Pregnancy outcomes in women receiving intrapartum epidural analgesia at the Chris Hani Baragwanath academic hospital a 6-month review
Date
2017
Authors
Padayachee, Veneshree
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Abstract
Objectives This study had two objectives. The first was to describe the maternal
outcomes and complications associated with epidural analgesia and the neonatal
outcomes of babies born to women receiving intrapartum epidural analgesia. The second
was to assess the progress of labour in women receiving epidural analgesia and the
incidence of caesarean section and assisted vaginal deliveries.
Study design This was a cross sectional retrospective descriptive study of all women
who received intrapartum epidural analgesia and the neonates born thereof between
01/05/2015 and 31/10/2015.
Methods Women who received intrapartum epidural analgesia were identified from the
epidural registers at the Chris Hani Baragwanath Academic Hospital (CHBAH). The
medical records of these women and their neonates were retrieved and the relevant data
reviewed, captured and analysed.
Results There were a total of 9305 women that delivered between 01/05/2015 and
31/10/2015, of which 302 received intrapartum epidural analgesia. The incidence of
epidural use during this period was 3.24%. The median gestational age at delivery was
38.9 (37 - 42) weeks’ gestation. The incidence of epidural related complications was 17%,
comprising of hypotension (13.4%) and other minor complications (3.6%) with no
associated morbidity or mortality. Eighty-four (29.7%) of the women had poor progress of
labour pre and post epidural and 13 (4.6%) women post epidural only. Oxytocin for
augmentation of labour was used in 96 (32.8%) women. The incidence of prolonged
second stage of labour was 26.9% with an average duration of 63 ±33 minutes, with a
longer duration observed in primigravid women.
There were 142 (50.2%) normal vaginal deliveries, 23 (8.1%) assisted vaginal deliveries
and 118 (41.7%) caesarean sections, of which fetal distress (23%) was the main
indication.
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There were a total of 62 cardiotopographs (CTG), that changed from reactive to
suspicious post epidural, of those 52 neonates were born with an Apgar score of >7.
Of the 283 neonates delivered, 278 (98.2%) neonates were born alive with 258 (91.2%)
neonates with Apgar scores of >7 and 23 (8.1%) with Apgar scores <7. The incidence of
adverse neonatal outcomes was 4.2%. The fetal outcomes stratified by maternal, epidural
and labour outcomes reflected neither associative nor causal relationship to adverse fetal
outcomes.
Conclusion At the CHBAH, intrapartum epidural analgesia uses resulted in a maternal
complication rate of 17%, with no reported maternal morbidity or mortality. There was no
statistical increase in the incidence of poor progress of labour, use of oxytocin and
caesarean section or assisted vaginal deliveries. Two hundred and fifty eight (91.2%)
neonates were born with Apgar scores of >7, and an adverse neonatal outcome rate of
4.2%. Therefore the benefits of epidurals analgesia outweigh the risks.
Description
Dissertation submitted to the Faculty of Health Science, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology