Using quantile regression to re-evaluate the epidural labor analgesia under new partogram: a prospective cohort study / 中华围产医学杂志

ABSTRACT

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.