Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan.
Department of Anesthesiology, Juntendo University Hospital, Hongo, Bunkyo-ku, Tokyo, Japan.
PLoS One. 2021 May 5;16(5):e0250596. doi: 10.1371/journal.pone.0250596. eCollection 2021.
This study aimed to examine the association between clinically diagnosed chorioamnionitis and failed conversion of epidural labor analgesia to cesarean delivery anesthesia.
This retrospective, single-center cohort study, conducted in a university hospital, enrolled term parturients undergoing emergency cesarean section after induction of epidural labor analgesia between September 2015 and May 2019. For the purpose of this study, all cases were re-examined to ensure that they fulfilled the criteria of chorioamnionitis, regardless of the actual indication for cesarean section proposed by obstetricians at the time of application. The primary outcome was failure of conversion of epidural labor analgesia to cesarean delivery anesthesia. Multivariable logistic regression analysis was performed to investigate the association between chorioamnionitis and failure of anesthesia for cesarean section.
Among the 180 parturients reviewed, 58 (43.9%) fulfilled the criteria for chorioamnionitis. Failure of epidural conversion in the chorioamnionitis (+) group was significantly higher than in the chorioamnionitis (-) group (46.6% [27/58] vs. 18.9% [14/74], crude odds ratio = 3.7, 95% confidence interval: 1.7-8.3). After adjustment for potential confounders (age, body mass index, multiparity, and duration for epidural labor analgesia), chorioamnionitis was found to be associated with failure of anesthesia for cesarean sections (adjusted odds ratio = 3.6, 95% confidence interval: 1.6-8.4).
Chorioamnionitis is associated with the failed conversion of epidural labor analgesia to cesarean delivery anesthesia.
本研究旨在探讨临床诊断的绒毛膜羊膜炎与硬膜外分娩镇痛转为剖宫产麻醉失败的关系。
这是一项在大学医院进行的回顾性单中心队列研究，纳入了 2015 年 9 月至 2019 年 5 月期间因硬膜外分娩镇痛诱导后行急诊剖宫产的足月产妇。为了本研究的目的，所有病例都重新检查，以确保它们符合绒毛膜羊膜炎的标准，而不管当时产科医生提出的剖宫产实际指征如何。主要结局是硬膜外分娩镇痛转为剖宫产麻醉失败。采用多变量逻辑回归分析来探讨绒毛膜羊膜炎与剖宫产麻醉失败之间的关系。
在回顾的 180 名产妇中，58 名（43.9%）符合绒毛膜羊膜炎的标准。绒毛膜羊膜炎（+）组硬膜外转换失败的发生率明显高于绒毛膜羊膜炎（-）组（46.6%[27/58]比 18.9%[14/74]，粗比值比=3.7，95%置信区间：1.7-8.3）。调整潜在混杂因素（年龄、体重指数、多胎妊娠和硬膜外分娩镇痛持续时间）后，发现绒毛膜羊膜炎与剖宫产麻醉失败相关（调整比值比=3.6，95%置信区间：1.6-8.4）。
绒毛膜羊膜炎与硬膜外分娩镇痛转为剖宫产麻醉失败有关。
