Neonatal Safety and Fetal Heart Rate Patterns With Ultrasound‐Guided Dural Puncture Epidural Versus Epidural Analgesia: A Randomized Controlled Trial

Background The dural puncture epidural (DPE) technique is a modification of conventional epidural (EP) analgesia that may enhance analgesic efficacy; however, its impact on neonatal safety requires rigorous evaluation. Methods In this single‐blind randomized controlled trial, 200 parturients at ≥ 37 weeks with singleton vertex fetuses were allocated to receive either DPE or EP labor analgesia. All procedures were performed under real‐time ultrasound guidance via a paramedian approach using a standardized analgesic regimen (0.09% ropivacaine with 0.4 μg/mL sufentanil, loading dose 10 mL, background infusion 10 mL/h, patient‐controlled bolus 10 mL, 15‐min lockout, maximum 40 mL/h). The primary outcome was the incidence of elevation in the National Institute of Child Health and Human Development (NICHD) Fetal Heart Tracing category from the baseline of intrapartum fetal heart rate (FHR) patterns. Results No significant intergroup clinical differences were observed in the primary outcome of NICHD category distribution, nor in specific FHR parameters (decelerations and variability), Apgar scores, or uterine contraction patterns. Although overall cesarean delivery rates were comparable, the distribution of indications for cesarean delivery differed significantly ( p = 0.005), with abnormal FHR patterns being more common in the DPE group and maternal indications more frequent in the EP group. The DPE technique exhibited a higher incidence of maternal transient side effects, including lower limb numbness (25.0% vs. 12.0%; RR 2.083, p = 0.018) and urinary retention (25.0% vs. 9.0%; RR 2.778, p = 0.003). Meanwhile, DPE provided superior analgesic efficacy, as evidenced by a shorter onset time, lower postanalgesia VAS scores, fewer PCA requests, decreased drug consumption, and a more extensive S2 sensory blockade. Conclusion Compared with conventional EP, the DPE technique did not adversely affect neonatal safety, as assessed by comprehensive FHR monitoring and Apgar scores. While DPE offers superior analgesic efficacy, its use is associated with an increased risk of transient maternal complications and altered indications for cesarean delivery. Trial Registration: ClinicalTrials.gov identifier: NCT05990504.