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Joyce C, Free R, Calpin P, Browne I, Robson M, Ffrench-O'Carroll R. Programmed intermittent epidural bolus regimen vs continuous epidural infusion: a retrospective study of motor block and obstetric outcomes using the Robson's Ten Group Classification System. Int J Obstet Anesth 2024; 59:104215. [PMID: 38902179 DOI: 10.1016/j.ijoa.2024.104215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Use of a programmed intermittent epidural bolus (PIEB) regimen during labour is associated with several benefits over a continuous epidural infusion (CEI), including reduced local anaesthetic consumption and reduced risk of motor block. We hypothesise that the benefits of a PIEB regimen may vary according to the Robson Ten Group Classification System (TGCS). The aim of this study was to determine if introduction of a PIEB regimen was associated with reduced incidence of motor block. We also wished to examine changes in obstetric outcomes following PIEB introduction across the Robson TGCS. METHODS This was a single-centre retrospective cohort study. Data were collected over two three-month periods before and after PIEB introduction. The primary outcome was the incidence of motor block. Maternal and obstetric outcomes across Robson Groups 1-4 were analysed. RESULTS Introduction of PIEB was associated with reduced incidence of motor block (28.4% (95% CI 25.7% to 31.3%) vs 22.4%, (95% CI 19.9% to 25.2%), difference 5.9% (95% CI 1.0% to 21.1%), P=0.003), with no association with changes in rates of caesarean section, operative vaginal delivery or other obstetric outcomes. Use of a PIEB regimen was associated with reduced incidence of motor block in Robson Group 4a (20.3% (16.0%, 28.0%) vs 12.0%, (7.6%, 16.4%), difference 9.9% (95% CI -17.4% to -2.4%) P=0.009). There were no significant changes in other outcomes assessed across Robson TGCS. CONCLUSION Introduction of PIEB for maintenance of labour analgesia was associated with reduced incidence of motor block in our institution compared with CEI. Presenting results according to Robson's TGCS in future studies may allow better elucidation of the impact of neuraxial analgesia on maternal and obstetric outcomes.
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Affiliation(s)
- C Joyce
- Department of Anaesthesiology, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - R Free
- Department of Anaesthesiology, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - P Calpin
- Department of Anaesthesiology, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - I Browne
- Department of Anaesthesiology, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - M Robson
- Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles Street, Dublin, Ireland
| | - R Ffrench-O'Carroll
- Department of Anaesthesiology, National Maternity Hospital, Holles Street, Dublin, Ireland.
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Allert R, Brüggmann D, Raimann FJ, Zander N, Louwen F, Jennewein L. The influence of epidural anesthesia in pregnancies with scheduled vaginal breech delivery at term: a hospital-based retrospective analysis. Arch Gynecol Obstet 2024; 310:261-268. [PMID: 37982831 PMCID: PMC11169086 DOI: 10.1007/s00404-023-07244-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/20/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there's little evidence and recommends further evaluation. OBJECTIVE The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia. DESIGN This study was a retrospective cohort study. SAMPLE This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018. METHODS Neonatal and maternal outcome was analyzed and compared between women receiving "walking" epidural anesthesia and women without an epidural anesthesia. RESULTS Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)". CONCLUSION Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.
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Affiliation(s)
- Roman Allert
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany.
| | - Dörthe Brüggmann
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Florian J Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Nadja Zander
- Department of Midwifery Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Frank Louwen
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
| | - Lukas Jennewein
- Department of Obstetrics and Gynecology, University Hospital Frankfurt, Goethe University, 60590, Frankfurt, Germany
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Fumagalli S, Nespoli A, Panzeri M, Pellegrini E, Ercolanoni M, Vrabie PS, Leoni O, Locatelli A. Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:629. [PMID: 38791843 PMCID: PMC11121066 DOI: 10.3390/ijerph21050629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Although the quality of care during childbirth is a maternity service's goal, less is known about the impact of the birth setting dimension on provision of care, defined as evidence-based intrapartum midwifery practices. This study's aim was to investigate the impact of hospital birth volume (≥1000 vs. <1000 births/year) on intrapartum midwifery care and perinatal outcomes. We conducted a population-based cohort study on healthy pregnant women who gave birth between 2018 and 2022 in Lombardy, Italy. A total of 145,224 (41.14%) women were selected from nationally linked databases. To achieve the primary aim, log-binomial regression models were constructed. More than 70% of healthy pregnant women gave birth in hospitals (≥1000 births/year) where there was lower use of nonpharmacological coping strategies, higher likelihood of epidural analgesia, episiotomy, birth companion's presence at birth, skin-to-skin contact, and first breastfeeding within 1 h (p-value < 0.001). Midwives attended almost all the births regardless of birth volume (98.80%), while gynecologists and pediatricians were more frequently present in smaller hospitals. There were no significant differences in perinatal outcomes. Our findings highlighted the impact of the birth setting dimension on the provision of care to healthy pregnant women.
