Epidural analgesia during birth and adverse neonatal outcomes: A population-based cohort study |
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| Institution: | 1. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark;2. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark;3. School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia;1. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia;2. Department of Rural Health, The University of South Australia, Adelaide, Australia;1. Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road Parkville, Victoria 3052, Australia;2. Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia;1. Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden;2. Department of Clinical and Experimental Medicine, Linköping University, Sweden;1. Faculty of Health, Dalhousie University, Halifax, NS, Canada;2. School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada;3. Nova Scotia Health Authority, Halifax, NS, Canada;4. Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada;1. School of Nursing, College of Health and Medicine, University of Tasmania, Advocate House, 9 Liverpool St, Hobart, TAS 7001, Australia;2. School of Nursing, College of Health and Medicine, University of Tasmania, Private Bag 135, HOBART TAS 7001, 71 Brooker Avenue, Hobart, TAS 7001, Australia;3. School of Health Sciences, College of Health and Medicine, University of Tasmania, Locked Bag 1322, Launceston 7250, Australia |
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| Abstract: | BackgroundIn general, epidural analgesia is considered a safe and efficient way to relieve pain during active labour and is increasingly used in childbirth. It is well documented that epidural analgesia during birth has benefits but also adverse effects. However, evidence is limited on how epidural analgesia influences neonatal outcome in a low-risk population of birthing women.AimTo examine low Apgar score, foetal hypoxia and admission to the neonatal intensive care unit in neonates of low-risk women receiving epidural analgesia during birth.MethodsA cohort study using registry data to investigate a population of 23,272 low-risk women giving birth at a university hospital.ResultsEpidural analgesia was used in 21.6% of low-risk women during birth. Low Apgar score, foetal hypoxia, and admission to the neonatal intensive care unit were found in 0.6%, 0.6%, and 10.0%, respectively in neonates of mothers receiving epidural analgesia during birth compared to 0.3%, 0.6%, and 5.6%, respectively in the non-exposed group. Epidural analgesia was associated with low Apgar score, adjusted odds ratio 1.76 (95% CI 1.07–2.90) and admission to the neonatal intensive care unit, adjusted odds ratio 1.43 (95% CI 1.26–1.62). A mediation analysis indicates the impact of epidural analgesia on adverse neonatal outcomes was mediated by obstetric complications like maternal fever, labour augmentation, and foetal malpresentation.ConclusionThis study found use of epidural analgesia during birth in low-risk pregnant women was associated with infant low Apgar score and admission to the neonatal intensive care unit. |
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| Keywords: | Term birth Epidural analgesia Apgar score Foetal hypoxia Neonatal intensive care unit EA"} {"#name":"keyword" "$":{"id":"kw0035"} "$$":[{"#name":"text" "_":"epidural analgesia BMI"} {"#name":"keyword" "$":{"id":"kw0045"} "$$":[{"#name":"text" "_":"body mass index NICU"} {"#name":"keyword" "$":{"id":"kw0055"} "$$":[{"#name":"text" "_":"neonatal intensive care unit PROM"} {"#name":"keyword" "$":{"id":"kw0065"} "$$":[{"#name":"text" "_":"prelabour rupture of membranes |
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