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Epidural analgesia during labour and severe maternal morbidity: population based study
Rachel J Kearns1,2, Aizhan Kyzayeva2, Lucy O E Halliday2
1Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK rachel.kearns@glasgow.ac.uk.
BMJ (Clinical Research Ed.)
|May 22, 2024
Summary
Epidural analgesia during labor significantly reduced severe maternal morbidity (SMM) by 35%. The benefits were more pronounced in women with medical indications and those delivering preterm, suggesting expanded access could improve maternal health.
Area of Science:
- Obstetrics and Gynecology
- Anesthesiology
- Public Health
Background:
- Severe maternal morbidity (SMM) poses a significant public health challenge.
- Epidural analgesia is commonly used for pain relief during labor.
- The specific impact of epidural analgesia on SMM, particularly in high-risk groups, requires further elucidation.
Purpose of the Study:
- To determine the effect of labor epidural analgesia on severe maternal morbidity (SMM).
- To explore if this effect is more pronounced in women with medical indications for epidural analgesia or those experiencing preterm labor.
Main Methods:
- A population-based study was conducted using data from all NHS hospitals in Scotland.
- Included 567,216 women in labor between 24+0 and 42+6 weeks' gestation from 2007-2019.
- SMM was defined by CDC criteria or critical care admission within 42 days postpartum.
Main Results:
- Epidural analgesia was associated with a 35% reduction in SMM (aRR 0.65).
- Greater risk reductions were observed in women with medical indications for epidural analgesia (aRR 0.50) and those delivering preterm (aRR 0.53).
- The protective effect of epidural analgesia on SMM increased as gestational age at birth decreased.
Conclusions:
- Labor epidural analgesia is associated with a significant reduction in severe maternal morbidity.
- The benefits are more pronounced in women with medical indications and in preterm births.
- Expanding access to epidural analgesia, especially for high-risk populations, may improve maternal health outcomes.
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