less than 7.15 (aOR, 2.69; 95% CI, 1.35–5.75) and umbilical arterial blood gas pH less than 7.10 (aOR, 3.69; 95% CI, 1.11–16.69) in multiparous women. There was no significant difference in incidence of cesarean delivery or Apgar score less than 7 at 5 min. Conclusion We observed several increased risks in obstetric and neonatal outcomes among pregnant women who received CSE analgesia during labor. Preparations for these risks are needed when administering CSE analgesia during labor.