title: Outcomes of labor epidural analgesia among women aged over 40: A single-institution retrospective study.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of labor epidural analgesia (LEA) on maternal and neonatal outcomes among parturients aged 40 years or older.
  
  
  METHODS
  We retrospectively reviewed medical records of all laboring, singleton and cephalic deliveries at ≥36 weeks' gestation at the Saitama Medical Center from April 2003 to September 2012. Women aged ≥40 years who received LEA (≥40 with LEA group) were compared with women aged ≥40 years who delivered without LEA (≥40 without LEA group) and women <40 years who received LEA (<40 with LEA group). Extracted outcomes included mode of delivery, oxytocin augmentation, duration of labor, amount of estimated blood loss, umbilical artery pH, Apgar scores, and neonatal intensive care unit admission.
  
  
  RESULTS
  This study included 4441 women. There were 74 women in the ≥40 with LEA group, 369 in the ≥40 without LEA group, and 601 in the <40 with LEA group. The maternal outcomes of emergency cesarean delivery rate (9.5%, 12.5%, 9.0%), instrumental delivery rate (33.8%, 10.3%, 28.3%), duration of labor (521 min, 321 min, 565 min), and estimated blood loss (524 g, 351 g, 412 g) were reported for the ≥40 with LEA, ≥40 without LEA, and <40 with LEA groups, respectively. Neonatal outcomes were not different between these groups. LEA use was not associated with emergency cesarean delivery in the multivariable analysis.
  
  
  CONCLUSIONS
  Our study showed that parturients aged ≥40 with LEA can expect similar LEA-associated labor outcomes to younger parturients with LEA.
authors.affiliation: Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Okazaki
authors.affiliation: Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Risa
authors.initials: R
authors.lastname: Fukushima
authors.affiliation: Department of Anesthesiology, Kitasato University Medical Center, Kitamoto, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Nagashima
authors.affiliation: Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mazda
authors.affiliation: Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Tamura
authors.affiliation: Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Katsuo
authors.initials: K
authors.lastname: Terui
authors.affiliation: Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan.
authors.forename: Motoshi
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006801:Humans; D000068104:Infant Health / Q000706:statistics & numerical data; D007231:Infant, Newborn; D007743:Labor, Obstetric / Q000187:drug effects*; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: cesarean section; labor management; obstetric anesthesia