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The effect of labor anaglesia service on maternal-fetal outcomes: A Retrospective Case Series
Abstract Number: F-26
Abstract Type: Original Research
Abstract Title: The effect of labor anaglesia service on maternal-fetal outcomes: A Retrospective Case Series
Introduction： The rate of cesarean deliveries has reached 50% in many hospitals, less than 1% of women in labor were given neuraxial labor analgesia 1. The aim of this study was to evaluate the impact of neuraxial (epidural) labor analgesia on maternal-fetal safety outcomes in a signal Chinese academic medical center.
Methods: A single-intervention impact study was conducted at The Second Affiliated Hospital, Wenzhou Medical University in Wenzhou. The study period was divided into 3 phases: Baseline data collection occurred between January 1 and June 30, 2009, when no analgesic method was routinely employed during labor; An intervention was then implemented, consisting of a neuraxial labor analgesia service, termed of phase-in period; The service was fully operational from June 1, 2010, and data were collected to June 30, 2011, which was defined as post-No Pain Labor N' Delivery (NPLD) phase. The maternal-fetal safety outcomes of delivery were compared between the different periods. Results were presented as crude and adjusted odds ratios or 99% CI.
Results: There were 15415 deliveries with 42.3% of nulliparous parturients in the 31-month study period. As the primary outcomes, the neuraxial labor analgesia rate increased from 0% to 57%, the vaginal delivery rate increased and cesarean delivery rate decreased by 3.5% after full implementation. As the secondary outcomes, there were significant decreases in the rate of episiotomy and severe perineal injury before and after the implementation periods. The intrapartum cesarean delivery rate and forceps delivery rate were unchanged. In addition, the oxytocin augmentation rate increased by 17.6%, the rates of postpartum oxytocin administration decreased by 17.8%, and the rate of naloxone administration decreased by 0.61%. No significant difference between the baseline and implementation periods was found in the rate of postpartum hemorrhage, neoneatal Apgar scores less than 7 at both 1 and 5min, 7 day mortality and the overall NICU admission rate.
Conclusion: Epidural labor analgesia can increase the vaginal delivery and reduce the frequency of cesarean delivery, especially the incidences of non-medical indications cesarean section. Moreover, the implementation of neuraxial labor analgesia is safe to maternal-fetal.
1. Int J Gynecol Obstet 2007;98(3):205–7.