Pregnancy outcomes in women receiving intrapartum epidural analgesia at the Chris Hani Baragwanath academic hospital a 6-month review

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. v 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.