Sachs Maike Katja, Kapfhammer Elisabeth, Brun Romana, Kandler Lukas, Ochsenbein Nicole
Division of Obstetrics, University Hospital Zurich Zürich, Switzerland.
Division of Gynaecology and Obstetrics, 30934 Kantonsspital Winterthur Winterthur, Switzerland.
J Perinat Med. 2025 May 23. doi: 10.1515/jpm-2024-0567.
Epidural analgesia is widely used for pain management during labor and delivery with inconsistent results regarding its influence on postpartum blood loss. Aim of our study was to investigate blood loss after vaginal delivery in women with epidural analgesia in consideration of established risk factors for postpartum hemorrhage and by using a validated blood measurement technique.
This prospective study was performed at the University Hospital Zurich. Included were 699 women with vaginal deliveries after 34 weeks of pregnancy. Blood loss was assessed by a validated measurement technique. Risk factors for increased blood loss were assessed and stratified by epidural analgesia use. Significant variables were entered into a stepwise multivariate regression analysis.
In the univariate analysis, women with epidural analgesia showed a significantly higher blood loss, compared to women without epidural analgesia. However, after multivariate regression analysis no association between increased blood loss and epidural anesthesia was observed. Furthermore, women with epidural analgesia were more often primiparous, experienced more often uterine atony and postpartum hemorrhage, bleeding from perineal laceration, vacuum extraction, longer second stage of labor and bigger neonatal head circumference.
Epidural analgesia itself is not associated with increased postpartum blood loss. However, there is a higher incidence of PPH in deliveries with obstetric risk factors, in which more frequent use of epidural analgesia is observed. In other words, not epidural analgesia is the cause of PPH, but difficult obstetric settings are associated with both higher use of epidural analgesia and increased blood loss.
硬膜外镇痛广泛用于分娩期间的疼痛管理，但其对产后失血的影响结果并不一致。我们研究的目的是考虑到已确定的产后出血风险因素，并使用经过验证的失血测量技术，调查硬膜外镇痛的产妇阴道分娩后的失血量。
这项前瞻性研究在苏黎世大学医院进行。纳入了699例妊娠34周后阴道分娩的妇女。通过经过验证的测量技术评估失血量。评估失血增加的风险因素，并根据硬膜外镇痛的使用情况进行分层。将显著变量纳入逐步多变量回归分析。
在单变量分析中，与未使用硬膜外镇痛的妇女相比，使用硬膜外镇痛的妇女失血量显著更高。然而，经过多变量回归分析，未观察到失血量增加与硬膜外麻醉之间存在关联。此外，使用硬膜外镇痛的妇女初产妇更多见，更常出现宫缩乏力和产后出血、会阴裂伤出血、真空吸引、第二产程延长和新生儿头围较大。
硬膜外镇痛本身与产后失血量增加无关。然而，在存在产科风险因素的分娩中，产后出血的发生率较高，其中硬膜外镇痛的使用更为频繁。换句话说，产后出血的原因不是硬膜外镇痛，而是困难的产科情况与硬膜外镇痛的更高使用率和失血量增加均有关。
