[Epidural analgesia during labour with a singleton alive fetus at term]

Abstract

Objective: Whether epidural analgesia (e.a.) have influence on the way of delivery, indications to cesarean section (c.s.) and neonatal outcome.

Material and methods: We have analysed 8784 deliveries. We excluded women with plural pregnancy, pre-term parturitions, elective c.s., still births. Finally we studied 339 parturitions with e.a. versus 6868 the others and theirs newborns.

Results: More frequent c.s. was in women with e.a. (18.6% vs 7.9%; p < 0.001) or forceps (f.d.) (7.7% vs 3.5%; p < 0.005). Among those with e.a. the most frequent indications to c.s. were labour with no progression (23.4% vs 4.0%; p < 0.001) and the others as hypoxia fetus (68.7% vs 82.6%; p < 0.01). The lost of blood with oblique to transfusion was more frequent at f.d. at comparison to c.s. and spontaneous delivery (26.9% vs 3.2% and 6.8%; p < 0.001). The condition of neonates at 1 min. according Apgar score was the worse after f.d. in comparison to spontaneous delivery (7.38 +/- 2.22 vs 8.79 +/- 1.41 points; p < 0.005) and after c.s. (7.38 +/- 2.22 vs 8.55 points; p < 0.05). In comparison the state at 5 min. was the similar after f.d. (9.11 +/- 1.24 vs 9.53 +/- 0.81 points; p = 0.05) and (9.11 +/- 1.24 vs 9.48 +/- 0.83 points; p = 0.09).

Conclusions: Women with epidural analgesia more frequent were ending the delivery by cesarean section or forceps. The forceps delivery was related with worse neonatal outcome at first minutes of live, and bigger lost of blood during labour. Epidural analgesia predisposed to cesarean section delivery caused of partus without progress and relatively deminished caused by fetus hypoxia.