Watanabe Kaede, Sakamaki Daisuke, Shiko Yuki, Kawasaki Yohei, Noguchi Shohei, Mazda Yusuke
Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
J Obstet Gynaecol Res. 2023 Apr;49(4):1144-1153. doi: 10.1111/jog.15571. Epub 2023 Feb 2.
This single-center observational study aimed to investigate the association between labor neuraxial analgesia (LNA) and neonatal outcomes.
We conducted a retrospective cohort study at a tertiary perinatal center and included all vaginal deliveries performed between November 2015 and December 2021. Obstetric and neonatal outcomes were compared between deliveries with LNA (LNA group) and without analgesia (control group). Propensity score (PS) matching was used for statistical analysis.
We included 2343 singleton deliveries performed in 1367 nulliparous and 976 multiparous women, in whom LNA was induced in 352 and 178 deliveries, respectively. After PS matching, the nulliparous LNA group had a significantly higher incidence of Apgar scores <7 at 1 (7.1% vs. 3.6%, p = 0.0139) and 5 min (2.3% vs. 0.7%, p = 0.0397) and meconium staining (29.8% vs. 23.2%, p = 0.0272) than the nulliparous control group. Other neonatal outcomes, including umbilical artery pH and neonatal intensive care unit admission rate, were comparable between the nulliparous LNA and control groups. No significant differences in neonatal outcomes were seen in multiparous women. Regarding fetal heart rate abnormalities, severe late deceleration (4.8% vs. 1.7%, p = 0.0036) and severe prolonged deceleration (17.0% vs. 11.9%, p = 0.0224) were more common in the nulliparous LNA group than in the nulliparous control group, and the multiparous LNA group exhibited more severe variable deceleration (21.3% vs. 14.3%, p = 0.0485) than the multiparous control group.
Our findings suggest that LNA is associated with short-term adverse neonatal and obstetric outcomes in vaginal deliveries. LNA should be performed with precautionary measures and adequate medical resources.
本单中心观察性研究旨在调查分娩期椎管内镇痛（LNA）与新生儿结局之间的关联。
我们在一家三级围产期中心进行了一项回顾性队列研究，纳入了2015年11月至2021年12月期间所有的阴道分娩。比较了接受LNA的分娩（LNA组）和未接受镇痛的分娩（对照组）的产科和新生儿结局。采用倾向评分（PS）匹配进行统计分析。
我们纳入了1367名单胎初产妇和976名单胎经产妇的2343例单胎分娩，其中分别有352例和178例分娩实施了LNA。PS匹配后，初产妇LNA组在出生后1分钟（7.1%对3.6%，p = 0.0139）和5分钟（2.3%对0.7%，p = 0.0397）时Apgar评分<7以及胎粪污染的发生率（29.8%对23.2%，p = 0.0272）显著高于初产妇对照组。其他新生儿结局，包括脐动脉pH值和新生儿重症监护病房入住率，在初产妇LNA组和对照组之间具有可比性。经产妇的新生儿结局未见显著差异。关于胎儿心率异常，初产妇LNA组严重晚期减速（4.8%对;1.7%，p = 0.0036）和严重延长减速（17.0%对11.9%，p = 0.0224）比初产妇对照组更常见，经产妇LNA组比经产妇对照组表现出更严重的变异减速（21.3%对14.3%，p = 0.0485）。
我们的研究结果表明，LNA与阴道分娩时短期不良新生儿和产科结局相关。实施LNA时应采取预防措施并配备充足的医疗资源。
