Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Int J Obstet Anesth. 2019 May;38:46-51. doi: 10.1016/j.ijoa.2018.12.001. Epub 2018 Dec 12.
The effect of accidental dural puncture during labor epidural analgesia on obstetric outcomes remains unexplored. In this retrospective cohort study, we tested the hypothesis that accidental dural puncture is associated with prolonged second stage of labor.
Anesthetic and obstetric data from nulliparous parturients who suffered an accidental dural puncture at term labor (n=89) during the years 2006-2012 were compared with randomly selected parturients with uncomplicated epidural analgesia (n=232). The primary outcome was the proportion of parturients with prolonged second stage of labor: secondary outcomes were the proportion of instrumented and cesarean deliveries. Statistical analysis included student t-test for continuous variables, chi-square test for binary variables, and logistic regressions for associations between accidental dural puncture and outcomes.
Demographic and obstetric characteristics of parturients were comparable except for a non-significant increase in prolonged second stage of labor in the accidental dural puncture group (27% vs. 17%, P=0.06). After adjusting for known potential confounders, multivariate logistic regression analyses revealed a significant association between accidental dural puncture and prolonged second stage of labor (adjusted risk ratio [aRR] 1.99, 95% CI 1.04 to 3.82; P=0.037). This was not accompanied by an increase in instrumented (aRR 0.57, 95% CI 0.27 to 1.21; P=0.15) or cesarean delivery (aRR 1.83, 95% CI 0.89 to 3.77; P=0.10).
Accidental dural puncture during labor analgesia was associated with prolonged second stage of labor in nulliparous parturients. Prospective studies are needed to assess the relationship between the quality of neuraxial block after accidental dural puncture and obstetric outcomes.
分娩时硬膜外镇痛时意外刺破硬脊膜对产科结局的影响尚不清楚。在这项回顾性队列研究中，我们检验了假设，即意外刺破硬脊膜与第二产程延长有关。
比较了 2006 年至 2012 年足月分娩时意外刺破硬脊膜的初产妇（n=89）和随机选择的无并发症硬膜外镇痛产妇（n=232）的麻醉和产科数据。主要结局是第二产程延长的产妇比例：次要结局是器械分娩和剖宫产的比例。统计分析包括连续变量的学生 t 检验、二项变量的卡方检验和意外刺破硬脊膜与结局之间的逻辑回归。
除第二产程延长的比例略有增加（意外刺破硬脊膜组为 27%，无并发症硬膜外镇痛组为 17%，P=0.06）外，产妇的人口统计学和产科特征无差异。在调整已知潜在混杂因素后，多变量逻辑回归分析显示意外刺破硬脊膜与第二产程延长之间存在显著关联（调整风险比[aRR]1.99，95%置信区间 1.04 至 3.82；P=0.037）。这并没有导致器械分娩（aRR 0.57，95%置信区间 0.27 至 1.21；P=0.15）或剖宫产（aRR 1.83，95%置信区间 0.89 至 3.77；P=0.10）增加。
分娩镇痛时意外刺破硬脊膜与初产妇第二产程延长有关。需要前瞻性研究来评估意外刺破硬脊膜后脊神经阻滞质量与产科结局之间的关系。
