Side effects from epidural analgesia in laboring women and risk of cesarean deliveryAJOG Global Reports at a Glance

Alessandro Ghidini, MD; Kelly Vanasche, BSN; Alyssa Cacace, BS; Marietta Cacace, BSN; Simona Fumagalli, RM; Anna Locatelli, MD

AJOG Global Reports (Feb 2024)

Side effects from epidural analgesia in laboring women and risk of cesarean deliveryAJOG Global Reports at a Glance

Alessandro Ghidini, MD,
Kelly Vanasche, BSN,
Alyssa Cacace, BS,
Marietta Cacace, BSN,
Simona Fumagalli, RM,
Anna Locatelli, MD

Affiliations

Alessandro Ghidini, MD: Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
Kelly Vanasche, BSN: Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
Alyssa Cacace, BS: Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA, USA (Alyssa Cacace)
Marietta Cacace, BSN: Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA (Dr Ghidini and Mses Vanasche, A Cacace and M Cacace)
Simona Fumagalli, RM: School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli); Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli).; Corresponding author: Simona Fumagalli, RM, PhD.
Anna Locatelli, MD: School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy (Ms Fumagalli and Dr Locatelli); Obstetrics, IRCCS San Gerardo dei Tintori, Monza, Italy (Ms Fumagalli and Dr Locatelli).

Journal volume & issue: Vol. 4, no. 1
p. 100297

Abstract

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BACKGROUND: Epidural analgesia may cause maternal hypotension and changes in the fetal heart rate. The implications of such side effects on the course of labor and delivery are incompletely understood. OBJECTIVE: This study aimed to assess whether the occurrence of maternal or fetal side effects associated with labor epidural analgesia increased the risk for cesarean delivery. STUDY DESIGN: This was a cohort study of all women who underwent epidural analgesia during labor for the period October 1, 2020 to December 31, 2020. Excluded were cases of multiples, fetal death, noncephalic presentation, and gestational age at birth 20% below the last value before epidural analgesia was administered, was related to changes in the fetal heart rate category. The principal outcome was cesarean delivery rate; binary logistic regression analysis was used to control for confounders, and mediation model analysis was used to quantify the extent to which significant variables participated in the causation pathway to cesarean delivery (SPSS version 28 was used for the analyses). RESULTS: A total of 439 women met the study criteria. Significant adverse reactions owing to epidural occurred in 184 of 439 women (41.9%) and included severe maternal hypotension in 159 of 439 participants (36.2%) and worsening fetal heart rate category in 50 of 439 participants (11.4%). The logistic regression analysis revealed that cervical dilation at epidural (P=.03), the duration of labor after epidural (P<.001), and worsening fetal heart rate category within 60 minutes of epidural administration (P=.01) were independently associated with recourse to cesarean delivery. The mediation analysis showed that both cervical dilatation at epidural administration and worsening fetal heart rate category had significant direct and indirect effects in the pathway to cesarean delivery. CONCLUSION: Worsening fetal heart rate category related to labor epidural independently increased the risk for cesarean delivery.

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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