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Affiliation(s)
- Simona Fumagalli
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (S.F.); (A.N.); (A.L.)
- Department of Obstetrics, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (S.F.); (A.N.); (A.L.)
- Department of Obstetrics, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Maria Panzeri
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (S.F.); (A.N.); (A.L.)
| | - Edda Pellegrini
- Maternal and Child Committee, Lombardy Region, 20124 Milan, Italy;
| | | | | | - Olivia Leoni
- Welfare Department, Epidemiologic Observatory, Lombardy Region, 20124 Milan, Italy;
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano Bicocca, 20900 Monza, Italy; (S.F.); (A.N.); (A.L.)
- Department of Obstetrics, Foundation IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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Ghidini A, Vanasche K, Cacace A, Cacace M, Fumagalli S, Locatelli A. Side effects from epidural analgesia in laboring women and risk of cesarean delivery. AJOG GLOBAL REPORTS 2024; 4:100297. [PMID: 38283322 PMCID: PMC10820310 DOI: 10.1016/j.xagr.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Epidural analgesia may cause maternal hypotension and changes in the fetal heart rate. The implications of such side effects on the course of labor and delivery are incompletely understood. OBJECTIVE This study aimed to assess whether the occurrence of maternal or fetal side effects associated with labor epidural analgesia increased the risk for cesarean delivery. STUDY DESIGN This was a cohort study of all women who underwent epidural analgesia during labor for the period October 1, 2020 to December 31, 2020. Excluded were cases of multiples, fetal death, noncephalic presentation, and gestational age at birth <37.0 weeks. Maternal vital signs and fetal heart rate tracings for the 1 hour before and 1 hour after epidural analgesia was administered were reviewed. The occurrence of maternal hypotension, defined as a continuous variable and dichotomized into a decrease in maternal systolic blood pressure to <90 mm Hg or a drop in systolic blood pressure by >20% below the last value before epidural analgesia was administered, was related to changes in the fetal heart rate category. The principal outcome was cesarean delivery rate; binary logistic regression analysis was used to control for confounders, and mediation model analysis was used to quantify the extent to which significant variables participated in the causation pathway to cesarean delivery (SPSS version 28 was used for the analyses). RESULTS A total of 439 women met the study criteria. Significant adverse reactions owing to epidural occurred in 184 of 439 women (41.9%) and included severe maternal hypotension in 159 of 439 participants (36.2%) and worsening fetal heart rate category in 50 of 439 participants (11.4%). The logistic regression analysis revealed that cervical dilation at epidural (P=.03), the duration of labor after epidural (P<.001), and worsening fetal heart rate category within 60 minutes of epidural administration (P=.01) were independently associated with recourse to cesarean delivery. The mediation analysis showed that both cervical dilatation at epidural administration and worsening fetal heart rate category had significant direct and indirect effects in the pathway to cesarean delivery. CONCLUSION Worsening fetal heart rate category related to labor epidural independently increased the risk for cesarean delivery.
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Affiliation(s)
- Alessandro Ghidini
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Kelly Vanasche
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Alyssa Cacace
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA, USA (Alyssa Cacace)
| | - Marietta Cacace
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli)
- Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli)
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli)
- Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli)
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Lucovnik M, Verdenik I, Stopar Pintaric T. Intrapartum Cesarean Section and Perinatal Outcomes after Epidural Analgesia or Remifentanil-PCA in Breech and Twin Deliveries. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1026. [PMID: 37374230 DOI: 10.3390/medicina59061026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Comparative data on the potential impact of various forms of labor analgesia on the mode of delivery and neonatal complications in vaginal deliveries of singleton breech and twin fetuses are lacking. The present study aimed to determine the associations between type of labor analgesia (epidural analgesia (EA) vs. remifentanil patient-controlled analgesia (PCA)) and intrapartum cesarean sections (CS), and maternal and neonatal adverse outcomes in breech and twin vaginal births. A retrospective analysis of planned vaginal breech and twin deliveries at the Department of Perinatology, University Medical Centre Ljubljana, was performed for the period 2013-2021, using data obtained from the Slovenian National Perinatal Information System. The pre-specified outcomes studied were the rates of CS in labor, postpartum hemorrhage, obstetric anal sphincter injury (OASI), an Apgar score of <7 at 5 min after birth, birth asphyxia, and neonatal intensive care admission. A total of 371 deliveries were analyzed, including 127 term breech and 244 twin births. There were no statistically significant nor clinically relevant differences between the EA and remifentanil-PCA groups in any of the outcomes studied. Our findings suggest that both EA and remifentanil-PCA are safe and comparable in terms of labor outcomes in singleton breech and twin deliveries.
