Key result
Epidural analgesia during routine childbirth was associated with minor differences in arterial cord pH (7.24 vs. 7.25) and base excess, but showed no relevant association with short-term morbidity.
Why the study?
To investigate the use and association of epidural analgesia on neonatal short-term outcome during term vaginal childbirth in primiparous parturients.
Does epidural analgesia affect short-term neonatal morbidity in primiparous women with spontaneous vaginal birth at term?
Cohort (n=247,536)
Yes
Does epidural analgesia affect short-term neonatal morbidity in primiparous women with spontaneous vaginal birth at term?
Answers are grounded in this paper and cite their sources.
Epidural analgesia during routine childbirth is associated with slightly higher rates of NICU admission and lower 5-minute APGAR scores, but no relevant association with short-term morbidity or perinatal mortality.
Objectives To investigate the use and association of epidural analgesia (EA) on neonatal short-term outcome in vaginal childbirth at term of primiparous parturients. Design Retrospective cohort study. Setting Data of the National Birth Registry of Austria between 2008 and 2017. Population Primiparous women with spontaneous vaginal birth at term of singleton pregnancies in Austria. Methods Linear and logistic regression models to investigate an association of epidural analgesia on short-term neonatal outcome in propensity score adjusted cohorts. Main outcome measures: Short-term morbidity assessed by arterial cord pH and base excess. Secondary outcomes were admission to a neonatal intensive care unit, APGAR scores, and perinatal mortality. Results: Of 247 536 included deliveries, 52 153 received EA (21%). Differences in pH (7.24 vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89 ± 3.2 mmol/l vs. 6.15 ± 3.2 mmol/l; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR score at 5 minutes below 7 was more frequent with EA (OR 1.45; 95% CI 1.29 to 1.63). Admission to a neonatological intensive care unit occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2 (95% CI 1.14 to 1.26). EA was not associated with perinatal mortality (OR 1.33; 95% CI 0.79 to 2.25). Conclusions EA showed no relevant association with short-term morbidity. Higher rates of NICU admission and APGAR score after 5 minutes below 7 were observed with EA. Overall use of EA in Austria is low, and investigation of causes may be indicated.
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Kraft et al. (2020) conducted a cohort in Spontaneous vaginal birth at term (n=247,536). Epidural analgesia vs. No epidural analgesia was evaluated on Short-term morbidity assessed by arterial cord pH and base excess (95% CI -0.0066 to -0.0047). Epidural analgesia during routine childbirth was associated with minor differences in arterial cord pH (7.24 vs. 7.25) and base excess, but showed no relevant association with short-term morbidity.
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