Epidural Analgesia, Obstetric
Conditions
Keywords
Labor epidural analgesia, Cesarean section, Instrumental delivery, Neonatal well-being
Brief summary
Aim of the study was to analyse data on cervical dilation and fetal descent patterns in low-risk women, who did or did not receive intermittent low-dose epidural analgesia (EA), and who had either a vaginal or a caesarean delivery. Therefore, we conducted a retrospective analysis, retrieving data from October 1st 2008 to October 31st 2018. We selected 6030 women categorized as Robson Group 1, divided into four groups according to the mode of delivery (vaginal or caesarean) and the presence of EA: * Vaginal delivery with EA (VD-e) * Vaginal delivery without EA (VD-n) * Caesarean delivery with EA (CD-e) * Caesarean delivery without EA (CD-n)
Interventions
None listed
Sponsors
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Robson class 1 (nulliparous, single, cephalic full-term pregnancy with spontaneous labour) * maternal age between 18 and 40 years * neonatal weight between 2500 and 4000 grams * cervical dilation \<7 cm at admission in the delivery suite
Exclusion criteria
* minimal duration of labour \< 3 hours (from admission to the delivery suite to delivery)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cervical dilation curve | First stage of labour (from admission to the delivery suite to full cervical dilation) | We modeled the cervical dilation curve using a high-degree mixed polynomial regression. The analysis was conducted separately in women with vaginal or caesarean delivery. The time of complete cervical dilation or caesarean delivery was considered the point 0 for cervical dilation, while the preceding events resulted in negative time compared to the 0. |
| Fetal head descent curve | From admission to the delivery room up to the time of delivery (either via vaginal route or caesarean section) | We modeled the fetal head descent curve using a mixed polynomial regression. The analysis was conducted separately in women with vaginal or caesarean delivery. The time of station +3 (i.e. vaginal birth) or caesarean delivery was considered the point 0 , while the preceding events resulted in negative time compared to the 0. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Type of vaginal delivery | At delivery | In the VD-e and VD-n groups, description of the type of delivery (eutocic or instrumental) |
| Maternal complications during vaginal delivery | At delivery. | Rate of maternal complications (postpartum haemorrhages, perineal lacerations, uterine atony) in the VD groups. |
| Length of active phase | Up to 24 hours from admission. | The beginning of the active phase was defined in the presence of regular painful uterine contractions, a substantial degree of cervical effacement and more rapid cervical dilation. Active phase ends at full cervical dilation. |
| Fetal indicators | After delivery | Apgar at 1 and 5 minutes, admission in Neonatal Intensive Care Unit (NICU), death |
| Episiotomy | At delivery. | Rate of episiotomy in the VD groups. |
| Length of second stage | Up to 24 hours from admission. | Second stage begins at full cervical dilation and ends at delivery. |
Countries
Italy
Outcome results
None listed