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The Impact of Continuing Epidural Analgesia during the Second Stage of Labor and the 2014 ACOG Definition of Arrest of Labor on Mode of Delivery and Newborn Outcomes in a Chinese Academic Medical Center
Abstract Number: SA-30
Abstract Type: Original Research
Background: The No Pain Labor & Delivery-Global Health Initiative (NPLD) was initiated in The Second Affiliated Hospital of Wenzhou Medical University in 2009. Despite an increase in rates of neuraxial labor analgesia (NA) and improved maternal outcomes, continuation of NA in the second stage of labor (CEADSSOL) was interrupted by care providers due to fears of increased risk of operative vaginal or cesarean delivery (CD) and adverse neonatal outcomes. Also, Chinese women and obstetric providers are quick to proceed to CD with arrest of labor with the belief that CD may be safer for the baby. This SOAP funded study evaluated the implementation of CEADSSOL and the ACOG statement in 2014 on proceeding to CD following arrest of labor on neonatal and maternal outcomes. We hypothesis that the jointed interventions would not have an adverse impact on neonatal or maternal outcomes.
Methods: This is an impact study. Data collection began March 2014 and ended in May 2015, one year after implementation of both interventions using an electronic medical record system and verified using case logs in the L & D suites. The primary outcome was NICU admission. The implementation of CEADSSOL with 0.08-0.15% ropivacaine and sufentanil 0.1-0.2 mcg/mL. The chi-squared test were used for analyses. A P < 0.05 was required to rejecting the null hypotheses.
Results: There were a total 10,414 deliveries during the study period. Post-intervention NICU admissions, antibiotics usage, intubation, and 7-day mortality rates were dramatically reduced compared to pre-interventions (Figure and table). Maternal outcomes including monthly rates of forceps, episiotomy, and intrapartum CD remained unchanged.The impact of the interventions was sustained between the first three and the last three months post interventions. The NA rate increased from 44% to 57% before and after the interventions as the CD rate decreased from 40% to 36%.The primary outcome was not changes when corrected for the increase in NA rate. There was no maternal death and only one 3 degree of perineal laceration during the study period.
Summary: The important finding of this study was the improvement in neonatal outcomes by implementing two jointed interventions without a cost of increased operative delivery. In fact, the jointed interventions decreased the CD rates in the post-intervention period with sustained effects. Similar finding have been observed at two additional Chinese hospitals that implemented NPLD.