Mode of Delivery after Epidural Analgesia in a Cohort of Low-Risk Nulliparas

Eriksen, LM; Nohr, EA; Kjærgaard, H

Mode of Delivery after Epidural Analgesia in a Cohort of Low-Risk Nulliparas

Eriksen, LM Nohr, EA Kjærgaard, H

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Publication Type:: Journal Article
Citation:: Birth, 2011, 38 (4), pp. 317 - 326
Issue Date:: 2011-12-01

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Field	Value	Language
dc.contributor.author	Eriksen, LM	en_US
dc.contributor.author	Nohr, EA	en_US
dc.contributor.author	Kjærgaard, H	en_US
dc.date.issued	2011-12-01	en_US
dc.identifier.citation	Birth, 2011, 38 (4), pp. 317 - 326	en_US
dc.identifier.issn	0730-7659	en_US
dc.identifier.uri	http://hdl.handle.net/10453/117470
dc.description.abstract	Background: Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between epidural analgesia and mode of delivery. Methods: Data were obtained from a prospective cohort from nine Danish labor wards and comprised 2,721 term nulliparous women with spontaneous onset of labor and a singleton fetus in cephalic presentation. Information about epidural analgesia, mode of delivery, and birth complications was obtained by the staff attending labor. Additional information was provided from self-administered questionnaires in gestational week 37. Multiple logistic regression analyses were used to estimate the association between epidural analgesia and birth outcomes. Results are presented as crude and adjusted odds ratios (OR [95% CI]). Results: Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1-8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3-2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5-8.2). Conclusions: In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction. © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.	en_US
dc.relation.ispartof	Birth	en_US
dc.relation.isbasedon	10.1111/j.1523-536X.2011.00486.x	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Analgesia, Epidural	en_US
dc.subject.mesh	Delivery, Obstetric	en_US
dc.subject.mesh	Cesarean Section	en_US
dc.subject.mesh	Vacuum Extraction, Obstetrical	en_US
dc.subject.mesh	Questionnaires	en_US
dc.subject.mesh	Logistic Models	en_US
dc.subject.mesh	Odds Ratio	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Parity	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Denmark	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Obstetric Labor Complications	en_US
dc.subject.mesh	Surveys and Questionnaires	en_US
dc.title	Mode of Delivery after Epidural Analgesia in a Cohort of Low-Risk Nulliparas	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	38	en_US
utslib.for	111402 Obstetrics and Gynaecology	en_US
utslib.for	11 Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	38	en_US

Abstract:

Background: Although epidural analgesia is widespread and very effective for alleviating labor pain, its use is still controversial, as the literature is inconsistent about the risk of adverse birth outcome after administration of epidural analgesia. The aim of this study was to explore associations between epidural analgesia and mode of delivery. Methods: Data were obtained from a prospective cohort from nine Danish labor wards and comprised 2,721 term nulliparous women with spontaneous onset of labor and a singleton fetus in cephalic presentation. Information about epidural analgesia, mode of delivery, and birth complications was obtained by the staff attending labor. Additional information was provided from self-administered questionnaires in gestational week 37. Multiple logistic regression analyses were used to estimate the association between epidural analgesia and birth outcomes. Results are presented as crude and adjusted odds ratios (OR [95% CI]). Results: Of the total cohort, 21.6 percent required epidural analgesia, 8.7 percent had emergency cesarean section, and 14.9 percent had vacuum extraction. Women with epidural analgesia had a higher risk of emergency cesarean section (adjusted OR: 5.8; 95% CI: 4.1-8.1), and vacuum extraction (adjusted OR: 1.7; 95% CI: 1.3-2.2). In a subgroup of the cohort with a very low overall risk of cesarean section, 3.4 percent had emergency cesarean section and an increased risk of emergency cesarean section was also found in this group (adjusted OR: 3.5; 95% CI: 1.5-8.2). Conclusions: In nulliparous women of a very low-risk population, use of epidural analgesia for labor pain was associated with higher risks of emergency cesarean section and vacuum extraction. © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

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http://hdl.handle.net/10453/117470