Liang Ching-Chung, Wong Shu-Yam, Chang Yao-Lung, Tsay Pei-Kwei, Chang Shuenn-Dhy, Lo Liang-Ming
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital. 5, Fusing St., Gueishan Township, Taoyuan County 333, Taiwan, ROC.
Chang Gung Med J. 2007 Mar-Apr;30(2):161-7.
The effect of epidural analgesia on nulliparous labor and delivery remains controversial. In addition, pregnancy and delivery have long been considered risk factors in the genesis of stress urinary incontinence (SUI). We sought to determine the effect of epidural analgesia and timing of administration on labor course and postpartum SUI.
Five hundred and eighty three nulliparous women were admitted for vaginal delivery at > or = 36 gestational weeks. We compared various obstetric parameters and SUI, at puerperium and 3 months postpartum, among patients who had epidural and non-epidural analgesia, and among those who had early (cervical dilatation < 3 cm) and late (cervical dilatation > or = 3 cm) epidural analgesia.
When compared with the non-epidural analgesia group (n = 319), the group that received epidural analgesia (n = 264) had significant prolongation of the first and second stages of labor, and higher likelihood for instrumental and cesarean delivery but similar incidence of severe vaginal laceration and postpartum SUI. Except for the first stage of labor, early administration of epidural analgesia did not result in a significant influence on obstetric parameters or an increased incidence of postpartum SUI.
Our findings showed that epidural analgesia is associated with an increased risk of prolonged labor, and instrumental and cesarean delivery but is not related to increased postpartum SUI. Regarding the impact of the timing of epidural analgesia given in the labor course, the first stage of labor appeared to last longer when analgesia was administered early rather than late.
硬膜外镇痛对初产妇分娩的影响仍存在争议。此外，妊娠和分娩长期以来一直被认为是压力性尿失禁（SUI）发生的危险因素。我们试图确定硬膜外镇痛及其给药时机对产程和产后压力性尿失禁的影响。
583例孕36周及以上的初产妇因阴道分娩入院。我们比较了硬膜外镇痛和非硬膜外镇痛患者，以及早期（宫颈扩张<3 cm）和晚期（宫颈扩张≥3 cm）硬膜外镇痛患者在产褥期和产后3个月的各种产科参数和压力性尿失禁情况。
与非硬膜外镇痛组（n = 319）相比，接受硬膜外镇痛的组（n = 264）第一和第二产程显著延长，器械助产和剖宫产的可能性更高，但严重阴道裂伤和产后压力性尿失禁的发生率相似。除第一产程外，早期给予硬膜外镇痛对产科参数没有显著影响，也不会增加产后压力性尿失禁的发生率。
我们的研究结果表明，硬膜外镇痛与产程延长、器械助产和剖宫产风险增加有关，但与产后压力性尿失禁增加无关。关于分娩过程中硬膜外镇痛给药时机的影响，早期给药时第一产程似乎比晚期给药持续时间更长。
