Effect of combined spinal-epidural analgesia in labor on frequency of emergency cesarean delivery among nulliparous Chinese women.
OBJECTIVE
To determine whether combined spinal-epidural analgesia (CSEA) during labor increases the frequency of emergency cesarean delivery among Chinese nulliparous women.


METHODS
In a retrospective study, the medical records of nulliparous women with a singleton fetus in cephalic presentation who delivered at term at Tongling Maternity Hospital, China, between January 2012 and December 2014 were reviewed. Information about CSEA, mode of delivery, labor duration, oxytocin augmentation, and neonatal outcome was obtained. Logistic regression was used to examine independent associations between CSEA and emergency cesarean after controlling for confounding variables.


RESULTS
Among 3456 women included, 1786 (51.7%) received CSEA and 1670 (48.3%) received no labor analgesia. Emergency cesarean was more frequent among CSEA users (219/1786 [12.3%]) than non-users (119/1670 [7.1%]; P<0.001). Among the maternal-fetal variables included in multivariate regression, maternal age, maternal height, cervical dilatation at admission, birth weight, and CSEA use were significantly associated with emergency cesarean. After adjustment, women with CSEA maintained a slightly increased risk for cesarean (adjusted odds ratio 1.54, 95% confidence interval 1.20-2.00).


CONCLUSIONS
Among Chinese nulliparous women, use of CSEA for labor pain was associated with an increased risk of emergency cesarean delivery; moreover, this effect was maintained after adjustment for other potential obstetric risk factors.
Obstetrics and Gynecology Department, The First Affiliated Hospital, Anhui Medical University, Hefei, China; Obstetrics and Gynecology Department, Tongling Maternity and Child Health Care Hospital, Tongling, China.
Fen
F
Wang
Obstetrics and Gynecology Department, The First Affiliated Hospital, Anhui Medical University, Hefei, China. Electronic address: caoyunxia6@126.com.
Yun-Xia
YX
Cao
Anesthesiology Department, Tongling Maternity and Child Health Care Hospital, Tongling, China.
Shan-Gao
SG
Ke
Obstetrics and Gynecology Department, Tongling Maternity and Child Health Care Hospital, Tongling, China.
Tao-Hua
TH
Zhu
Obstetrics and Gynecology Department, Tongling Maternity and Child Health Care Hospital, Tongling, China.
Miao
M
Zhang
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D001724:Birth Weight; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002681:China; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D048949:Labor Pain / Q000188:drug therapy*; D007747:Labor Stage, First; D007743:Labor, Obstetric / Q000187:drug effects*; D016015:Logistic Models; D008423:Maternal Age; D015999:Multivariate Analysis; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
Combined spinal–epidural analgesia; Emergency cesarean; Labor analgesia; Labor duration; Labor outcome; Nulliparous women