Danish Midwifery Education, University College Metropol, Copenhagen, Denmark.
Birth. 2011 Dec;38(4):317-26. doi: 10.1111/j.1523-536X.2011.00486.x. Epub 2011 Sep 6.
Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between epidural analgesia and mode of delivery.
Data were obtained from a prospective cohort from nine Danish labor wards and comprised 2,721 term nulliparous women with spontaneous onset of labor and a singleton fetus in cephalic presentation. Information about epidural analgesia, mode of delivery, and birth complications was obtained by the staff attending labor. Additional information was provided from self-administered questionnaires in gestational week 37. Multiple logistic regression analyses were used to estimate the association between epidural analgesia and birth outcomes. Results are presented as crude and adjusted odds ratios (OR [95% CI]).
Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1-8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3-2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5-8.2).
In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction.
尽管硬膜外镇痛被广泛应用于缓解分娩疼痛，并且非常有效，但它的使用仍存在争议，因为文献中关于硬膜外镇痛后不良分娩结局的风险并不一致。本研究旨在探讨硬膜外镇痛与分娩方式之间的关系。
数据来自丹麦 9 个产房的前瞻性队列，包括 2721 名足月初产妇，且为自发性临产和头位单胎。分娩室工作人员获取关于硬膜外镇痛、分娩方式和分娩并发症的信息。在妊娠 37 周时通过自填问卷提供额外信息。使用多因素逻辑回归分析来估计硬膜外镇痛与分娩结局之间的关系。结果以粗比数比（OR [95%CI]）和调整后的 OR（95%CI）表示。
在总队列中，21.6%的产妇需要硬膜外镇痛，8.7%的产妇行急诊剖宫产，14.9%的产妇行产钳助产。接受硬膜外镇痛的产妇行急诊剖宫产的风险更高（调整后的 OR：5.8；95% CI：4.1-8.1），行产钳助产的风险也更高（调整后的 OR：1.7；95% CI：1.3-2.2）。在一个剖宫产风险总体非常低的队列亚组中，有 3.4%的产妇行急诊剖宫产，且该组中也发现急诊剖宫产的风险增加（调整后的 OR：3.5；95% CI：1.5-8.2）。
在低危人群的初产妇中，使用硬膜外镇痛缓解分娩疼痛与急诊剖宫产和产钳助产的风险增加相关。
