Eshkoli Tamar, Jacobs Merav, Saban Alla, Baumfeld Yael, Ben Shushan-Amor Renana, Yohay Zehava, Weintraub Adi Y
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel.
Arch Gynecol Obstet. 2025 Jan 30. doi: 10.1007/s00404-025-07959-y.
To assess the association between Epidural Analgesia (EA) during Vaginal Birth After Cesarean (VBAC) and delivery mode (spontaneous or instrumental vaginal delivery). Secondary objectives include maternal and neonatal outcomes.
In this retrospective population-based cohort study, all women who underwent a VBAC with and without EA, between the years 1996-2016 at the Soroka University Medical Center (SUMC) were included. Women who delivered by cesarean section (elective and non-elective) and those who gave birth to a newborn with chromosomal abnormalities or major malformations, and multifetal gestations were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. The primary outcome was the type of delivery. Univariate analysis was followed by a multivariate analysis to control for confounders. A p value of < 0.05 was considered statistically significant.
During the study period, 17,516 women who have had a previous CS met the inclusion criteria, of which 15% (n = 2652) used EA during labor, while the rest of the cohort 85% (n = 14,864) were non-EA users. Women in the EA group had higher rates of instrumental delivery and postpartum hemorrhage (PPH) as well as higher rates of oxytocin augmentation and a longer second stage of labor. The use of EA was found to be an independent risk factor for instrumental delivery after controlling for maternal age, ethnicity, parity, DM (diabetes mellitus), hypertensive disorders of pregnancy, oxytocin augmentation, prolonged second stage of labor, induction of labor, fertility treatments and oligohydramnios. However, no significant differences were observed regarding neonatal outcomes including perinatal mortality, birth weight, Apgar scores and shoulder dystocia rates.
EA for women undergoing a VBAC was associated with higher rates of instrumental delivery and PPH, oxytocin augmentation and a longer second stage of labor compared with women without EA. However, neonatal outcomes did not differ between the groups.
评估剖宫产术后阴道分娩（VBAC）期间硬膜外镇痛（EA）与分娩方式（自然分娩或器械助产阴道分娩）之间的关联。次要目标包括母婴结局。
在这项基于人群的回顾性队列研究中，纳入了1996年至2016年间在索罗卡大学医学中心（SUMC）接受或未接受EA的所有VBAC妇女。剖宫产（择期和非择期）分娩的妇女以及分娩出有染色体异常或重大畸形新生儿的妇女和多胎妊娠妇女被排除在外。记录人口统计学、临床和产科特征，并比较两组之间的妊娠并发症和不良围产期结局。主要结局是分娩类型。先进行单因素分析，然后进行多因素分析以控制混杂因素。p值<0.05被认为具有统计学意义。
在研究期间，17516名既往有剖宫产史的妇女符合纳入标准，其中15%（n=2652）在分娩时使用了EA，而其余85%（n=14864）的队列未使用EA。EA组妇女器械助产分娩率、产后出血（PPH）率较高，催产素使用增加率也较高，第二产程较长。在控制了产妇年龄、种族、产次、糖尿病（DM）、妊娠高血压疾病、催产素使用增加、第二产程延长、引产、生育治疗和羊水过少等因素后，发现使用EA是器械助产分娩的独立危险因素。然而，在围产期死亡率、出生体重、阿氏评分和肩难产率等新生儿结局方面未观察到显著差异。
与未使用EA的妇女相比，接受VBAC的妇女使用EA与器械助产分娩率、PPH率、催产素使用增加和第二产程较长相关。然而，两组之间的新生儿结局没有差异。