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Affiliation(s)
- Miha Lucovnik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Ivan Verdenik
- Department of Perinatology, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slajmerjeva 3, 1000 Ljubljana, Slovenia
| | - Tatjana Stopar Pintaric
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Slajmerjeva 3, 1000 Ljubljana, Slovenia
- Institute of Anatomy, Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Fieni S, di Pasquo E, Formisano D, Basevi V, Perrone E, Ghi T. Epidural analgesia and the risk of operative delivery among women at term: A propensity score matched study. Eur J Obstet Gynecol Reprod Biol 2022; 276:174-178. [DOI: 10.1016/j.ejogrb.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022]
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Delivery mode and neonatal morbidity after remifentanil-PCA or epidural analgesia using the Ten Groups Classification System: A 5-year single-centre analysis of more than 10 000 deliveries. Eur J Obstet Gynecol Reprod Biol 2022; 277:53-56. [PMID: 35998385 DOI: 10.1016/j.ejogrb.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to explore the potential association between remifentanil patient-controlled analgesia (RPCA) or epidural analgesia (EA), and caesarean section (CS) rate, operative vaginal delivery rate (OVD), operative delivery (OD) rate (CS or OVD) with pathological cardiotocography (CTG) tracing, Apgar score < 7 at 5 min after birth, incidence of perinatal asphyxia and neonatal intensive care unit (NICU) admission within four groups of the Ten Groups Classification System (TGCS) labour types; group 1: nulliparous, singleton cephalic, ≥37 weeks, spontaneous onset of labour; group 2a: nulliparous, singleton cephalic, ≥37 weeks, induction of labour; group 3: multiparous, singleton cephalic, ≥37 weeks, spontaneous onset of labour; group 4a: multipara, singleton cephalic, ≥37 weeks, induction of labour). We hypothesized that labour and delivery outcomes between RPCA and EA would differ within the different TGCS labour types. STUDY DESIGN 10,561 deliveries (4876 with RPCA, 5685 with EA) at the University Clinical Centre Ljubljana, Slovenia, from 2015 through 2019 were analysed using the Slovenian National Perinatal Information System data. RESULTS Compared to EA, RPCA was associated with lower CS and OVD rates in nulliparous women with spontaneous onset of labour (group 1) (CS: 9.9 % vs14.3 %; P < 0.001) (OVD: 5.1 % vs 8.4 %; P < 0.001), in nulliparous women with induced labour (group 2a) (CS: 14.8 % vs 24.2 %; P < 0.001) (OVD: 6.5 % vs 8.9 %; P = 0.036) and in multiparous women with spontaneous onset of labour (group 3) (CS: 1.1 % vs 2.4 %; P = 0.021) (OVD: 0.1 % vs 0.8 %; P = 0.007), respectively. RPCA was associated with a lower incidence of OD with pathologic CTG in all four studied groups (groups 1, 2a, 3, 4a). No differences in APGAR < 7 at 5 min, neonatal asphyxia, and NICU admission were recorded between the two analgesic techniques within any of the TGCS groups. CONCLUSION Compared to EA, RPCA was not associated with worse delivery and neonatal outcomes within any of the four studied TGCS groups. RPCA could be used for labour analgesia routinely if strict adherence to protocols is ensured and regular staff training is provided.
