The effect of epidural analgesia on the course of the labour and neonatal outcomes

Saulė Starkauskaitė1

1Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

Abstract: epidural analgesia is considered to be the most effective and most often recommended method of pain relief during labour. Anyway, in literature epidural analgesia is associated with various childbirth complications – increased rates of instrumental delivery, caesarean section, dystocia, longer duration of labour and worse neonatal outcomes.

Aim: to investigate whether the use epidural analgesia can be associated with worse rates of labor and neonatal outcomes.

Methods: in this retrospective cohort study, we reviewed medical records of 609 primiparous women, who gave birth in the hospital of Lithuanian University of Health Science Kaunas Clinics. The study group of 220 pregnant women at term who delivered under epidural analgesia was compared with the control group of 389 patients, who delivered without epidural analgesia. The rates of vacuum extraction, caesarean section, dystocia and the status of newborns were reviewed and compared between the groups.

Results: caesarean section was significantly more common among controls (26.2% vs 19.1%, p=0.048). They also showed a greater need of vacuum extraction although the difference was statistically insignificant (2.3% vs 1.4%, p=0.551). Dystocia was more often diagnosed for women, who delivered under epidural analgesia (11.4% vs 5.1%, p=0.006). The longer duration of labour was also found in the study group (602 ± 358 min vs 480 ± 384 min; p<0.0001). The neonatal status according to Apgar score after 1 and 5 minutes did not differ significantly between the groups (p=0.335 and p=0.691).

Conclusions:  the use of epidural analgesia for the pain relief during labour did not increase the incidence of instrumental delivery or caesarean section and did not cause worse neonatal outcomes. Women who delivered under epidural analgesia had a significantly longer duration of labor and were more likely to require drug induction of labour.

Keywords: epidural analgesia, caesarean section, vacuum extraction, dystocia, duration of the delivery.