Department of Anaesthesiology, Fujian Provincial Jinshan Hospital, Fuzhou, China.
Department of Anaesthesiology, Southern Medical University Nanfang Hospital, Guangzhou, China.
BMJ Open. 2022 Jul 29;12(7):e060245. doi: 10.1136/bmjopen-2021-060245.
This study aimed to retrospectively analyse the influence of epidural labour analgesia (ELA) on delivery and maternal and neonatal outcomes in nulliparous women with gestational diabetes mellitus (GDM) using propensity score-matched analysis.
Retrospective cohort analysis.
Primary care practices in a teaching hospital from March 2018 to October 2021.
A total of 816 delivery records of nulliparous women with GDM were collected and retrospectively analysed.
ELA and non-ELA (NELA) cohorts were assessed.
The primary outcome assessed was delivery type (spontaneous, assisted vaginal or caesarean). The secondary outcomes assessed included labour duration and maternal and neonatal outcomes.
A total of 137 propensity score-matched pairs of ELA and NELA patients were analysed. ELA was associated with a decreased rate of caesarean section (18.3% vs 46.0% in the ELA vs NELA cohort, respectively; p<0.05) and an increased occurrence of assisted vaginal delivery (35.8% vs 12.4% in the ELA vs NELA cohort, respectively; p<0.05). The duration of the first and total stages of labour was prolonged, the occurrence of postpartum fever increased, and the duration of hospital stay was shortened in those receiving ELA (all p<0.05). Additionally, neonatal birth weight, plasma glucose levels and neonatal macrosomia occurrence increased, while neonatal intensive care unit admissions and neonatal hypoglycaemia decreased in the ELA versus the NELA group (all p<0.05). With respect to other maternal and neonatal outcomes, both cohorts were similar.
The use of ELA decreases the rate of caesarean section and improves maternal and neonatal outcomes in nulliparous women with GDM.
ChiCTR-2000033091.
本研究旨在通过倾向评分匹配分析，回顾性分析硬膜外分娩镇痛（ELA）对初产妇伴妊娠期糖尿病（GDM）分娩及母婴结局的影响。
回顾性队列分析。
一所教学医院的基层医疗机构，时间为 2018 年 3 月至 2021 年 10 月。
共收集和回顾分析了 816 例初产妇伴 GDM 的分娩记录。
评估 ELA 和非 ELA（NELA）组。
主要结局评估为分娩方式（自然、辅助阴道分娩或剖宫产）。次要结局评估包括产程时间和母婴结局。
共分析了 137 对 ELA 和 NELA 患者的倾向评分匹配对。ELA 组剖宫产率降低（18.3%对 ELA 组和 NELA 组的 46.0%；p<0.05），辅助阴道分娩发生率增加（35.8%对 ELA 组和 NELA 组的 12.4%；p<0.05）。接受 ELA 的产妇第一产程和总产程时间延长，产后发热发生率增加，住院时间缩短（均 p<0.05）。此外，ELA 组新生儿出生体重、血浆葡萄糖水平和新生儿巨大儿发生率增加，新生儿重症监护病房入院率和新生儿低血糖发生率降低（均 p<0.05）。对于其他母婴结局，两组相似。
在初产妇伴 GDM 中，使用 ELA 可降低剖宫产率，改善母婴结局。
ChiCTR-2000033091。
