Tatsuki Onishi, Wakata Ryuichi, Hoshino Sayo, Kasai Kyomi
Department of Anesthesia, Adachi Hospital, Higashinotoin-Nijo-Kudaru, Nakagyo-ku, Kyoto 604-0837, Japan; Faculty of Data Science, Shiga University, 1-1-1 Bamba, Hikone, Shiga 522-0069, Japan.
Department of Anesthesia, Adachi Hospital, Higashinotoin-Nijo-Kudaru, Nakagyo-ku, Kyoto 604-0837, Japan.
Eur J Obstet Gynecol Reprod Biol. 2025 Apr;307:91-97. doi: 10.1016/j.ejogrb.2025.01.041. Epub 2025 Jan 31.
Emergency caesarean section is associated with maternal and foetal complications, potentially exacerbated by general anaesthesia use.
To determine whether labour epidural analgesia use affects caesarean section incidence.
This retrospective single-centre cohort study involved women in labour (n = 11,792) between 1 January 2015 and 31 December 2021. The primary outcome was caesarean section incidence, determined from electronic medical records; secondary outcome was caesarean section incidence change over time.
Of 5849 deliveries from 1 August 2018, when round-the-clock labour epidural analgesia became available, until 31 December 2021, 1,433 (24.5 %) involved labour epidural analgesia. Of these, 203 (14.2 %) involved unintended caesarean section, less than that in the non-labour epidural analgesia group (22.2 %) (hazard ratio: 0.47; 95 % confidence interval [CI]: 0.41-0.55, p < 0.001). Sensitivity analysis, assuming 50 % of non-labour epidural analgesia cases should have had used labour epidural analgesia, yielded a hazard ratio of 0.65 (95 %CI: 0.57-0.75, p < 0.001). Propensity-score matching adjusted for possible confounders. Temporal changes in caesarean section incidence were analysed between 1 August 2018 and 31 October 2021. This passage of time explained the reduction in values for the difference-in-differences analysis by 20.5 % (95 %CI: 5.5-35.6, p = 0.007). Interrupted time series analysis revealed caesarean section incidence increased with time after round-the-clock labour epidural analgesia became available in the non-labour epidural analgesia group (p = 0.01).
Round-the-clock labour epidural analgesia use is associated with decreased caesarean section incidence, partly due to optimisation of eligibility criteria. Labour epidural analgesia use should be expanded to aid vaginal delivery and improve maternal well-being.
急诊剖宫产与母婴并发症相关，全身麻醉的使用可能会加剧这些并发症。
确定分娩时使用硬膜外镇痛是否会影响剖宫产发生率。
这项回顾性单中心队列研究纳入了2015年1月1日至2021年12月31日期间分娩的女性（n = 11792）。主要结局是剖宫产发生率，通过电子病历确定；次要结局是剖宫产发生率随时间的变化。
在2018年8月1日（此时开始提供全天候分娩硬膜外镇痛）至2021年12月31日的5849例分娩中，1433例（24.5%）使用了分娩硬膜外镇痛。其中，203例（14.2%）为意外剖宫产，低于非分娩硬膜外镇痛组（22.2%）（风险比：0.47；95%置信区间[CI]：0.41 - 0.55，p < 0.001）。敏感性分析假设50%的非分娩硬膜外镇痛病例本应使用分娩硬膜外镇痛，得出风险比为0.65（95%CI：0.57 - 0.75，p < 0.001）。倾向得分匹配对可能的混杂因素进行了调整。分析了2018年8月1日至2021年10月31日期间剖宫产发生率的时间变化。这段时间解释了差异分析值下降的20.5%（95%CI：5.5 - 35.6，p = 0.007）。中断时间序列分析显示，在非分娩硬膜外镇痛组中，全天候分娩硬膜外镇痛可用后，剖宫产发生率随时间增加（p = 0.01）。
全天候使用分娩硬膜外镇痛与剖宫产发生率降低相关，部分原因是资格标准的优化。应扩大分娩硬膜外镇痛的使用，以帮助阴道分娩并改善产妇健康。
