Abstract
Introduction: Labour pains are described by most women as the most excruciating pain they had experienced ever and commensurate to breaking multiple bones together. But safety of epidural analgesia in terms of neonatal outcome has been a controversial aspect.
Aims and Objectives: To study the neonatal outcomes of maternal epidural analgesia during labour, particularly with respect to respiratory depression and need for resuscitation.
Materials and Methods: 100 consecutive cases of normal delivery with epidural analgesia were enrolled at a single center from June’2016 to December’ 2016. Babies born with congenital anomalies, chromosomal disorders were excluded. The cord blood gas, APGAR score, need and extent of resuscitation, NICU admission, Birth asphyxia & neonatal encephalopathy were noted.
Results: 76 women delivered spontaneously vaginally,9 women required assistance in form of vacuum and 15 women were taken for caesarean section. Only 4 babies required active resuscitation in form of Positive pressure ventilation or Delivery room CPAP. 8 newborns required high flow nasal cannula (HFNC) for <1 hour for respiratory distress. None of the babies had a pH of less than 7. Two babies were admitted in NICU for preterm care and 1 for transient tachypnea of newborn.
Conclusion: There was no evidence of birth-asphyxia or neonatal encephalopathy secondary to maternal epidural analgesia in our study.
References
- Kumar M, Paes B; Epidural opioid analgesia and neonatal respiratory depression; Journal of Perinatology. 2003;23:425-427
- Kumar M, Chandra S, Ijaz Z, Senthilselvan A; Epidural analgesia in labour and neonatal respiratory distress: A casecontrol study; Child Foetal Neonatal Ed;2014;99:116–119
- Reynolds F, Sharma S, Seed PT. Analgesia in labour and foetal acid-base balance: A meta-analysis comparing epidural with systemic opioid analgesia. BJOG: An International Journal of Obstetrics and Gynaecology; 2003;109(12):1344-53.
- Hasegawa J, Farina A, Turchi G, Hasegawa Y, Zanello M, Baroncini S. Effects of epidural analgesia on labour length, instrumental delivery, and neonatal short-term outcome; J.Anesth. 2013; 27(1):43-7.
- Gizzo SI, Di Gangi S, Saccardi C, PatrelliTS, Paccagnella G, Sansone L, Barbara F,D'Antona D, Nardelli GB. Epiduralanalgesia during labor: Impact on delivery outcome, neonatal well-being, and early breast feeding; Breastfeed Med. 2012;7: 262-8
- Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or noanalgesia in labour. Cochrane Database Syst. Rev. 2011;12
- Soncini E, Grignaffini A, Anfuso S, Cavicchioni O. Epidural analgesia duringlabour: maternal, fetal and neonatalaspects; Minerva Ginecol. 2003;55(3):263-9
- Bakhamees H, Hegazy E. Does epidural increase the incidence of cesarean delivery or instrumental labour in Saudi populations? Middle East Journal of Anaesthesiology; 2007;19(3):693-704
- Torvaldsen S, Roberts CL: No increased risk of caesarean or instrumental delivery for nulliparous women who have epidural analgesia early in (term) labour;Evid Based Med. 2012, 17 (1): 21-22. 10.1136/ebm-2011-100092
- Ngyuen US, Rothman KJ, Demissie S, Jackson DJ, Lang JM, Ecker JL: Epidural analgesia and risks of Cesarean and operative vaginal deliveries in nulliparous and multiparous women. Matern Child Health J. 2010, 14: 705-712. 10.1007/s10995-009-0515-9
- Shrestha B, Devgan A, Sharma M. Effects of maternal epidural analgesia on theneonate a prospective cohort study; Italian Journal of Paediatrics. 2014;40:99
- Sylavanus K et al: The Effect of Epidural Labour Analgesia on Neonatal Outcomes: A Prospective Randomised Study; British Journal of Medicine & Medical Research 14(10): 1-8, 2016.
Corresponding Author
Dr S.P. Senthil Kumar
A-602, Veraciousrosedale, Varthur Kodi, Whitefield, Bengaluru-560066, India