Introduction

Epidural anesthesia is a well-established procedure in obstetrics for pain relief in labor and has been well researched as it comes to cephalic presentation. However, in vaginal intended breech delivery less research has addressed the influence of epidural anesthesia. The Greentop guideline on breech delivery states that there’s little evidence and recommends further evaluation.

Objective

The aim of this study was to compare maternal and neonatal outcomes in vaginally intended breech deliveries at term with and without an epidural anesthesia.

Design

This study was a retrospective cohort study.

Sample

This study included 2122 women at term with a singleton breech pregnancy from 37 + 0 weeks of pregnancy on and a birth weight of at least 2500 g at the obstetric department of University hospital Frankfurt from January 2007 to December 2018.

Methods

Neonatal and maternal outcome was analyzed and compared between women receiving “walking” epidural anesthesia and women without an epidural anesthesia.

Results

Fetal morbidity, measured with a modified PREMODA score, showed no significant difference between deliveries with (2.96%) or without (1.79%; p = 0.168) an epidural anesthesia. Cesarean delivery rates were significantly higher in deliveries with an epidural (35 vs. 26.2%, p = 0.0003), but after exclusion of multiparous women, cesarean delivery rates were not significantly different (40.2% cesarean deliveries with an epidural vs. 41.5%, p = 0.717). As compared to no epidurals, epidural anesthesia in vaginal delivery was associated with a significantly higher rate of manual assistance (33.8 versus 52.1%) and a longer duration of birth (223.7 ± 194 versus 516.2 ± 310 min) (both p < 0.0001)".

Conclusion

Epidural anesthesia can be offered as a safe option for pain relief without increasing neonatal or maternal morbidity and mortality. Nevertheless, it is associated with a longer birth duration and manually assisted delivery.

中文翻译：

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硬膜外麻醉对足月阴道臀位分娩妊娠的影响：基于医院的回顾性分析

介绍

硬膜外麻醉是产科中一种行之有效的缓解分娩疼痛的手术，并且在头颅先露方面已得到充分研究。然而，在阴道臀位分娩中，很少有研究讨论硬膜外麻醉的影响。Greentop 关于臀位分娩的指南指出，证据很少，建议进一步评估。

客观的

本研究的目的是比较采用和不采用硬膜外麻醉的足月阴道臀位分娩的孕产妇和新生儿结局。

设计

这项研究是一项回顾性队列研究。

样本

这项研究包括 2007 年 1 月至 2018 年 12 月在法兰克福大学医院产科的 2122 名足月单胎臀位妊娠妇女，她们怀孕 37+0 周，出生体重至少 2500 克。

方法

对接受“步行”硬膜外麻醉的妇女和未接受硬膜外麻醉的妇女的新生儿和产妇结局进行了分析和比较。

结果

 使用改良的 PREMODA 评分测量的胎儿发病率显示，使用硬膜外麻醉 (2.96%) 或不使用硬膜外麻醉(1.79%； p = 0.168)的分娩之间没有显着差异。硬膜外分娩的剖腹产率显着较高（35% vs. 26.2%，p  = 0.0003），但排除经产妇后，剖腹产率没有显着差异（硬膜外剖宫产率为 40.2% vs. 41.5%，p  = 0.717）。与无硬膜外麻醉相比，阴道分娩中硬膜外麻醉与手动辅助率显着较高（33.8% vs 52.1%）和较长的分娩持续时间（223.7 ± 194 vs 516.2 ± 310 分钟）相关（均 p < 0.0001 ）  " 。

结论

硬膜外麻醉可以作为缓解疼痛的安全选择，而不会增加新生儿或孕产妇的发病率和死亡率。然而，它与较长的分娩持续时间和人工辅助分娩有关。