硬膜外镇痛对罗布森1类产妇分娩方式的影响：一项回顾性队列研究。
The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study.
作者信息
Ambrosetti Fedora, Grandi Giovanni, Petrella Elisabetta, Sampogna Veronica, Donno Lara, Rinaldi Laura, Ghirardini Anna Maria, Facchinetti Fabio
机构信息
Department of Medical and Surgical Sciences for Mother, Child, and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (Dr Ambrosetti, XX Grandi, XX Petrella, XX Sampogna, and XX Facchinetti).
Anesthesia and Intensive Care Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy (XX Donno, XX Rinaldi, and XX Ghirardini).
出版信息
AJOG Glob Rep. 2023 Apr 5;3(2):100207. doi: 10.1016/j.xagr.2023.100207. eCollection 2023 May.
BACKGROUND
The use of epidural analgesia represents the gold standard for pain management during labor, but the influence of the use of epidural analgesia on delivery mode is not fully understood.
OBJECTIVE
This study aimed to analyze the impact of epidural analgesia on the delivery mode, namely, cesarean delivery, vaginal delivery, and operative vaginal delivery rates, in Robson class 1 women.
STUDY DESIGN
A retrospective cohort study was conducted on all Robson class 1 women who delivered from January 1, 2019, to December 31, 2019, in the University Hospital of Modena. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were maternal, anesthesiologic, and neonatal effects of epidural analgesia (duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission).
RESULTS
A total of 744 women were included in the final analysis, of which 198 (26.6%) underwent epidural analgesia on request and 546 (73.4%) did not. In women with and without epidural analgesia, the cesarean delivery rate was 8.1% vs 7%, the vaginal delivery rate was 79.3% vs 81.1%, and the operative vaginal delivery rate was 12.6% vs 11.9%, respectively. A significant increase in both the first stage of labor (66.3±38.5 vs 43.8±38.8 minutes; <.0001) and total duration of labor (328.0±206.7 vs 201.7±168.3 minutes; <.0001) was found in women receiving epidural analgesia. No change was recorded in the second stage of labor. A shorter duration of labor was observed (<.0001) when epidural analgesia was started earlier (dilation: 2-4 cm vs >4 cm). No significant difference in Apgar score and neonatal intensive care unit admission was found.
CONCLUSION
The use of epidural analgesia was not associated with an increased risk of cesarean delivery or operative vaginal delivery in Robson class 1 women. Further investigations are needed to evaluate its impact on the duration of labor, namely the duration of the first stage of labor, and on the possible advantages of starting epidural analgesia at an early stage.
背景
硬膜外镇痛的使用是分娩期疼痛管理的金标准，但硬膜外镇痛的使用对分娩方式的影响尚未完全明确。
目的
本研究旨在分析硬膜外镇痛对罗布森1类产妇分娩方式的影响，即剖宫产、阴道分娩和阴道助产率。
研究设计
对2019年1月1日至2019年12月31日在摩德纳大学医院分娩的所有罗布森1类产妇进行一项回顾性队列研究。主要结局为分娩方式（剖宫产、阴道分娩和阴道助产率），次要结局为硬膜外镇痛的母体、麻醉学和新生儿效应（产程、第二产程时长、阿氏评分和新生儿重症监护病房入住情况）。
结果
共有744名女性纳入最终分析，其中198名（26.6%）应要求接受了硬膜外镇痛，546名（73.4%）未接受。接受和未接受硬膜外镇痛的女性中，剖宫产率分别为8.1%和7%，阴道分娩率分别为79.3%和81.1%，阴道助产率分别为12.6%和11.9%。接受硬膜外镇痛的女性第一产程（66.3±38.5 vs 43.8±38.8分钟；<.0001）和总产程（328.0±206.7 vs 201.7±168.3分钟；<.0001）均显著延长。第二产程无变化。硬膜外镇痛开始时间较早（宫口扩张2 - 4 cm vs >4 cm）时，产程较短（<.0001）。阿氏评分和新生儿重症监护病房入住情况无显著差异。
结论
在罗布森1类产妇中，使用硬膜外镇痛与剖宫产或阴道助产风险增加无关。需要进一步研究以评估其对产程，即第一产程时长的影响，以及早期开始硬膜外镇痛的可能优势。
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