title: Are there any strategies to improve neonatal outcomes associated with epidural analgesia in labor?
abstract: OBJECTIVE
  This study was aimed at evaluating the relationship between epidural analgesia and perinatal outcomes and at verifying the advisability of procedural changes in assistance to labor.
  
  
  METHODS
  From January to December 2012, we conducted a retrospective case-control study on 1,963 laboring pregnant women admitted to the Parma University Hospital. We considered two groups: Group 1 received epidural analgesia and Group 2 received no analgesia. Women with elective cesarean sections, multiple pregnancies or deliveries at &lt;34 weeks were excluded. We recorded maternal data (age, type of delivery, obstetric procedures, premature rupture of membranes, screenings for Group-B Streptococcus) and neonatal data (birth weight, gestational age, 1- and 5-minute Apgar scores, diagnosis at discharge).
  
  
  RESULTS
  Of the 1,963 laboring women, 287 requested analgesia and 1,676 did not. We found no significant differences between the two groups in the rates of cesarean section, clavicle fracture, and 1-minute Apgar score between 4 and 7. By contrast, we observed a higher rate of instrumental deliveries (p&lt;0.01), fetal occiput posterior position (p&lt;0.05), neonatal cephalohematoma (p=0.01) in Group 1 than in Group 2 . In Group 1 we also found a higher number of newborns with 1-minute Apgar score of 3 or less (p=0.016). In addition, a significantly higher number of women in Group 1 had fever during labor (p=0.003, odds ratio 5.01).
  
  
  CONCLUSIONS
  Our results suggest that strategies should be activated to overcome or limit the side-effects of analgesia in labor through prospective and multidisciplinary studies.
authors.affiliation: Università degli studi di Parma. armanimarta@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: Armani
authors.forename: Carla
authors.initials: C
authors.lastname: Gaggiano
authors.forename: Sara
authors.initials: S
authors.lastname: Dallaglio
authors.forename: Enzo
authors.initials: E
authors.lastname: Romanini
authors.forename: Carmen
authors.initials: C
authors.lastname: Sospiri
authors.forename: Cinzia
authors.initials: C
authors.lastname: Magnani
mesh_terms: D015360:Analgesia, Epidural; D016022:Case-Control Studies; D002585:Cesarean Section; D036861:Delivery, Obstetric; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies