Effect of epidural analgesia on neonatal outcomes in primiparas with meconium-stained amniotic fluid
Objective To observe the outcomes of neonates after using epidural analgesia(EA)during labor in primiparas with meconium-stained amniotic fluid,and to investigate the influence of EA on the outcomes of neonates.Methods From February 2022 to January 2023,691 primiparas with meconium-stained amniotic fluid during vaginal delivery in Guangzhou Women and Children's Medical Center of Guangzhou Medical University were divided into EA group(n=544)and non-EA group(n=147).The clinical data including gestational age,body mass index at delivery,pregnancy comorbidities and first stage of labor,and maternal-fetal outcomes including postpartum blood loss within 24 h after labor,Apgar's scores,hospitalization rate of neonates and umbilical cord blood pH were compared between two groups.Based on the neonatal outcome,691 patients were divided into adverse outcome group(n=220)and non-adverse outcome group(n=324),and the clinical data as gestational age,body mass index,first stage of labor and second stage of labor were compared between two groups.Multivariate logistic regression analysis was performed to identify the influencing factors of neonatal adverse outcomes after EA in primiparas with meconium-stained amniotic fluid.Results The primiparas were older in EA group[(29.63±3.10)years]than non-EA group[(28.91±3.72)years](t=-2.373,P=0.018).The gestational age was longer in EA group[(39.61±0.84)weeks]than that in non-EA group[(39.18±1.03)weeks](t=-4.747,P＜0.001).The rates of oxytocin use and category Ⅱ/Ⅲ fetal heart rate were higher in EA group(51.7％,79.8％)than those in non-EA group(29.9％,63.3％)(x2=21.920,P＜0.001;x2=17.436,P＜0.001).The durations of first stage of labor and second stage of labor were longer in EA group[(590.96±227.19),(47.86±27.90)min]than those in non-EA group[(363.78±197.46),(42.09±34.79)min](t=-11.972,P＜0.001;t=-2.105,P=0.036).The rates of pregnancy comorbidities,planned delivery and episiotomy were lower in EA group(21.5％,13.1％,58.1％)than those in non-EA group(33.3％,20.4％,68.7％)(P＜0.05),and there were no significant differences in the body mass index of primiparas at delivery,primiparas body temperature ≥38 ℃ during labor and birth weight of neonates(P＞0.05).The blood loss within 24 h after labor was larger in EA group[(283.10±117.59)mL]than that in non-EA group[(251.84±90.66)mL)](t=-2.991,P=0.003).There were no significant differences in the rates of assisted labor,Apgar's score ≤7,Apgar's score ≤3,neonatal hospitalization rate,umbilical cord blood pH ≤7.15,and umbilical cord blood pH ≤7.0 between two groups(P＞0.05).The gestational age was longer in adverse outcome group[(39.74±0.78)weeks]than that in non-adverse outcome group[(39.53±0.88)weeks](t=2.844,P=0.005).The rates of oxytocin use,episiotomy and category Ⅱ/Ⅲ fetal heart rate were higher in adverse outcome group(56.8％,70.9％,95.9％)than those in non-adverse outcome group(48.1％,49.4％,68.8％)(P＜0.05).The duration of first stage of labor was longer in adverse outcome group[(631.86±196.71)min]than that in non-adverse outcome group[(563.19±242.12)min](t=3.636,P＜0.001).There were no significant differences in the age,body mass index of primiparas at delivery,second stage of labor,birth weight of neonates,and rates of pregnancy comorbidities,planned delivery and primiparas body temperature ≥ 38 ℃ during labor between adverse outcome group and non-adverse outcome group(P＞0.05).The gestational age(OR=1.294,95％CI:1.004-1.668,P=0.046),episiotomy(OR=1.820,95％CI:1.179-2.809,P=0.007),category Ⅱ/Ⅲfetal heart rate(OR=9.682,95％CI:4.647-20.172,P＜0.001),and first stage of labor(OR=1.001,95％CI:1.000-1.002,P=0.023)were the influencing factors of neonatal adverse outcomes when using EA during labor in primiparas with meconium-stained amniotic fluid.Conclusions EA during labor in primiparas with meconium-stained amniotic fluid does not increase the neonatal adverse outcomes,and the long gestational age,category Ⅱ/Ⅲ fetal heart rate,episiotomy and prolonged duration of first stage of labor would increase the risk of neonatal adverse outcome.
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