Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark; School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia.
Women Birth. 2021 May;34(3):e286-e291. doi: 10.1016/j.wombi.2020.05.012. Epub 2020 Jun 18.
In general, epidural analgesia is considered a safe and efficient way to relieve pain during active labour and is increasingly used in childbirth. It is well documented that epidural analgesia during birth has benefits but also adverse effects. However, evidence is limited on how epidural analgesia influences neonatal outcome in a low-risk population of birthing women.
To examine low Apgar score, foetal hypoxia and admission to the neonatal intensive care unit in neonates of low-risk women receiving epidural analgesia during birth.
A cohort study using registry data to investigate a population of 23,272 low-risk women giving birth at a university hospital.
Epidural analgesia was used in 21.6% of low-risk women during birth. Low Apgar score, foetal hypoxia, and admission to the neonatal intensive care unit were found in 0.6%, 0.6%, and 10.0%, respectively in neonates of mothers receiving epidural analgesia during birth compared to 0.3%, 0.6%, and 5.6%, respectively in the non-exposed group. Epidural analgesia was associated with low Apgar score, adjusted odds ratio 1.76 (95% CI 1.07-2.90) and admission to the neonatal intensive care unit, adjusted odds ratio 1.43 (95% CI 1.26-1.62). A mediation analysis indicates the impact of epidural analgesia on adverse neonatal outcomes was mediated by obstetric complications like maternal fever, labour augmentation, and foetal malpresentation.
This study found use of epidural analgesia during birth in low-risk pregnant women was associated with infant low Apgar score and admission to the neonatal intensive care unit.
一般来说，硬膜外镇痛被认为是缓解活跃分娩时疼痛的安全有效的方法，在分娩中越来越多地使用。有充分的证据表明，分娩时硬膜外镇痛有好处，但也有不良反应。然而，关于硬膜外镇痛如何影响低风险产妇人群新生儿结局的证据有限。
检查低 Apgar 评分、胎儿缺氧和低风险产妇分娩时接受硬膜外镇痛的新生儿入住新生儿重症监护病房的情况。
一项队列研究使用登记数据调查了在一所大学医院分娩的 23272 名低风险妇女的人群。
在低风险妇女分娩期间，21.6%的妇女使用了硬膜外镇痛。与未暴露组相比，在接受分娩时硬膜外镇痛的母亲的新生儿中，低 Apgar 评分、胎儿缺氧和入住新生儿重症监护病房的比例分别为 0.6%、0.6%和 10.0%，而在未暴露组中，这一比例分别为 0.3%、0.6%和 5.6%。硬膜外镇痛与低 Apgar 评分相关，调整后的优势比为 1.76（95%CI 1.07-2.90），与入住新生儿重症监护病房相关，调整后的优势比为 1.43（95%CI 1.26-1.62）。中介分析表明，硬膜外镇痛对不良新生儿结局的影响是通过母体发热、产程延长和胎儿胎位不正等产科并发症介导的。
本研究发现，低风险孕妇分娩时使用硬膜外镇痛与婴儿低 Apgar 评分和入住新生儿重症监护病房有关。
