Evaluation of effects of epidural analgesia on labor and neonatal outcomes in patients undergoing epidural analgesia for normal delivery

Objective: Labor pain is one of the most severe pain that women can experience throughout their whole life. Epidural analgesia is widely used for over 30 years in obstetric analgesia. In this study, its aimed to evalute the effects of epidural analgesia on labor and neonatal outcomes in patients undergoing epidural analgesia for normal delivery. Material - Method: Pregnancy and birth records of all patients admitted to Cukurova University Medical Faculty Hospital, Obstetrics and Gynecology Clinic because of the onset of labor or has been hospitalized for delivery between January 1, 2013 and December 31, 2013 were retrospectively analyzed. A total of 106 pregnant women that meet the inclusion criteria (between ages 17-39, between 34-41 weeks of gestation, singleton pregnancies with cephalic presentation, examination does not suggest cephalopelvic disproportion, not have a systemic disease, not morbidly obese, reactive fetal heart rate monitoring and have sufficient amniotic fluid) were enrolled in the study. 251 pregnant women with the same characteristics also were included as a control group. All patients were given detailed information about epidural analgesia and informed consent. Groups were compared in terms of demographic characteristics (age, gravida, parity), obstetric outcomes (intrapartum fetal heart rate patterns that do not trust, duration of the stages of birth, presence of meconium-stained amniotic fluid, mode of delivery, operative vaginal delivery needs, rate of opening episiotomy during delivery) and neonatal outcomes; (preterm birth, postterm birth, birth weight, APGAR score, perinatal mortality, neonatal intensive care needs). Results for the level of statistical significance were considered of p values <0.05. Results: In this study, 106 patients with epidural analgesia during labor, and 251 patients as a control group were included. The mean age was 26.2 ± 5.72 in epidural group and was 28.1 ± 5.94 in the control group. The mean weight of the patients was 74.4 ± 12.39 in the epidural group, and was 75.5 ± 13.23 in the control group. The mean cervical dilatation in the first admission was 2.1 ± 1.1 for both groups included in the study. Gestational age of the patients participating in the study ranged from 34 weeks to 41 weeks. For epidural group; the gestational age was between 34-36.6 weeks for 18.9%, between 37-39.6 weeks for 59.4%, and ≥40 weeks for 21.7% of patients in the epidural group. For the control group; the gestational age was between 34-36.6 weeks for 19.9%, between 37-39.6 weeks for 53.4%, and ≥40 weeks for 26.7% of patients in the control group. The mean duration of the active phase of the first stage of labor were 3 hours and 2 hours in the epidural group and control group, respectively. The duration of the second stage of labor was 35 minutes in the epidural group and was 15 minutes in the control group. Active phase was longer for one hour, and the duration of second stage was longer for 20 minutes in the epidural group. Complications and prolongation of phase in the third stage of labor was 2.1% in the epidural group and 1.6% in the control group. Retained placenta was observed 2.8% and 0.8% in epidural and control group, respectively. Postpartum atony was occured 3.8% and 1.6%, respectively. Unreliable (??) fetal heart rate pattern was observed as 2.8% and 8.8%, respectively. The proportion of patients episiotomy opened during labor was 54.2% and 18.8% in the epidural group and control group. In the epidural group, 89.6% of patients gave birth by normal delivery and 10.4% of patients gave birth by cesarean section. In the control group, 74.1% of patients gave birth by normal delivery and 25.9% of patients gave birth by cesarean section. There were not statistically significant differences for 1. and 5. minutes APGAR scores between groups. Neonatal intensive care needs after birth was 23.6% in the epidural group and was 10.4% in the control group. From 106 patients have epidural analgesia for labor, the need for additional doses of epidural analgesia was required in 63 patients. 65.2% of patients with first pregnancy (n: 66) and 50% of patients with two or more pregnancy (n: 40) were in need of additional doses of epidural analgesia. Conclusion: Normal delivery with epidural analgesia is an advantageous method in terms of patient comfort. However, epidural analgesia may cause prolongation in the active phase and second stage of labor. In terms of neonatal effects, APGAR scores remained unchanged; but epidural analgesia was associated with the need for follow-up in intensive care. Key words: Epidural analgesia, normal delivery, obstetric and fetal outcomes