Epidural Analgesia during Routine Childbirth: A 10 Years Retrospective
Analysis from the National Birth Registry Austria
Abstract
Objectives To investigate the use and association of epidural analgesia
(EA) on neonatal short-term outcome in vaginal childbirth at term of
primiparous parturients. Design Retrospective cohort study. Setting Data
of the National Birth Registry of Austria between 2008 and 2017.
Population Primiparous women with spontaneous vaginal birth at term of
singleton pregnancies in Austria. Methods Linear and logistic regression
models to investigate an association of epidural analgesia on short-term
neonatal outcome in propensity score adjusted cohorts. Main outcome
measures: Short-term morbidity assessed by arterial cord pH and base
excess. Secondary outcomes were admission to a neonatal intensive care
unit, APGAR scores, and perinatal mortality. Results: Of 247 536
included deliveries, 52 153 received EA (21%). Differences in pH (7.24
vs. 7.25; 97.5% CI -0.0066 to -0.0047) and BE (-5.89 ± 3.2 mmol/l vs.
6.15 ± 3.2 mmol/l; 97.5% CI 0.32 to 0.40) with EA could be shown. APGAR
score at 5 minutes below 7 was more frequent with EA (OR 1.45; 95% CI
1.29 to 1.63). Admission to a neonatological intensive care unit
occurred more often with EA (4.7% vs. 3.4%) with an OR for EA of 1.2
(95% CI 1.14 to 1.26). EA was not associated with perinatal mortality
(OR 1.33; 95% CI 0.79 to 2.25). Conclusions EA showed no relevant
association with short-term morbidity. Higher rates of NICU admission
and APGAR score after 5 minutes below 7 were observed with EA. Overall
use of EA in Austria is low, and investigation of causes may be
indicated.