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Research Article| Volume 34, ISSUE 3, e286-e291, May 2021

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Epidural analgesia during birth and adverse neonatal outcomes: A population-based cohort study

  • Diana Høtoft
    Correspondence
    Corresponding author.
    Affiliations
    Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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  • Rikke Damkjær Maimburg
    Affiliations
    Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark

    Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark

    School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith 2751, Australia
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      Abstract

      Background

      In general, epidural analgesia is considered a safe and efficient way to relieve pain during active labour and is increasingly used in childbirth. It is well documented that epidural analgesia during birth has benefits but also adverse effects. However, evidence is limited on how epidural analgesia influences neonatal outcome in a low-risk population of birthing women.

      Aim

      To examine low Apgar score, foetal hypoxia and admission to the neonatal intensive care unit in neonates of low-risk women receiving epidural analgesia during birth.

      Methods

      A cohort study using registry data to investigate a population of 23,272 low-risk women giving birth at a university hospital.

      Results

      Epidural analgesia was used in 21.6% of low-risk women during birth. Low Apgar score, foetal hypoxia, and admission to the neonatal intensive care unit were found in 0.6%, 0.6%, and 10.0%, respectively in neonates of mothers receiving epidural analgesia during birth compared to 0.3%, 0.6%, and 5.6%, respectively in the non-exposed group. Epidural analgesia was associated with low Apgar score, adjusted odds ratio 1.76 (95% CI 1.07–2.90) and admission to the neonatal intensive care unit, adjusted odds ratio 1.43 (95% CI 1.26–1.62). A mediation analysis indicates the impact of epidural analgesia on adverse neonatal outcomes was mediated by obstetric complications like maternal fever, labour augmentation, and foetal malpresentation.

      Conclusion

      This study found use of epidural analgesia during birth in low-risk pregnant women was associated with infant low Apgar score and admission to the neonatal intensive care unit.

      Keywords

      Abbreviations:

      EA (epidural analgesia), BMI (body mass index), NICU (neonatal intensive care unit), PROM (prelabour rupture of membranes)
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