Turner Jessica, Flatley Christopher, Kumar Sailesh
Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Aust N Z J Obstet Gynaecol. 2020 Jun;60(3):336-343. doi: 10.1111/ajo.13045. Epub 2019 Sep 4.
Epidural analgesia increases length of labour and risk of operative delivery (caesarean or instrumental).
This study aimed to assess the impact of epidural anaesthesia on maternal and neonatal adverse outcomes when the second stage of labour was prolonged.
A retrospective cohort study of women delivering at term at the Mater Mother's Hospital, Brisbane between 2008 and 2017. Intrapartum, maternal and neonatal outcomes were assessed and dichotomised according to the presence of prolonged second stage of labour and further by epidural use. Prolonged second stage of labour was defined as: nulliparous women ≥3 h (with epidural) and ≥2 h (without); multiparous women ≥2 h (with epidural) and ≥1 h (without).
There were 48 352 women who met the inclusion criteria - 43 676 without and 4676 with prolonged second stage of labour. The overall epidural rate was 35.9%. Women with epidural had significantly lower odds of achieving a spontaneous vaginal birth and higher odds of an operative birth regardless of length of second stage. While rates of several adverse maternal and neonatal outcomes were higher when the second stage was prolonged, after adjusting for clinically relevant confounders, epidural use was not associated with increased odds of the majority of these adverse outcomes. Indeed, epidural use was associated with a significant reduction in the odds of obstetric anal sphincter injuries and reduced odds of neonatal acidosis in women with prolonged second stage.
While epidural increases the risk of operative birth, this is not associated with an increase in adverse maternal or neonatal outcomes.
硬膜外镇痛会延长产程并增加手术分娩（剖宫产或器械助产）的风险。
本研究旨在评估当第二产程延长时，硬膜外麻醉对母婴不良结局的影响。
对2008年至2017年在布里斯班玛特母亲医院足月分娩的女性进行一项回顾性队列研究。在分娩期间，根据第二产程是否延长以及是否使用硬膜外麻醉对母婴结局进行评估并二分法分类。第二产程延长的定义为：初产妇硬膜外麻醉下≥3小时，未使用硬膜外麻醉下≥2小时；经产妇硬膜外麻醉下≥2小时，未使用硬膜外麻醉下≥1小时。
有48352名女性符合纳入标准，其中43676名第二产程未延长，4676名第二产程延长。总体硬膜外麻醉率为35.9%。无论第二产程长短，使用硬膜外麻醉的女性自然阴道分娩的几率显著降低，手术分娩的几率更高。虽然第二产程延长时几种母婴不良结局的发生率较高，但在调整了临床相关混杂因素后，使用硬膜外麻醉与这些不良结局中大多数的几率增加无关。事实上，使用硬膜外麻醉与第二产程延长的女性产科肛门括约肌损伤几率显著降低以及新生儿酸中毒几率降低有关。
虽然硬膜外麻醉会增加手术分娩的风险，但这与母婴不良结局的增加无关。
