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Comparison of Outcomes between Parturients Experiencing Shorter or Longer Analgesia/Anesthesia Durations for Labor to Primary Cesarean Conversion: A Retrospective Matched Cohort Study
Abstract Number: F1B-1
Abstract Type: Original Research
Failure to progress (FTP) labor endangers both the maternal and neonatal safety, and cesarean delivery (CD) is an effective treatment. The timing of turning to CD is commonly encouraged to be delayed for prevention of the primary CD. This study aimed to compare the influences of the length of anesthesia durations on the maternal and neonatal outcomes, which could be used to offer potential evidence for optimizing the timing for conversion to primary CD from FTP.
We reviewed the medical records of all the parturients who received labor epidural analgesia with FTP to primary CD between 05/2015 and 01/2018. A group of patients with shorter anesthesia duration (the interval from the beginning of labor analgesia to the end of CD) being < 10 h were identified (Group S), and another group of controls with anesthesia duration being >= 10h were matched to the same age, body mass index (BMI), gravida, gestational age, and neonatal birth weight with propensity scores (Group L). Data points included: incidences of alternative anesthesia approach and epidural replacement for CD, anesthesia complications, intraoperative blood loss and blood administration, length of hospital stay, and newborn Apgar scores.
We collected data of 303 patients in the Group S and 606 in Group L (1:2 ratio matched). After all the other factors were matched, the parity was still significantly different between the two groups (Group S, 0.3±0.7 v.s. Group L, 0.2±0.6; P=0.0230), therefore its effect was adjusted. After the adjustment, intraoperative blood loss was less in Group S as compared with Group L (800 (700-900) v.s. 800 (700-1000) ml, P=0.0498). Being in the Group L would increase the blood loss by 4.82%. Group S had significantly shorter length of stay compared with Group L (112.7(103.6-123.0) v.s. 123.1 (113.4-134.0) hours, P<0.0001). Being in the Group L would increase length of stay by 9.02%. The incidence of epidural replacement for CD was less in Group S (0% v.s. 2.3%, P=0.0070).
Thuillier et al found that the median duration of labor before CD was significantly prolonged in nulliparous parturients (10h v.s. 8h). We chose 10h as a watershed time-point, and found that three of the maternal indices (intraoperative blood loss, incidence of epidural replacement for CD, and length of hospital stay) were larger in the Group L, which implied potential maternal benefit for parturients to receive CD earlier than 10h, although the neonatal outcomes seemed not to be affected. Our data also indicated labor epidural tended to fail after 10h-12h. Such failed labor epidural could unfortunately fail at inconvenient times resulting in unsatisfactory maternal/ fetal outcome. Therefore, a well-balanced and fully informed decision needs to be vested before commit the parturient into a longer than 10-h trenching trial of labor process.
1. Thuillier C, Am J Obstet Gynecol 2017
2. ACOG Am J Obstet Gynecol 2014