From the Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Anesth Analg. 2023 Nov 1;137(5):1047-1055. doi: 10.1213/ANE.0000000000006435. Epub 2023 Mar 7.
The use of labor neuraxial analgesia (NA) in China has increased significantly in the past decade, and the current rate of use is unknown. This study aimed to describe the epidemiology of NA based on a large multicenter cross-sectional survey, the China Labor and Delivery Survey (CLDS) (2015-2016), and to evaluate the association between NA and intrapartum caesarean delivery (CD) and maternal and neonatal outcomes.
The CLDS was a facility-based cross-sectional investigation with a cluster random sampling scheme conducted from 2015 to 2016. A specific weight was assigned to each individual based on the sampling frame. Logistic regression was adopted to analyze the factors associated with the use of NA. A propensity score matching scheme was used to analyze the associations between NA and intrapartum CD and perinatal outcomes.
A total of 51,488 vaginal deliveries or intrapartum CD were included in our study, excluding prelabor CDs. The weighted NA rate was 17.3% (95% confidence interval [CI], 16.6-18.0) in this survey population. Nulliparous, previous CD, hypertensive disorders, and labor augmentation were associated with higher use of NA. In the propensity score-matched analysis, NA was associated with reduced risks of intrapartum CD, especially intrapartum CD by maternal request (adjusted odds ratio [aOR], 0.68; 95% CI, 0.60-0.78 and aOR, 0.48; 95% CI, 0.30-0.76, respectively), 3rd or 4th degree perineal laceration (aOR, 0.36; 95% CI, 0.15-0.89), and 5-minute Apgar score ≤3 (aOR, 0.15; 95% CI, 0.03-0.66).
The use of NA may be associated with improved obstetric outcomes, including fewer intrapartum CD, less birth canal trauma, and better neonatal outcomes in China.
在过去的十年中，中国使用分娩镇痛（NA）的比例显著增加，目前的使用率尚不清楚。本研究旨在通过一项大型多中心横断面调查（2015-2016 年中国分娩调查，CLDS）描述基于 NA 的流行病学，并评估其与产时剖宫产（CD）以及母婴结局的关系。
CLDS 采用基于机构的横断面调查，采用聚类随机抽样方案，于 2015 年至 2016 年进行。根据抽样框架为每个个体分配特定权重。采用逻辑回归分析与 NA 使用相关的因素。采用倾向评分匹配方案分析 NA 与产时 CD 和围产儿结局之间的关系。
本研究共纳入 51488 例阴道分娩或产时 CD（不包括产前 CD），加权 NA 率为 17.3%（95%可信区间[CI]：16.6-18.0）。初产妇、既往剖宫产史、妊娠高血压疾病和产程中催产与更高的 NA 使用相关。在倾向评分匹配分析中，NA 与产时 CD 风险降低相关，尤其是产妇要求的产时 CD（调整后的优势比[aOR]：0.68；95%CI：0.60-0.78 和 aOR：0.48；95%CI：0.30-0.76）、三度或四度会阴裂伤（aOR：0.36；95%CI：0.15-0.89）和 5 分钟 Apgar 评分≤3（aOR：0.15；95%CI：0.03-0.66）。
在中国，NA 的使用可能与改善产科结局相关，包括产时 CD 减少、分娩通道创伤减少和新生儿结局改善。
