A study on epidural analgesia in labour and its foetomaternal outcomes in a tertiary care centre

Mihir Surendra Chaudhari; Susan John

doi:10.18203/2320-1770.ijrcog20260897

Authors

Mihir Surendra Chaudhari Department of Obstetrics and Gynecology, Ernakulam Medical Centre, Kochi, Kerala, India
Susan John Department of Obstetrics and Gynecology, Ernakulam Medical Centre, Kochi, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260897

Keywords:

Epidural analgesia, Foetomaternal outcome, Labour pain, Neonatal outcome, 11 point-Numerical Rating Scale

Abstract

Background: Epidural analgesia is considered the most effective method for labour pain relief. However, concerns persist regarding its influence on labour progression, operative delivery and neonatal outcomes. This study evaluated foetomaternal outcomes associated with epidural labour analgesia.

Methods: This prospective observational study was conducted over a period of eleven months in a tertiary care teaching hospital. Sample size was calculated using nMaster software with 80% power and 95% confidence, yielding a minimum of 34 participants per group; 50 women were enrolled in each group (total n=100) to enhance power. Parturients were allocated into epidural (n=50) and non-epidural (n=50) groups. Maternal outcomes included pain scores assessed by the Numerical Rating Scale (NRS), duration of labour stages and mode of delivery. Neonatal outcomes included Apgar scores at 1 and 5 minutes and neonatal intensive care unit (NICU) admissions. Statistical analysis was performed using Student’s t-test and Chi-square test, with p<0.05 considered significant.

Results: Pain scores were significantly lower in the epidural group at all measured intervals after 15 minutes (p<0.0001). The duration of the first and second stages of labour was significantly prolonged in the epidural group. There was no statistically significant difference in caesarean section rates, instrumental deliveries, Apgar scores or NICU admissions between groups. Maternal complications were minimal and comparable.

Conclusions: Epidural labour analgesia provides effective pain relief without increasing caesarean section rates or adversely affecting neonatal outcomes, although it is associated with a modest prolongation of labour.

Metrics

Metrics Loading ...

References

Wong CA. Advances in labour analgesia. Int J Obstet Anesth. 2020;43:1-8.

Sultan P, Halpern SH, Pushpanathan E, Patel S, Carvalho B. Labour analgesia and obstetric outcomes: recent advances. Anesth Analg. 2021;132(5):1342-52.

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9. DOI: https://doi.org/10.1126/science.150.3699.971

Lederman RP, Lederman E, Work B Jr, McCann DS. Anxiety and epinephrine in labour: relation to duration and fetal heart rate. Am J Obstet Gynecol 1978;132(5):495-500. DOI: https://doi.org/10.1016/0002-9378(78)90742-1

Chestnut DH. Obstetric anesthesia: principles and practice. 6th ed. Philadelphia: Elsevier. 2020.

Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev. 2018;5:331. DOI: https://doi.org/10.1002/14651858.CD000331.pub4

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 209: obstetric analgesia and anesthesia. Obstet Gynecol. 2019;133(3):208-25. DOI: https://doi.org/10.1097/AOG.0000000000003132

Rosen MA. Low-dose epidural techniques for labour analgesia. Curr Opin Anaesthesiol. 2021;34(3):268-73.

Zhang J, Klebanoff MA, DerSimonian R. Epidural analgesia and mode of delivery. Am J Obstet Gynecol. 2019;220(4):376.

Liang H, Chen M, Xu J, Li Y, Zhao X, Liu H. Effect of epidural analgesia on the duration of labour stages: a cohort study. BMC Pregnancy Childbirth. 2022;22:321.

Liu X, Landon MB, Cheng W, Leffert LR. Epidural analgesia and severe maternal morbidity: a population-based study. BMJ. 2023;381:75556.

Kaur M, Singh PM, Trikha A. Fetomaternal outcomes with epidural analgesia: an Indian perspective. J Obstet Gynaecol.2022; 72(3):215-21.

Gupta S, Sharma R, Kaur S. Labour analgesia practices in developing countries. Indian J Anaesth. 2022;66(2):93-9.

World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: WHO. 2018.

Anupama MK, Nair AS, Sreedevi A. Fetomaternal outcome in parturient women with and without epidural labour analgesia. Indian J Clin Anaesth. 2019;6(2):220-3. DOI: https://doi.org/10.18231/j.ijca.2019.041

Ahmed S, Ali A, Rahman H. Labour progress with epidural analgesia: prospective analysis. J Obstet Anaesth Crit Care. 2023;13(1):12-8.

Halpern SH, Leighton BL, Ohlsson A, Barrett JF, Rice A. Effect of epidural vs parenteral opioid analgesia on labour outcomes. JAMA. 1998;280(24):2105-10. DOI: https://doi.org/10.1001/jama.280.24.2105

Singh R, Verma R, Jain A. Instrumental delivery and epidural analgesia: a comparative study. Indian J Anaesth. 2022;66(4):287-92.

Leighton BL, Halpern SH. The effects of epidural analgesia on labour, maternal and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002;186(5):69-77. DOI: https://doi.org/10.1016/S0002-9378(02)70182-8

Patel P, Shah D, Mehta K. Neonatal outcomes associated with epidural labour analgesia. BMC Anesthesiol. 2024;24:55.

Palmer CM, Maciulla JE, Cork RC, Nogami WM, Gorman RS. Fetal heart rate changes with neuraxial labour analgesia. Int J Obstet Anesth. 2021;46:102-9.

Sharma N, Gupta S, Kumar R. Impact of epidural analgesia on mode of delivery in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2023;12(4):1021-6.