The Association of the Degree of Labor Pain at the Time of Epidural Analgesia Placement and Mode of Delivery in Nulliparous Women Presenting for an Induction of Labor: A Retrospective Study
Abstract Number: 9
Abstract Type: Original Research
Introduction: Many studies have been conducted addressing whether labor neuraxial analgesia or the timing of neuraxial anesthesia visa vie cervical dilatation influences mode of delivery. However, no studies have addressed whether the timing of neuraxial analgesia visa vie the degree of pain the woman is experiencing at the time of epidural placement is associated with mode of delivery. The purpose of this study is to determine if the degree of labor pain at the time of neuraxial labor analgesia placement is associated with mode of delivery.
Methods: All women who presented to the labor floor from July 2005 through September 2008 for an induction of labor, were 37-41 weeks gestation, were <4 cm cervical dilatation, and requested labor neuraxial analgesia with a pain score of 0-3 were assessed retrospectively. Maternal and neonatal outcomes were compared with a similar group of women with greater pain scores (4-6 and 7-10). The following maternal data was collected: age, height, weight, mode of delivery, duration of first and second stage of labor, and pain scores (0-10) at the time of epidural placement. Neonatal data collected included birth weight, need for NICU admission, and Apgar scores at 1 and 5 minutes. Mode of delivery was either vaginal, instrumental assisted vaginal delivery (vacuum + forcep), or cesarean delivery. The data was analyzed with Chi-Square tests. P<0.05 was considered significant.
Results: We found 185 nulliparous women with low pain scores at the time of initiation of neuraxial analgesia. There was no significant difference among groups in maternal height, Apgar scores, or need for NICU admission, but maternal weight was greater in the low pain score group. There was also no significant difference in terms of mode of delivery. The cesarean delivery rate was 41%, 36%, and 34% in the low, moderate and high pain score groups, respectively, p=0.13. We also did not find a difference in the operative delivery rate (cesarean + instrumental assisted vaginal delivery) with a 49%, 45%, and 45% incidence in the low, moderate and high pain score groups, respectively, p=0.40.
Discussion: We found that the amount of pain at the time of neuraxial analgesia placement did not influence the mode of delivery in nulliparous women presenting for an induction of labor. We conclude that neuraxial analgesia can be safely placed without regard to the amount of labor pain.