Labor analgesia and its impact on the maternal and perinatal outcomes

This was a retrospective cohort study in parturients who underwent labor analgesia. Parturients were categorized into three groups: Group 1 (n=83)—analgesia performed with cervical dilatation ≤4.0 cm; Group 2 (n=82)—analgesia performed with cervical dilatation between 5.0 and 8.0 cm; and Group 3 (n=83)—analgesia performed with cervical dilatation ≥9.0 cm.

RESULTS:

Analgesia in parturients with cervical dilatation ≥9.0 cm showed a higher prevalence and a 3.86-fold increase (OR 3.86; 95%CI 1.50–9.87; p=0.009) in the risk of forceps delivery. Analgesia in parturients with cervical dilatation ≤4.0 cm showed a higher prevalence and a 3.31-fold increase (OR 3.31; 95%CI 1.62–6.77; p=0.0016) in the risk of cesarean section. Analgesia in parturients with cervical dilatation ≥9.0 cm was associated with a higher prevalence of fetal bradycardia (20.7%), a need for neonatal oxygen therapy (6.1%), and a need for admission to a neonatal intensive care unit (4.9%). Analgesia in parturients with cervical dilatation ≤4 cm was associated with a higher prevalence of Apgar score <7 at 1st minute (44.6%).

CONCLUSION:

Performing labor analgesia in parturients with cervical dilatation ≤4.0 or ≥9.0 cm was associated with a higher prevalence of adverse maternal and perinatal outcomes.

Keywords
Delivery room; Analgesia; Perinatal mortality

	Group 1 (n=83)	Group 2 (n=82)	Group 3 (n=82)	p-value
Age (years)	18.0 (16.0–27.0)^A.B	22.0 (20.7–26.0)	25.0 (21.0–30.0)	<0.0001^†
BMI (kg/m²)	32.3 (28.6–33.9)	30.8 (28.6–32.4)	30.9 (29.0–32.9)	0.05^†
Gestational age (weeks)	40.1 (39.0–40.5)	39.3 (38.1–40.2)	39.6 (37.7–40.7)	0.05^†
Birth weight (g)	3180.0 (474)	3207 (439)	3139 (543)	0.605^∫
Apgar score at 1st minute	8 (6–8)^A.B	8 (8–8)	8 (8–8)	0.0004^†
Apgar score at 5th minute	9 (9–9)	9 (9–9)	9 (9–9)	>0.9999^†

	Group 1 (n=83)	Group 2 (n=82)	Group 3 (n=82)	p-value^§
Arterial hypotension	0% (0/83)	0% (0/82)	0% (0/82)	*
Nausea	0% (0/83)	0% (0/82)	0% (0/82)	*
Vomiting	0% (0/83)	0% (0/82)	0% (0/82)	*
Pruritus	0% (0/83)	0% (0/82)	0% (0/82)	*
Respiratory depression	0% (0/83)	0% (0/82)	0% (0/82)	*
Fetal bradycardia	9.6% (8/83)	8.5% (7/82)	20.7% (17/82)	0.036
Apgar score <7 at 1st minute	44.6% (37/83)	17.1% (14/82)	22.0% (18/82)	<0.001
Need for neonatal oxygen therapy	0% (0/83)	0% (0/82)	6.1% (5/82)	0.016
Need for neonatal ICU	0% (0/83)	0% (0/82)	4.9% (4/82)	0.017

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

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[1] *Corresponding author: araujojred@terra.com.br