Epidural Analgesia and Neonatal Morbidity: A Retrospective Cohort Study

Abstract

(1) Background: Epidural analgesia (EA), at the present time, is one of the most effective methods to reduce labor pain. In recent years its use has increased, being used between 20⁻70% of all deliveries; (2) Methods: Historical cohort on a total of 2947 deliveries during the years 2012⁻2016 at the "Mancha-Centro Hospital" of Alcázar de San Juan. The main outcome variables were four neonatal morbidity (NM) criteria: umbilical artery pH of <7.10, Apgar score at 5 min < 7, need for advanced resuscitation and composite morbidity. We used the multivariate analysis to control confounding bias. (3) Results: No statistical relationship between EA and the second stage of labor duration with none of the four criteria of NM used (p > 0.005). However, the type of delivery was associated with three criteria (pH, resuscitation, and composite morbidity). The instrumental delivery presented an OR of pH < 7.10 of 2.68 95% CI [1.15, 6.27], an OR of advanced resuscitation of 2.44 95% CI [1.17, 5.08] and OR of composite morbidity of 2.86 95% CI [1.59, 5.12]; (4) Conclusions: The EA and the second stage of labor duration are not related to the NM. While the instrumental delivery doubles the risk of NM compared to the normal vaginal delivery.

Keywords: Apgar; epidural analgesia; neonatal morbidity; neonatal resuscitation; umbilical artery pH.

Figure 1

Selection of the subjects under study. (a) Population 1. Selection of the subjects under study. (b) Population 2. Selection of the subjects under study.

Figure 1

Selection of the subjects under study. (a) Population 1. Selection of the subjects under study. (b) Population 2. Selection of the subjects under study.