Unit of Anesthesiology, Resuscitation and Pain Treatment, University Hospital Joan XXIII, Carrer Dr. Mallafré Guasch, 4, Tarragona, Spain.
Unit of Anesthesiology, Resuscitation and Pain Treatment, University Hospital of Burgos, Burgos, Spain.
BMC Pregnancy Childbirth. 2019 Jan 30;19(1):52. doi: 10.1186/s12884-019-2191-0.
In regard to obstetrical analgesia management there are different results related to the use of epidural analgesia versus mechanical adverse outcomes at delivery.
Cohort study of 23,183 consecutive, term, singleton vaginal deliveries, including spontaneous and induced labours, at a single institution from January 2004 to June 2016 to determine the association between epidural analgesia and different mechanical complications affecting maternal health such as severe perineal tears (SPT), abnormal foetal head position at delivery, instrumental delivery and caesarean section (CS). Multivariate logistic regression models were constructed to evaluate the risk factors of these mechanical complications with respect to possible cofounders.
Epidural analgesia was used in 15,821 (68.24%) women. The logistic regression model showed a non-significant association between the use of epidural analgesia and SPT (odds ratio [OR], 078; 95% confidence interval [CI], 0.48-1.26; p = 0.310). Instrumental delivery and CSs were more frequently performed in cases than controls (p = < 0.001), with OR of 1.19 (95% CI: 1.10-1.29) for CS and with OR of 3.27 (95% CI: 2.93-4.61) for instrumental delivery. The abnormal foetal position head at delivery were significantly lower in the neonates delivered without epidural analgesia compared with those in which epidural analgesia was used (p < 0.001) with OR of 1.43 (95% CI:1.27-1.72).
Epidural analgesia is not associated with an increase of SPT, but it was an independent risk factor for instrumental delivery, CS and abnormal foetal head position at delivery.
在产科镇痛管理中，硬膜外镇痛与分娩时机械不良结局的使用相关有不同的结果。
这是一项 2004 年 1 月至 2016 年 6 月在一家机构进行的 23183 例连续足月单胎阴道分娩的队列研究，包括自发性和诱导性分娩，以确定硬膜外镇痛与影响产妇健康的不同机械并发症（如严重会阴撕裂、分娩时胎头位置异常、器械分娩和剖宫产）之间的关系。构建多变量逻辑回归模型，以评估这些机械并发症的风险因素，以及可能的混杂因素。
硬膜外镇痛在 15821 名（68.24%）妇女中使用。逻辑回归模型显示，硬膜外镇痛的使用与严重会阴撕裂（比值比[OR]，0.78；95%置信区间[CI]，0.48-1.26；p=0.310）之间无显著关联。器械分娩和剖宫产在病例组中比对照组更频繁（p<0.001），剖宫产的 OR 为 1.19（95%CI：1.10-1.29），器械分娩的 OR 为 3.27（95%CI：2.93-4.61）。与使用硬膜外镇痛的新生儿相比，未使用硬膜外镇痛的新生儿分娩时胎头位置异常明显较低（p<0.001），OR 为 1.43（95%CI：1.27-1.72）。
硬膜外镇痛与严重会阴撕裂的发生率增加无关，但与器械分娩、剖宫产和胎头位置异常有关。
