Sidelnick Carlos, Karmon Anatte, Levy Amalia, Greemberg Lev, Shapira Yoram, Sheiner Eyal
Division of Anesthesiology, Soroka University Medical Center, Ben-Gurion University of the Negev, Be'er-Sheva 84105, Israel.
J Matern Fetal Neonatal Med. 2009 Apr;22(4):348-52. doi: 10.1080/14767050802464536.
The present study aimed to characterise grandmultiparous women receiving intra-partum epidural analgesia and investigate associations between this method of pain relief and labour outcomes in grandmultiparas.
A population-based study was conducted comparing obstetric and perinatal characteristics of grandmultiparous women with and without epidural analgesia. Deliveries occurred during the years 1988-2006. Multiple logistic regression models were constructed to find independent risk factors associated with epidural analgesia, cesarean section and 1st stage labour dystocia.
Out of 41,488 deliveries to grandmultiparous women included in the study, intra-partum epidural analgesia was utilised in 877 (2.1%). Multivariate analysis revealed that grandmultiparas who received epidural pain relief were significantly older and more likely to suffer from pre-mature rupture of the membranes, polyhydramnion, oligohydramnion, labour induction and a macrosomic fetus. After controlling for potential confounding, use of epidural analgesia remained an independent risk factor for 1st stage labour dystocia (odds ratio (OR) = 1.5; 95% confidence interval (CI) = 1.08-2.2) and cesarean delivery (OR = 2.9; 95% CI = 2.4-3.5) in grandmultiparas.
Grandmultiparous women who received intra-partum epidural analgesia have entirely different obstetric characteristics as compared with those who did not receive this method of pain relief. Although epidural use was demonstrated to be an independent risk factor for 1st stage labour dystocia and cesarean section in this population, residual confounding cannot be excluded.
本研究旨在描述接受产时硬膜外镇痛的经产妇特征，并调查这种疼痛缓解方法与经产妇分娩结局之间的关联。
开展一项基于人群的研究，比较接受和未接受硬膜外镇痛的经产妇的产科和围产期特征。分娩发生在1988年至2006年期间。构建多元逻辑回归模型以找出与硬膜外镇痛、剖宫产和第一产程难产相关的独立危险因素。
在纳入研究的41488例经产妇分娩中，877例（2.1%）使用了产时硬膜外镇痛。多变量分析显示，接受硬膜外镇痛的经产妇年龄显著更大，更有可能发生胎膜早破、羊水过多、羊水过少、引产和巨大胎儿。在控制潜在混杂因素后，硬膜外镇痛的使用仍然是经产妇第一产程难产（优势比（OR）=1.5；95%置信区间（CI）=1.08 - 2.2）和剖宫产（OR = 2.9；95%CI = 2.4 - 3.5）的独立危险因素。
与未接受这种疼痛缓解方法的经产妇相比，接受产时硬膜外镇痛的经产妇具有完全不同的产科特征。尽管在该人群中硬膜外镇痛的使用被证明是第一产程难产和剖宫产的独立危险因素，但不能排除残余混杂因素的影响。
