Epidural analgesia and rate of cesarean section, maternal and neonatal outcomes: Retrospective study

Abstract

The neuraxial technique is standard medical care for labor pain relief. Epidural analgesia is linked to an increased likelihood of assisted vaginal birth but does not raise the overall cesarean section (CS) delivery risk. Few studies in the Middle East and Saudi Arabia have examined epidural analgesia's effect on emergency cesarean section rates among vaginal deliveries. This retrospective study at a tertiary care center in Saudi Arabia included 387 term pregnant women. Patients were divided into two groups: 240 received epidural analgesia, and 147 served as controls. Inclusion criteria included women aged 18-40 with specific fetal characteristics. Maternal and neonatal outcomes were analyzed using Chi-squared, Fisher's exact, and Wilcoxon tests. Women who received epidural analgesia were younger, with lower gravidity and parity, and had a higher rate of emergency cesarean sections. No significant differences were found in instrumental delivery rates, severe tears, or postpartum hemorrhage between groups. Neonatal outcomes, including Apgar scores, birth weight, and neonatal intensive care unit (NICU) admissions, were similar. Logistic regression indicated a higher likelihood of emergency CS with epidural analgesia, but this was insignificant in multivariable analysis. Gravidity and parity were inversely associated with emergency CS and instrumental deliveries. While epidural analgesia was linked to higher C-sections, further analysis showed no significant effect. Maternal and neonatal outcomes were similar between groups. These findings support the safe use of epidural analgesia for labor pain management in Saudi Arabia, offering reassurance to both patients and healthcare providers.

Keywords: Cesarean sections; NICU; epidural analgesia; instrumental deliveries; vaginal birth.

Figure 1

The rates of routes of birth in the current study