PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: This study was a retrospective cohort study.
METHODS: 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)\".
CONCLUSIONS: 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.
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.
METHODS: This study was a retrospective cohort study.
METHODS: 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)\".
CONCLUSIONS: 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.
摘要：
背景：硬膜外麻醉是产科中公认的缓解分娩疼痛的方法，并且在头颅表现方面已经得到了充分的研究。然而,在阴道分娩中，很少有研究解决硬膜外麻醉的影响。关于臀位分娩的Greentop指南指出，几乎没有证据，并建议进一步评估。
目的：本研究的目的是比较有或没有硬膜外麻醉的足月阴道有意臀位分娩的产妇和新生儿结局。
方法：本研究为回顾性队列研究。
方法：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名从怀孕37+0周且出生体重至少为2500g的单胎臀位妊娠妇女。
方法：分析并比较接受“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。
结果：胎儿发病率，用修改的PREMODA评分测量，在使用（2.96％）或不使用（1.79％；p=0.168）硬膜外麻醉的分娩之间没有显着差异。硬膜外分娩的剖宫产率明显较高（35vs.26.2%,p=0.0003),但是在排除多产妇女之后，剖宫产率无显著差异(40.2%硬膜外剖宫产与41.5%,p=0.717）。与没有硬膜外麻醉相比，经阴道分娩的硬膜外麻醉与较高的人工辅助率（33.8对52.1％）和较长的分娩时间（223.7±194对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产妇的发病率和死亡率。然而，它与更长的出生时间和人工辅助分娩有关.
目的：本研究的目的是比较有或没有硬膜外麻醉的足月阴道有意臀位分娩的产妇和新生儿结局。
方法：本研究为回顾性队列研究。
方法：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名从怀孕37+0周且出生体重至少为2500g的单胎臀位妊娠妇女。
方法：分析并比较接受“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。
结果：胎儿发病率，用修改的PREMODA评分测量，在使用（2.96％）或不使用（1.79％；p=0.168）硬膜外麻醉的分娩之间没有显着差异。硬膜外分娩的剖宫产率明显较高（35vs.26.2%,p=0.0003),但是在排除多产妇女之后，剖宫产率无显著差异(40.2%硬膜外剖宫产与41.5%,p=0.717）。与没有硬膜外麻醉相比，经阴道分娩的硬膜外麻醉与较高的人工辅助率（33.8对52.1％）和较长的分娩时间（223.7±194对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产妇的发病率和死亡率。然而，它与更长的出生时间和人工辅助分娩有关.
