PDF(Pubmed)
Abstract：
To determine the effect of labour epidural on severe maternal morbidity (SMM) and to explore whether this effect might be greater in women with a medical indication for epidural analgesia during labour, or with preterm labour.
Population based study.
All NHS hospitals in Scotland.
567 216 women in labour at 24+0 to 42+6 weeks\' gestation between 1 January 2007 and 31 December 2019, delivering vaginally or through unplanned caesarean section.
The primary outcome was SMM, defined as the presence of ≥1 of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, with either occurring at any point from date of delivery to 42 days post partum (described as SMM). Secondary outcomes included a composite of ≥1 of the 21 CDC conditions and critical care admission (SMM plus critical care admission), and respiratory morbidity.
Of the 567 216 women, 125 024 (22.0%) had epidural analgesia during labour. SMM occurred in 2412 women (4.3 per 1000 births, 95% confidence interval (CI) 4.1 to 4.4). Epidural analgesia was associated with a reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), SMM plus critical care admission (0.46, 0.29 to 0.73), and respiratory morbidity (0.42, 0.16 to 1.15), although the last of these was underpowered and had wide confidence intervals. Greater risk reductions in SMM were detected among women with a medical indication for epidural analgesia (0.50, 0.34 to 0.72) compared with those with no such indication (0.67, 0.43 to 1.03; P<0.001 for difference). More marked reductions in SMM were seen in women delivering preterm (0.53, 0.37 to 0.76) compared with those delivering at term or post term (1.09, 0.98 to 1.21; P<0.001 for difference). The observed reduced risk of SMM with epidural analgesia was increasingly noticeable as gestational age at birth decreased in the whole cohort, and in women with a medical indication for epidural analgesia.
Epidural analgesia during labour was associated with a 35% reduction in SMM, and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health.
Population based study.
All NHS hospitals in Scotland.
567 216 women in labour at 24+0 to 42+6 weeks\' gestation between 1 January 2007 and 31 December 2019, delivering vaginally or through unplanned caesarean section.
The primary outcome was SMM, defined as the presence of ≥1 of 21 conditions used by the US Centers for Disease Control and Prevention (CDC) as criteria for SMM, or a critical care admission, with either occurring at any point from date of delivery to 42 days post partum (described as SMM). Secondary outcomes included a composite of ≥1 of the 21 CDC conditions and critical care admission (SMM plus critical care admission), and respiratory morbidity.
Of the 567 216 women, 125 024 (22.0%) had epidural analgesia during labour. SMM occurred in 2412 women (4.3 per 1000 births, 95% confidence interval (CI) 4.1 to 4.4). Epidural analgesia was associated with a reduction in SMM (adjusted relative risk 0.65, 95% CI 0.50 to 0.85), SMM plus critical care admission (0.46, 0.29 to 0.73), and respiratory morbidity (0.42, 0.16 to 1.15), although the last of these was underpowered and had wide confidence intervals. Greater risk reductions in SMM were detected among women with a medical indication for epidural analgesia (0.50, 0.34 to 0.72) compared with those with no such indication (0.67, 0.43 to 1.03; P<0.001 for difference). More marked reductions in SMM were seen in women delivering preterm (0.53, 0.37 to 0.76) compared with those delivering at term or post term (1.09, 0.98 to 1.21; P<0.001 for difference). The observed reduced risk of SMM with epidural analgesia was increasingly noticeable as gestational age at birth decreased in the whole cohort, and in women with a medical indication for epidural analgesia.
Epidural analgesia during labour was associated with a 35% reduction in SMM, and showed a more pronounced effect in women with medical indications for epidural analgesia and with preterm births. Expanding access to epidural analgesia for all women during labour, and particularly for those at greatest risk, could improve maternal health.
摘要：
确定硬膜外分娩对严重产妇发病率（SMM）的影响，并探讨在分娩期间有硬膜外镇痛医学指征的女性中，这种影响是否更大。或早产。
基于人口的研究。
苏格兰的所有NHS医院。
567216名妇女在2007年1月1日至2019年12月31日期间妊娠24+0至42+6周分娩，阴道分娩或通过计划外剖腹产。
主要结果是SMM，定义为美国疾病控制与预防中心（CDC）作为SMM标准的21种疾病中存在≥1，或者重症监护入院，其中任何一种都发生在从分娩之日起至产后42天的任何时间点(称为SMM)。次要结果包括21项CDC疾病中≥1项和重症监护入院（SMM加重症监护入院）的复合结果。和呼吸道发病率。
在567216名女性中,分娩期间硬膜外镇痛125024（22.0％）。SMM发生在2412名妇女中(每1000名婴儿中有4.3名，95%置信区间(CI)4.1至4.4)。硬膜外镇痛与SMM降低相关(调整后相对危险度0.65,95%CI0.50~0.85),SMM加上重症监护住院（0.46，0.29至0.73），和呼吸道发病率（0.42，0.16至1.15），尽管最后一个功能不足，并且置信区间较宽。有硬膜外镇痛医学指征的女性（0.50，0.34至0.72）与没有这种指征的女性（0.67，0.43至1.03；差异P<0.001）相比，SMM的风险降低更大。与足月或足月后分娩的妇女（1.09，0.98至1.21；差异P<0.001）相比，早产分娩的妇女的SMM降低更明显（0.53，0.37至0.76）。在整个队列中，随着出生时胎龄的减少，硬膜外镇痛观察到的SMM风险降低越来越明显。以及有硬膜外镇痛医学指征的女性。
分娩期间硬膜外镇痛与SMM减少35%相关，并且在有硬膜外镇痛医学指征和早产的妇女中显示出更明显的效果。扩大分娩期间所有妇女的硬膜外镇痛，尤其是那些面临最大风险的人，可以改善产妇健康。
基于人口的研究。
苏格兰的所有NHS医院。
567216名妇女在2007年1月1日至2019年12月31日期间妊娠24+0至42+6周分娩，阴道分娩或通过计划外剖腹产。
主要结果是SMM，定义为美国疾病控制与预防中心（CDC）作为SMM标准的21种疾病中存在≥1，或者重症监护入院，其中任何一种都发生在从分娩之日起至产后42天的任何时间点(称为SMM)。次要结果包括21项CDC疾病中≥1项和重症监护入院（SMM加重症监护入院）的复合结果。和呼吸道发病率。
在567216名女性中,分娩期间硬膜外镇痛125024（22.0％）。SMM发生在2412名妇女中(每1000名婴儿中有4.3名，95%置信区间(CI)4.1至4.4)。硬膜外镇痛与SMM降低相关(调整后相对危险度0.65,95%CI0.50~0.85),SMM加上重症监护住院（0.46，0.29至0.73），和呼吸道发病率（0.42，0.16至1.15），尽管最后一个功能不足，并且置信区间较宽。有硬膜外镇痛医学指征的女性（0.50，0.34至0.72）与没有这种指征的女性（0.67，0.43至1.03；差异P<0.001）相比，SMM的风险降低更大。与足月或足月后分娩的妇女（1.09，0.98至1.21；差异P<0.001）相比，早产分娩的妇女的SMM降低更明显（0.53，0.37至0.76）。在整个队列中，随着出生时胎龄的减少，硬膜外镇痛观察到的SMM风险降低越来越明显。以及有硬膜外镇痛医学指征的女性。
分娩期间硬膜外镇痛与SMM减少35%相关，并且在有硬膜外镇痛医学指征和早产的妇女中显示出更明显的效果。扩大分娩期间所有妇女的硬膜外镇痛，尤其是那些面临最大风险的人，可以改善产妇健康。