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Levin G, Tsur A, Tenenbaum L, Mor N, Zamir M, Meyer R. Predictors of successful vaginal birth after cesarean without an epidural among women with no prior vaginal delivery. Birth 2022; 49:159-165. [PMID: 34490653 DOI: 10.1111/birt.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/31/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data are scarce on predictors for success of labor after cesarean (LAC) among women delivering without epidural anesthesia (EA). We aimed to study the predictors for success of LAC among women with no prior vaginal delivery that did not use EA. METHODS A retrospective study including all women undergoing LAC between 3/2011 and 1/2021 with no prior vaginal delivery that did not use EA. Factors associated with successful vaginal birth after cesarean were examined using multivariable analysis. RESULTS Of the 466 no EA LAC, 339 (72.7%) delivered vaginally. Women in the successful LAC group had lower pregestational and predelivery BMI as compared to those who had a repeat cesarean [odds ratio (OR) 95% confidence interval (CI) 0.90 (0.85-0.94), P < 0.001, and 0.89 (0.85-0.93), P < 0.001, respectively]. The rate of labor dystocia in previous cesarean was lower in the LAC success group [92 (27.1%) vs 50 (39.4%), OR 95% CI 0.57 (0.37-0.88)]. Mean gestational age at LAC was lower in the LAC success group (385/7 ± 25/7 vs 395/7 ± 15/7 , P = 0.014). In a multivariable logistic regression analysis, the following factors were negatively and independently associated with LAC success: higher predelivery BMI [adjusted odds ratio (aOR) 95% CI 0.90 (0.86-0.95)], higher gestational age at previous cesarean and at LAC [aOR 95% CI 0.81 (0.70-0.93) and 0.97 (0.94-0.98), respectively], induction of labor [aOR 95% CI 0.08 (0.03-0.25)], and duration of ruptured membranes [aOR 95% CI 0.97 (0.96-0.99)]. CONCLUSIONS We have identified that lower BMI, lower gestational age, shorter ruptured membranes duration, and spontaneous labor are associated with successful LAC among nonusers of EA with no prior vaginal delivery at one tertiary care facility in Israel.
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Affiliation(s)
- Gabriel Levin
- Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Lee Tenenbaum
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Nizan Mor
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Michal Zamir
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv-Hebrew University, Tel-Aviv, Israel
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Newnham EC, Moran PS, Begley CM, Carroll M, Daly D. Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study. Women Birth 2021; 34:e435-e441. [DOI: 10.1016/j.wombi.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Lin R, Shi P, Li H, Liu Z, Xu Z. Association between epidural analgesia and indications for intrapartum caesarean delivery in group 1 of the 10-group classification system at a tertiary maternity hospital, Shanghai, China: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:464. [PMID: 34187400 PMCID: PMC8243735 DOI: 10.1186/s12884-021-03925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background In this study, we aimed to determine whether epidural analgesia affects the indications for intrapartum caesarean delivery, such as foetal distress, dystocia, or maternal request, in nulliparous term women with spontaneous labour (Group 1 in the 10-Group Classification System). Methods We conducted a retrospective cohort study and collected data from the electronic medical records of deliveries performed in our institution between 1 January 2017 and 30 June 2017. Women conforming to the criterion of Group 1 according to the 10-Group Classification System were enrolled. We compared labour outcomes between women with and without epidural analgesia and analysed the association between epidural analgesia and indications for caesarean by using multivariate logistic regression analysis. Results A total of 3212 women met the inclusion criteria, and 2876 were enrolled in the final analyses. Women who received epidural analgesia had a significantly lower intrapartum caesarean delivery rate (16.0% vs. 26.7%, P < 0.001), higher rates of amniotomy (53.4% vs. 42.3%, P < 0.001) and oxytocin augmentation (79.5% vs. 67.0%, P < 0.001), and a higher incidence of intrapartum fever (≥38 °C) (23.3% vs. 8.5%, P < 0.001) than those who did not receive epidural analgesia. There were no significant differences between the groups for most indications, except a lower probability of maternal request for caesarean delivery (3.9% vs. 10.5%, P < 0.001) observed in women who received epidural analgesia than in those who did not. Epidural analgesia was revealed to be associated with a decreased risk of maternal request for caesarean delivery (adjusted odds ratio [aOR], 0.30; 95% confidence interval [CI], 0.22–0.42; P < 0.001); however, oxytocin augmentation was related to an increased risk of maternal request (aOR, 2.34; 95%CI, 1.47–3.75; P < 0.001). Regarding the reasons for the maternal request for caesarean delivery, significantly fewer women complained of pain (0.5% vs. 4.6%, P < 0.001) or had no labour progress (1.3% vs. 3.6%, P < 0.001) among those who received analgesia. Conclusions Among the women in Group 1, epidural analgesia was associated with a lower intrapartum caesarean delivery rate, which may be explained by a reduction in the risk of maternal request for an intrapartum caesarean delivery.
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Affiliation(s)
- Rong Lin
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 W Gaoke Rd, Shanghai, 201024, China
| | - Peng Shi
- Department of Statistics and Data Management, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, China.,Center of Evidence-based Medicine, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, China
| | - Haibing Li
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 W Gaoke Rd, Shanghai, 201024, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 W Gaoke Rd, Shanghai, 201024, China.
