O'Hana Hanny Pal, Levy Amalia, Rozen Amit, Greemberg Lev, Shapira Yoram, Sheiner Eyal
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
J Matern Fetal Neonatal Med. 2008 Aug;21(8):517-21. doi: 10.1080/14767050802040864.
The present study was designed to investigate the influence of epidural analgesia on labor progress and outcome in nulliparous women.
A population-based study comparing women with and without epidural analgesia was conducted. Deliveries occurred during 1988-2006 at the Soroka University Medical Center. A multivariable logistic regression model with backward elimination was constructed to control for confounders.
During the study period there were 39 498 deliveries; epidural analgesia was given in 9960 (25.2%) of these. Using a multivariable analysis with backward elimination, the following conditions were significantly associated with the use of epidural analgesia: advanced maternal age, oligohydramnios, premature rupture of membranes, induction of labor, and Jewish (vs. Bedouin) ethnicity. These patients were more likely to deliver by cesarean delivery (CD; OR = 1.4, 95% CI 1.3-1.5; p < 0.001) and vacuum extraction (OR = 1.5, 95% CI 1.4-1.7; p < 0.001). After controlling for possible confounders such as macrosomia, failed induction, hypertensive disorders, gestational diabetes, maternal age, labor dystocia, and ethnicity, epidural analgesia was not found to be an independent risk factor for CD but rather a protective factor (OR = 0.9, 95% CI 0.8-0.9; p = 0.038). When vacuum extraction was the outcome variable, epidural analgesia was documented as an independent risk factor (OR = 1.1, 95% CI 1.01-1.3; p = 0.04).
Epidural analgesia in nulliparous parturients increases the risk for labor dystocia and accordingly is an independent risk factor for vacuum extraction. Nevertheless, it does not pose an independent risk for cesarean delivery.
本研究旨在探讨硬膜外镇痛对初产妇分娩进程及结局的影响。
开展一项基于人群的研究，比较使用和未使用硬膜外镇痛的女性。分娩发生在1988年至2006年期间的索罗卡大学医学中心。构建了一个采用向后逐步回归法的多变量逻辑回归模型以控制混杂因素。
在研究期间，共有39498例分娩；其中9960例（25.2%）接受了硬膜外镇痛。采用向后逐步回归法进行多变量分析时，以下情况与硬膜外镇痛的使用显著相关：产妇年龄较大、羊水过少、胎膜早破、引产以及犹太族（与贝都因族相比）。这些患者剖宫产（CD）分娩（OR = 1.4，95% CI 1.3 - 1.5；p < 0.001）和真空吸引分娩（OR = 1.5，95% CI 1.4 - 1.7；p < 0.001）的可能性更高。在控制了可能的混杂因素如巨大儿、引产失败、高血压疾病、妊娠期糖尿病、产妇年龄、产程异常和种族后，未发现硬膜外镇痛是剖宫产的独立危险因素，反而为保护因素（OR = 0.9，95% CI 0.8 - 0.9；p = 0.038）。当以真空吸引分娩作为结局变量时，硬膜外镇痛被记录为独立危险因素（OR = 1.1，95% CI 1.01 - 1.3；p = 0.04）。
初产妇硬膜外镇痛会增加产程异常的风险，因此是真空吸引分娩的独立危险因素。然而，它并非剖宫产的独立危险因素。
