Impact of Low-Dose Epidural Analgesia on Labour Progression in Low-Risk Women

Fondazione Policlinico Universitario Agostino Gemelli IRCCS5,995 enrolled

Overview

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)

Study Type

OBSERVATIONAL

Enrollment

5,995

Conditions

Epidural Analgesia, Obstetric

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 40 Years

Medical Language ↔ Plain English

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)

Locations (1)

Fondazione Policlinico Universitario A. Gemelli IRCCS

Rome, RM, Italy

Outcomes

Primary Outcomes

Cervical dilation curve

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.

Time frame: First stage of labour (from admission to the delivery suite to full cervical dilation)

Fetal head descent curve

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.

Time frame: From admission to the delivery room up to the time of delivery (either via vaginal route or caesarean section)

Secondary Outcomes

Length of active phase

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.

Time frame: Up to 24 hours from admission.

Length of second stage

Second stage begins at full cervical dilation and ends at delivery.

Time frame: Up to 24 hours from admission.

Type of vaginal delivery

In the VD-e and VD-n groups, description of the type of delivery (eutocic or instrumental)

Time frame: At delivery

Maternal complications during vaginal delivery

Rate of maternal complications (postpartum haemorrhages, perineal lacerations, uterine atony) in the VD groups.

Time frame: At delivery.

Episiotomy

Rate of episiotomy in the VD groups.

Time frame: At delivery.

Fetal indicators

Apgar at 1 and 5 minutes, admission in Neonatal Intensive Care Unit (NICU), death

Time frame: After delivery