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2699 W Gaoke Rd, Shanghai, 201024, China.
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Gu N, Dai Y, Lu D, Chen T, Zhang M, Huang T, Qi Y, Han X, Xie L, Yang J, Fan C, Yan Y, Zhang A, Weng X, Zhang H, Su L, Li Y, Hu Y. Evaluation of cesarean delivery rates in different levels of hospitals in Jiangsu Province, China, using the 10-Group classification system. J Matern Fetal Neonatal Med 2021; 35:5539-5545. [PMID: 33588678 DOI: 10.1080/14767058.2021.1887124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare cesarean delivery (CD) rates in referral and non-referral hospitals in Maternal Safety Collaboration in Jiangsu province, China. METHODS Sixteen participants (4 referral hospitals, 12 non-referral hospitals) from Drum Tower Hospital Collaboration for Maternal Safety reported CD rates in 2019 using ten-group classification system and maternal/neonatal morbidity and mortality. RESULTS A total of 22,676 CDs were performed among 52,499 deliveries and the average CD rate was 43.2% (range 34.8-69.6%). CD rate in non-referral hospitals (44.7%) was significantly higher than it was in referral hospitals (40.4%, p < .001). Term singleton cephalic nulliparous women with spontaneous labor (Group 1) or induced labor (Group 2a) had higher CD rates if they were cared in non-referral hospitals compared with those in referral hospitals (Group 1: 11.8% vs. 4.4%, p < .001; Group 2a: 29.1% vs. 21.3%, p < .001). In non-referral hospitals, CD rate in Group 5 and the proportion of Group 5 to the overall population were also significantly higher than those in referral hospitals (98.5% vs. 92.5%, p < .001; and 21.0% vs. 14.5%, p < .001). CONCLUSION To decrease the CD rate, we need to take efforts in decreasing unnecessary operations for term singleton cephalic nulliparous women and increasing the rate of trial of labor after CD.
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Affiliation(s)
- Ning Gu
- Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Yimin Dai
- Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
| | - Dan Lu
- Department of Obstetrics and Gynecology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, China
| | - Tingmei Chen
- Department of Obstetrics and Gynecology, Jiangsu University Affiliated Fourth Hospital, Zhenjiang, China
| | - Muling Zhang
- Department of Obstetrics and Gynecology, Huaian First People's Hospital Affiliated to Nanjing Medical University, Huaian, China
| | - Tao Huang
- Department of Obstetrics and Gynecology, Yangzhou Maternal and Child Health Hospital, Yangzhou, China
| | - Yalan Qi
- Department of Obstetrics and Gynecology, Suqian People's Hospital of Nanjing Drum Tower Hospital Group, Suqian, China
| | - Xinning Han
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Lihua Xie
- Department of Obstetrics and Gynecology, Nanjing Gaochun People's Hospital, Nanjing, China
| | - Jishi Yang
- Department of Obstetrics and Gynecology, Taixing People's Hospital, Taizhou, China
| | - Chengling Fan
- Department of Obstetrics and Gynecology, Baoying Maternal and Child Health Hospital, Yangzhou, China
| | - Yunhua Yan
- Department of Obstetrics and Gynecology, The People's Hospital of Danyang, Zhenjiang, China
| | - Anhong Zhang
- Department of Obstetrics and Gynecology, The Affiliated Jiangning Hospital Of Nanjing Medical University, Nanjing, China
| | - Xiaoping Weng
- Department of Obstetrics and Gynecology, Luhe People's Hospital, Nanjing, China
| | - Huiling Zhang
- Department of Obstetrics and Gynecology, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Li Su
- Department of Obstetrics and Gynecology, Yangzhong People's Hospital, Zhenjiang, China
| | - Yingyan Li
- Department of Obstetrics and Gynecology, Gaochun Fukang Hospital, Nanjing, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
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Landau R, Friedman A, Guglielminotti J. Neuraxial labor analgesia, obstetrical outcomes, and the Robson 10-Group Classification. Int J Obstet Anesth 2018; 37:1-4. [PMID: 30545585 DOI: 10.1016/j.ijoa.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/31/2018] [Accepted: 11/20/2018] [Indexed: 11/17/2022]
Affiliation(s)
- R Landau
- Department of Anesthesiology and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, USA.
| | - A Friedman
- Department of Anesthesiology and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, USA
| | - J Guglielminotti
- Department of Anesthesiology and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, USA
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